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Photodynamic Therapy for Barrett’s Esophagus and Esophageal Carcinoma
Bashar J. Qumseya,Waseem David,Herbert C. Wolfsen 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.1
This paper reviews the use of photodynamic therapy (PDT) in patients with Barrett’s esophagus and esophageal carcinoma. We describe the history of PDT, mechanics, photosensitizers for PDT in patients with esophageal disease. Finally, we discuss its utility and limitations in this setting.
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Do Han Kim,Somashekar G. Krishna,Emmanuel Coronel,Paul T. Kröner,Herbert C. Wolfsen,Michael B. Wallace,Juan E. Corral 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.2
Background/Aims: Endoscopic visualization of the microscopic anatomy can facilitate the real-time diagnosis of pancreatobiliarydisorders and provide guidance for treatment. This study aimed to review the technique, image classification, and diagnosticperformance of confocal laser endomicroscopy (CLE). Methods: We conducted a systematic review of CLE in pancreatic and biliary ducts of humans, and have provided a narrative of thetechnique, image classification, diagnostic performance, ongoing research, and limitations. Results: Probe-based CLE differentiates malignant from benign biliary strictures (sensitivity, ≥89%; specificity, ≥61%). NeedlebasedCLE differentiates mucinous from non-mucinous pancreatic cysts (sensitivity, 59%; specificity, ≥94%) and identifies dysplasia. Pancreatitis may develop in 2-7% of pancreatic cyst cases. Needle-based CLE has potential applications in adenocarcinoma,neuroendocrine tumors, and pancreatitis (chronic or autoimmune). Costs, catheter lifespan, endoscopist training, and interobservervariability are challenges for routine utilization. Conclusions: CLE reveals microscopic pancreatobiliary system anatomy with adequate specificity and sensitivity. Reducing costs andsimplifying image interpretation will promote utilization by advanced endoscopists.
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Predictors of Esophageal Stricture Formation Post Endoscopic Mucosal Resection
Bashar Qumseya,Abraham M. Panossian,Cynthia Rizk,David Cangemi,Christianne Wolfsen,Massimo Raimondo,Timothy Woodward,Michael B. Wallace,Herbert Wolfsen 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.2
Background/Aims: Stricture formation is a common complication after endoscopic mucosal resection. Predictors of stricture formationhave not been well studied. Methods: We conducted a retrospective, observational, descriptive study by using a prospective endoscopic mucosal resection databasein a tertiary referral center. For each patient, we extracted the age, sex, lesion size, use of ablative therapy, and detection of esophagealstrictures. The primary outcome was the presence of esophageal stricture at follow-up. Multivariate logistic regression was used to analyzethe association between the primary outcome and predictors. Results: Of 136 patients, 27% (n=37) had esophageal strictures. Thirty-two percent (n=44) needed endoscopic dilation to relieve dysphagia(median, 2; range, 1 to 8). Multivariate logistic regression analysis showed that the size of the lesion excised is associated with increasedodds of having a stricture (odds ratio, 1.6; 95% confidence interval, 1.1 to 2.3; p=0.01), when controlling for age, sex, and ablativemodalities. Similarly, the number of lesions removed in the index procedure was associated with increased odds of developing a stricture(odds ratio, 2.3; 95% confidence interval, 1.3 to 4.2; p=0.007). Conclusions: Stricture formation after esophageal endoscopic mucosal resection is common. Risk factors for stricture formation includelarge mucosal resections and the resection of multiple lesions on the initial procedure.
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