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New Innovations in Endoscopic Therapy

Alzoubaidi, Durayd; (2020) New Innovations in Endoscopic Therapy. Doctoral thesis (M.D(Res)), UCL (University College London). Green open access

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Abstract

Barrett’s oesophagus (BE) is the pre-cancerous condition that leads to oesophageal adenocarcinoma (OAC). The progression of BE from intestinal metaplasia (IM) to dysplasia and OAC occurs in only a few patients. Once dysplasia and intramucosal cancer (IMC) has developed, these patients carry a significant risk of developing OAC. Despite significant advances in treatment modalities in the past decade, there still remains a high mortality rate with only a small number of patients alive at five years from diagnosis. Successful intervention at an early stage of the disease has been shown to have desirable outcomes. Historically, surgical intervention with oesophagectomy in patients with early disease has shown to achieve curative outcomes. Oesophagectomy by experienced surgeons in high volume tertiary referral centres still carries a significant mortality rate (2-3%). The development of minimally invasive endoscopic therapeutic modalities such as radiofrequency ablation (RFA), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have revolutionised the management of patient with early oesophageal neoplasia with great outcomes and acceptable complication rates. These modalities have now been endorsed by various international guidelines; however despite current treatment modalities there still exists a group of patients that do not respond adequately to available treatment modalities and therefore this thesis and the chapters that follow will examine the new treatment modalities for the management of patients with early oesophageal neoplasia and will test the hypothesis that patients with early oesophageal neoplasia can be successfully treated with minimally invasive endoscopic therapy. This thesis will outline the use of a new endoscopic resection modality (EMR Captivator device) with a new ablative technique (Cryoablation) that utilises cold therapy rather than the conventional heat therapy (RFA). This thesis will also outline new quality indicators in endoscopic therapy of early oesophageal neoplasia, which was developed, in order to unify endoscopic therapy in the UK. It is well known that endoscopic therapy can result into adverse events such as bleeding during or/and after the procedure. Currently haemostatic modalities exits but not always effective and limited by the site of the bleed and skills of the operator. Hemospray, is a new haemostatic powder that is increasingly used internationally. This thesis will outline the creation and development of the international Hemospray registry, and study Hemospray in various pathologies.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: New Innovations in Endoscopic Therapy
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2020. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10111469
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