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RISS 인기검색어
- 검색키워드
- 저자 : Nikhil A. Kumta (검색결과 3 건)
- 무료
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Peroral Endoscopic Myotomy: Establishing a New Program
Nikhil A. Kumta,Shivani Mehta,Prashant Kedia,Kristen Weaver,Reem Z. Sharaiha,Norio Fukami,Hitomi Minami,Fernando Casas,Monica Gaidhane,Arnon Lambroza,Michel Kahaleh 대한소화기내시경학회 2014 Clinical Endoscopy Vol.47 No.5
Achalasia is an esophageal motility disorder characterized by incomplete relaxation of the lower esophageal sphincter (LES) and aperistalsis of the esophageal body. Treatment of achalasia is aimed at decreasing the resting pressure in the LES. Peroral endoscopic myotomy (POEM), derived from natural orifice transluminal endoscopic surgery (NOTES) and advances in endoscopic submucosal dissection (ESD), presents a novel, minimally invasive, and curative endoscopic treatment for achalasia. POEM involves an esophageal mucosal incision followed by creation of a submucosal tunnel crossing the esophagogastric junction and myotomy before closure of the mucosal incision. Although the procedure is technically demanding and requires a certain degree of skill and competency, treatment success is high (90%) with low complication rates. Since the first described POEM in humans in 2010, it has been used increasingly at centers worldwide. This article reviews available published clinical studies demonstrating POEM efficacy and safety in order to present a proposal on how to establish a dedicated POEM program and reach base proficiency for the procedure.
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Diagnosis and Management of Rectal Neuroendocrine Tumors
Shreya Chablaney,Zachary A. Zator,Nikhil A. Kumta 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.6
The incidence of rectal neuroendocrine tumors (NETs) has increased by almost ten-fold over the past 30 years. There has been a heightened awareness of the malignant potential of rectal NETs. Fortunately, many rectal NETs are discovered at earlier stages due to colon cancer screening programs. Endoscopic ultrasound is useful in assessing both residual tumor burden after retrospective diagnosis and tumor characteristics to help guide subsequent management. Current guidelines suggest endoscopic resection of rectal NETs ≤10 mm as a safe therapeutic option given their low risk of metastasis. Although a number of endoscopic interventions exist, the best technique for resection has not been identified. Endoscopic submucosal dissection (ESD) has high complete and en-bloc resection rates, but also an increased risk of complications including perforation. In addition, ESD is only performed at tertiary centers by experienced advanced endoscopists. Endoscopic mucosal resection has been shown to have variable complete resection rates, but modifications to the technique such as the addition of band ligation have improved outcomes. Prospective studies are needed to further compare the available endoscopic interventions, and to elucidate the most appropriate course of management of rectal NETs.
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The Role of Endoscopy in Small Bowel Neuroendocrine Tumors
Ji Yoon Yoon,Nikhil A. Kumta,Michelle Kang Kim 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Small bowel neuroendocrine tumors (NETs) represent approximately one-third of NETs of the gastrointestinal tract, and theirincidence is increasing. When determining if endoscopic resection is appropriate, endoscopic ultrasound is used to assess the lesionsize and depth of invasion for duodenal NETs. A number of techniques, including endoscopic mucosal resection (EMR), bandassistedEMR (band-EMR), endoscopic submucosal dissection (ESD), and over-the-scope clip-assisted endoscopic full-thicknessresection (EFTR), have been studied; however, the best technique for endoscopic resection remains unclear. The vast majority ofcurrently available data are retrospective, and prospective studies with longer follow-up times are required. For jejunal and ilealNETs, endoscopic techniques such as video capsule endoscopy (VCE) and balloon enteroscopy (BE) assist in diagnosis. This includeslocalization of the primary NET in metastatic disease where initial workup has been negative, and the identification of multifocaldisease, which may change management and prognostication.
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