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Systematic Review and Meta-analysis
- Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis
- Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari
- Clin Endosc 2025;58(2):240-252. Published online February 3, 2025
- DOI: https://doi.org/10.5946/ce.2024.120
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Graphical Abstract
Abstract
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Supplementary Material
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ePub - Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption. -
Citations
Citations to this article as recorded by
- Successful Colonic Stenting Across the Ileocecal Valve With Severe Malignant Stenosis Using Ultra‐thin Scope and Single‐balloon Overtube
Takato Maeda, Norihiro Hanabata, Shohei Igarashi, Masayoshi Ko, Koji Shimaya, Hiroshi Numao, Masaki Munakata, Hirotake Sakuraba
DEN Open.2026;[Epub] CrossRef - Nationwide Analysis of Right-Sided Colonic Stenting: Rarely Used but Reduces Stoma Creation Significantly
Khalid Ahmed, Ahmed Dirweesh, Zachary D. Leslie, Yasmin Ali, Nabeel Azeem, Eric Wise, Cyrus Jahansouz, Martin Freeman, Stuart K. Amateau
Techniques and Innovations in Gastrointestinal Endoscopy.2026; 28(1): 250952. CrossRef - Minimally invasive, maximum impact: advances in the application of colonic stents
Filippos Koutroumpakis, Emmanuel Coronel
Current Opinion in Gastroenterology.2026; 42(1): 19. CrossRef - Causes of stenting complications for malignant colorectal stenosis in patients with acute obstructive colonic obstruction
Khosiyat T. Solijonova, I. A. Semenenko, A. E. Voynovskiy, P. A. Barbado Mamedova, O. V. Kanadashvili, G. V. Sinyavin, A. R. Iskandarova
Surgery and Oncology.2026; 16(1): 86. CrossRef - Embracing minimally invasive approaches to colorectal cancer resection
Nan Zun Teo, James Weiquan Li, James Chi Yung Ngu, Tiing Leong Ang
Singapore Medical Journal.2025; 66(Suppl 1): S38. CrossRef
- Successful Colonic Stenting Across the Ileocecal Valve With Severe Malignant Stenosis Using Ultra‐thin Scope and Single‐balloon Overtube
- 4,583 View
- 203 Download
- 4 Web of Science
- 5 Crossref
Original Article
- Efficacy and Safety of Endoscopic Submucosal Dissection for Superficial Gastric Neoplasms: A Latin American Cohort Study
- Fernando Palacios-Salas, Harold Benites-Goñi, Luis Marin-Calderón, Paulo Bardalez-Cruz, Jorge Vásquez-Quiroga, Edgar Alva-Alva, Bryan Medina-Morales, Jairo Asencios-Cusihuallpa
- Clin Endosc 2022;55(2):248-255. Published online November 12, 2021
- DOI: https://doi.org/10.5946/ce.2021.192
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Abstract
PDFPubReaderePub
- Background
/Aims: Endoscopic submucosal dissection (ESD) is the preferred technique for treating early gastric cancer (EGC). However, very few studies have been conducted in South America. This study aimed to assess the efficacy and safety of ESD for EGC.
Methods
We analyzed data from a prospective cohort from 2013 to 2020. A total of 152 superficial gastric neoplasms that fulfilled the absolute or expanded criteria for ESD were included. Outcomes were en bloc, R0, and curative resection rates, incidence of adverse events, and length of procedure.
Results
The age of the enrolled patients was 68.4±11.3 years. The number of included patients based on the absolute and expanded indications was 150 and 2, respectively. En bloc, R0, and curative resections were achieved in 98.0%, 96.1%, and 89.5% of the cases, respectively. Bleeding and perforation were reported in 5.9% and 6.6% of the cases, respectively. Histopathological examination revealed lowgrade dysplasia, high-grade dysplasia, well-differentiated adenocarcinoma, and poorly differentiated adenocarcinoma in 13, 20, 117, and 2 cases, respectively.
Conclusions
Our study shows that ESD performed by properly trained endoscopists in reference centers is safe and effective, with comparable therapeutic outcomes to those reported in the Eastern series. -
Citations
Citations to this article as recorded by- Chilean Association of Digestive Endoscopy (ACHED) guidelines for the detection of early gastric cancer and surveillance of gastric premalignant conditions in high-risk populations
Gonzalo Latorre, Alberto Espino, Raúl Araya, Matías Arteaga, Harold Benites-Goñi, María Ester Bufadel, Dacio Cabrera-Hinojosa, Roberto Candia, Julian Cordero, Oscar Corsi, Pablo Cortés, Felipe Donoso, Fabian Emura, Carolina Heredia, Daniel Martínez, Rodri
Gastroenterología y Hepatología.2026; 49(3): 502633. CrossRef - Chilean Association of Digestive Endoscopy (ACHED) guidelines for the detection of early gastric cancer and surveillance of gastric premalignant conditions in high-risk populations
Gonzalo Latorre, Alberto Espino, Raúl Araya, Matías Arteaga, Harold Benites-Goñi, María Ester Bufadel, Dacio Cabrera-Hinojosa, Roberto Candia, Julian Cordero, Oscar Corsi, Pablo Cortés, Felipe Donoso, Fabian Emura, Carolina Heredia, Daniel Martínez, Rodri
Gastroenterología y Hepatología (English Edition).2026; 49(3): 502633. CrossRef - Outcomes and validity of risk stratification tools for endoscopic submucosal dissection of early gastric cancer in Western Australia
Ciaran Judge, Abir Halder, Puraskar Pateria, Tzeng Khor, Niroshan Muwanwella, Marcus Chin, Krish Ragunath
JGH Open.2024;[Epub] CrossRef - Disección submucosa endoscópica en cáncer gástrico temprano indiferenciado: evaluación de los primeros casos y análisis de su aplicación como indicación absoluta en Perú
Fernando Palacios-Salas, Luis Marin-Calderón, Juan Chirinos-Vega, Paulo Bardalez-Cruz, Patricia Valera-Luján, Dacio Cabrera-Hinojosa, Harold Benites-Goñi
Revista de Gastroenterología del Perú.2024; 44(4): 333. CrossRef - Short-Term and Long-Term Outcomes of Liver Cirrhosis in Gastric Neoplasm Patients Undergoing Endoscopic Submucosal Dissection
Xu-Rui Liu, Lian-Shuo Li, Fei Liu, Zi-Wei Li, Xiao-Yu Liu, Wei Zhang, Dong Peng
Journal of Laparoendoscopic & Advanced Surgical Techniques.2023; 33(7): 640. CrossRef - Endoscopic submucosal dissection for early gastric cancer: It is time to consider the quality of its outcomes
Gwang Ha Kim
World Journal of Gastroenterology.2023; 29(43): 5800. CrossRef - Endoscopic diagnosis of early gastric cancer
Dong Chan Joo, Gwang Ha Kim
Journal of the Korean Medical Association.2022; 65(5): 267. CrossRef - Therapeutic approach to non-curative resection after endoscopic treatment in early gastric cancer
Eun Jeong Gong, Chang Seok Bang
Journal of the Korean Medical Association.2022; 65(5): 284. CrossRef
- Chilean Association of Digestive Endoscopy (ACHED) guidelines for the detection of early gastric cancer and surveillance of gastric premalignant conditions in high-risk populations
- 7,507 View
- 261 Download
- 7 Web of Science
- 8 Crossref
Focused Review Series: Expanding the Indication with Safety Issue of Endoscopic Ultrasound
- Future Perspectives on Endoscopic Ultrasonography-Guided Therapy for Pancreatic Neoplasm
- Woo Hyun Paik, Sang Hyub Lee, Sunguk Jang
- Clin Endosc 2018;51(3):229-234. Published online May 18, 2018
- DOI: https://doi.org/10.5946/ce.2018.063
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Abstract
PDFPubReaderePub
- Endoscopic ultrasonography (EUS)-guided therapy with ethanol injection or catheter-based radiofrequency ablation for pancreatic neoplasm has been conducted as a potential alternate treatment modality for patients who are not eligible for surgery. On the basis of the limited number of studies available, EUS-guided ablation therapy with the aforementioned methods for small pancreatic neoplasms has demonstrated promising technical feasibility and safety profiles. To be considered as a legitimate alternative option to surgery, however, EUS-guided ablation therapy must provide a long-term efficacy profile along with the consensus among experts regarding its treatment parameter. This review focuses on the clinical issues and future perspectives of EUS-guided therapy for pancreatic neoplasm.
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Citations
Citations to this article as recorded by- An updated review on ablative treatment of pancreatic cystic lesions
Andrew Canakis, Ryan Law, Todd Baron
Gastrointestinal Endoscopy.2020; 91(3): 520. CrossRef - Endosonography-guided Radiofrequency Ablation in Pancreatic Diseases
Giuseppe Vanella, Gabriele Capurso, Paolo G. Arcidiacono
Journal of Clinical Gastroenterology.2020; 54(7): 591. CrossRef
- An updated review on ablative treatment of pancreatic cystic lesions
- 8,143 View
- 146 Download
- 3 Web of Science
- 2 Crossref
Original Article
- Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Neoplasms
- Jung Soo Park, Young Hoon Youn, Jae Jun Park, Jie-Hyun Kim, Hyojin Park
- Clin Endosc 2016;49(2):168-175. Published online February 12, 2016
- DOI: https://doi.org/10.5946/ce.2015.080
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Abstract
PDFPubReaderePub
- Background
/Aims: Endoscopic treatment has been broadly applied to superficial esophageal neoplasms. Endoscopic submucosal dissection (ESD) allows for high rates of en bloc resection, precise histological assessment, and low rates of local recurrence. The aim of this study was to evaluate the outcomes of ESD for superficial esophageal neoplasms.
Methods
We retrospectively reviewed 36 esophageal ESDs for superficial squamous neoplasms in 32 patients between March 2009 and August 2014 at Gangnam Severance Hospital.
Results
The median patient age was 64 years, and 30 men were included. The indications were early squamous cell carcinoma in 26 lesions, adenoma with high-grade dysplasia in five lesions, and low-grade dysplasia in five lesions. The en bloc resection and R0 resection rates were 97.2% (35 of 36) and 91.7% (33 of 36), respectively. Microperforation and post-ESD bleeding occurred in 5.6% (2 of 36) and 5.6% (2 of 36), respectively. Post-ESD esophageal strictures developed in five patients (13.9%). Five patients (15.6%) had an additional treatment after ESD (concurrent chemoradiation therapy in three, radiation therapy in one, and surgery in one patient). There was no disease-specific mortality during the median follow-up of 31 months.
Conclusions
Favorable clinical outcomes were observed in ESD for superficial esophageal squamous neoplasms. Esophageal ESD could be a good treatment option in terms of efficacy and safety. -
Citations
Citations to this article as recorded by- A Perioperative Hydrogel Platform for Integrated Endoscopic Submucosal Dissection Management
Zizhao Wang, Yang Yang, Hongxin Sun, Peng Fan, Xiaoqing Jia, Liang Zhang, Ting Wang, Jiulong Zhao, Qian Chen, Shige Wang
ACS Applied Materials & Interfaces.2026; 18(13): 18821. CrossRef - Efficacy and safety of repeat endoscopic submucosal dissection for recurrent, synchronous, and metachronous esophageal squamous cell carcinoma: a systematic review and meta-analysis
Harsimran Kalsi, Anushree Rai, Samneet Singh Arora, Sahib Singh, Tony S. Brar, Yaseen Perbtani, Babu P. Mohan
Gastrointestinal Endoscopy.2025; 102(5): 642. CrossRef - Predictors of technical difficulty for trainees in esophageal endoscopic submucosal dissection
Tomoya Ueda, Ryu Ishihara, Shunsuke Yoshii, James Weiquan Li, Yuya Asada, Daiki Kitagawa, Atsuko Kizawa, Takehiro Ninomiya, Yuki Okubo, Yushi Kawakami, Yasuhiro Tani, Satoki Shichijo, Takashi Kanesaka, Sachiko Yamamoto, Yoji Takeuchi, Koji Higashino, Nori
Esophagus.2024; 21(1): 58. CrossRef - A superficial esophageal cancer with a Rokitansky diverticulum treated by endoscopic submucosal dissection with dental floss clip traction: Letter to the editor
Xueyi Lin, Li Fan, Min Lin
Clinics and Research in Hepatology and Gastroenterology.2024; 48(6): 102368. CrossRef - Development and validation of a model to determine the risk of esophageal strictures after endoscopic submucosal dissection for esophageal neoplasms
Si-yuan Xia, Qing Lu, Zi-jing Wang, Tao Gan, Jin-lin Yang, Zhu Wang
Surgical Endoscopy.2023; 37(3): 2163. CrossRef - High-power green-light laser endoscopic submucosal dissection for non-muscle-invasive bladder cancer: A technical improvement and its initial application
Jilu Zheng, Feifan Liu, Keqin Zhang, Yuzhu Xiang, Lianjun Li, Haiyang Zhang, Yinan Zhang, Ning Suo, Zilong Wang, Chenglin Han, Xunbo Jin, Muwen Wang, Chunxiao Wei, Ji Chen
Journal of Cancer Research and Therapeutics.2023; 19(4): 945. CrossRef - Management of esophageal neoplasms by endoscopic submucosal dissection: experience over 100 consecutive procedures
Josué Aliaga Ramos, Yoshinori Morita, Takashi Toyonaga, Danilo Carvalho, Moises Salgado Pedrosa, Vitor N. Arantes
Clinical Endoscopy.2023; 56(5): 613. CrossRef - Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection
Waku Hatta, Tomoyuki Koike, Hiroko Abe, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Atsushi Masamune
DEN Open.2022;[Epub] CrossRef - Additional endoscopic treatments for patients with positive lateral margins after endoscopic resection of early esophageal squamous cell carcinoma
Yong Feng, Wei Wei, Shuo Guo, Bao-Qing Li
Oncology Letters.2022;[Epub] CrossRef - Prevention of delayed bleeding with vonoprazan in upper gastrointestinal endoscopic treatment
Hiroko Abe, Waku Hatta, Yohei Ogata, Tomoyuki Koike, Masahiro Saito, Xiaoyi Jin, Kenichiro Nakagawa, Takeshi Kanno, Kaname Uno, Naoki Asano, Akira Imatani, Tomohiro Nakamura, Naoki Nakaya, Kunio Tarasawa, Kenji Fujimori, Kiyohide Fushimi, Atsushi Masamune
Journal of Gastroenterology.2021; 56(7): 640. CrossRef - Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society’s Intrapapillary Capillary Loop Classification
Waku Hatta, Tomoyuki Koike, Yohei Ogata, Yutaka Kondo, Nobuyuki Ara, Kaname Uno, Naoki Asano, Akira Imatani, Atsushi Masamune
Diagnostics.2021; 11(11): 1941. CrossRef - Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms
Nan Lin, Jie Lin, Jinrong Gong
Medicine.2021; 100(51): e28396. CrossRef - Close Observation versus Additional Surgery after Noncurative Endoscopic Resection of Esophageal Squamous Cell Carcinoma
Byeong Geun Song, Ga Hee Kim, Charles J. Cho, Hyeong Ryul Kim, Yang Won Min, Hyuk Lee, Byung-Hoon Min, Ho June Song, Yong-Hee Kim, Jun Haeng Lee, Hwoon-Yong Jung, Jae Ill Zo, Young Mog Shim
Digestive Surgery.2021; 38(3): 247. CrossRef - Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia
Waku Hatta, Takuji Gotoda, Tomoyuki Koike, Atsushi Masamune
Digestive Endoscopy.2020; 32(6): 861. CrossRef - Endoscopic resection of early squamous neoplasia of the oesophagus: long-term follow-up in a UK population from a tertiary hospital
Jen Yee Kuan, Sameul Baskind, Yeson Kim, Stephen McGrath, Ramakrishna Chaparala, Arash Assadsangabi, Neeraj Prasad, George Regi, Yeng Ang
European Journal of Gastroenterology & Hepatology.2020; 32(7): 789. CrossRef - Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis
Jen-Hao Yeh, Ru-Yi Huang, Ching-Tai Lee, Chih-Wen Lin, Ming-Hung Hsu, Tsung-Chin Wu, Po-Jen Hsiao, Wen-Lun Wang
Therapeutic Advances in Gastroenterology.2020;[Epub] CrossRef Prediction of Lymph Node Metastasis in Superficial Esophageal Cancer Using a Pattern Recognition Neural Network
Han Chen, Xiaoying Zhou, Xinyu Tang, Shuo Li, Guoxin Zhang
Cancer Management and Research.2020; Volume 12: 12249. CrossRef- Predictors of technical difficulty during endoscopic submucosal dissection of superficial esophageal cancer
Hiromasa Hazama, Masaki Tanaka, Naomi Kakushima, Yohei Yabuuchi, Masao Yoshida, Noboru Kawata, Kohei Takizawa, Sayo Ito, Kenichiro Imai, Kinichi Hotta, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Keita Mori, Hiroyuki Ono
Surgical Endoscopy.2019; 33(9): 2909. CrossRef - A Case of Esophageal Squamous Cell Carcinoma in situ Arising from Esophageal Squamous Papilloma
Jae Yeong Cho, Dae Young Cheung, Tae Jung Kim, Jae Kwang Kim
Clinical Endoscopy.2019; 52(1): 72. CrossRef - Endoscopic Submucosal Single- or Multi-tunnel Dissection for Near-Circumferential and Circumferential Superficial Esophageal Neoplastic Lesions
Lin-Lin Zhu, Jun-Chao Wu, Yi-Ping Wang, Du He, Wen-Yan Zhang, Tao Gan, Jin-Lin Yang
Gastroenterology Research and Practice.2019; 2019: 1. CrossRef - Outcomes of endoscopic submucosal dissection for early oesophageal squamous cell neoplasia at a Western centre
Diane Lorenzo, Maximilien Barret, Sarah Leblanc, Benoit Terris, Frédéric Beuvon, Romain Coriat, Stanislas Chaussade, Frédéric Prat
United European Gastroenterology Journal.2019; 7(8): 1084. CrossRef - Commentary on “Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia”
Soo In Choi, Jun Chul Park
Clinical Endoscopy.2019; 52(3): 205. CrossRef - Endoscopic Treatment for Esophageal Cancer
Eun Jeong Gong, Do Hoon Kim
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2019; 19(3): 156. CrossRef - UEG Week 2019 Oral Presentations
United European Gastroenterology Journal.2019; 7(S8): 10. CrossRef - Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis
Shengfei Wang, Yangle Huang, Juntao Xie, Lingdun Zhuge, Longlong Shao, Jiaqing Xiang, Yawei Zhang, Yihua Sun, Hong Hu, Sufeng Chen, Toni Lerut, James D. Luketich, Jie Zhang, Haiquan Chen
Surgical Endoscopy.2018; 32(3): 1441. CrossRef - Risk factors of electrocoagulation syndrome after esophageal endoscopic submucosal dissection
Dae Won Ma, Young Hoon Youn, Da Hyun Jung, Jae Jun Park, Jie-Hyun Kim, Hyojin Park
World Journal of Gastroenterology.2018; 24(10): 1144. CrossRef - Endoscopic Treatment for Esophageal Cancer
Yang Won Min
The Korean Journal of Gastroenterology.2018; 71(3): 116. CrossRef - Endoscopic submucosal dissection under general anesthesia for superficial esophageal squamous cell carcinoma is associated with better clinical outcomes
Byeong Geun Song, Yang Won Min, Ra Ri Cha, Hyuk Lee, Byung-Hoon Min, Jun Haeng Lee, Poong-Lyul Rhee, Jae J. Kim
BMC Gastroenterology.2018;[Epub] CrossRef - Long-Term Survival and Tumor Recurrence in Patients with Superficial Esophageal Cancer after Complete Non-Curative Endoscopic Resection: A Single-Center Case Series
Ji Wan Lee, Charles J. Cho, Do Hoon Kim, Ji Yong Ahn, Jeong Hoon Lee, Kee Don Choi, Ho June Song, Sook Ryun Park, Hyun Joo Lee, Yong Hee Kim, Gin Hyug Lee, Hwoon-Yong Jung, Sung-Bae Kim, Jong Hoon Kim, Seung-Il Park
Clinical Endoscopy.2018; 51(5): 470. CrossRef - Endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer: choice of new approach
Gen Suzuki, Hideya Yamazaki, Norihiro Aibe, Koji Masui, Naomi Sasaki, Daisuke Shimizu, Takuya Kimoto, Atsushi Shiozaki, Osamu Dohi, Hitoshi Fujiwara, Takeshi Ishikawa, Hirotaka Konishi, Yuji Naito, Eigo Otsuji, Kei Yamada
Radiation Oncology.2018;[Epub] CrossRef - Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma
Byeong Geun Song, Yang Won Min, Jun Haeng Lee, Hyuk Lee, Byung-Hoon Min, Poong-Lyul Rhee, Jae J. Kim
Surgical Endoscopy.2017; 31(10): 3905. CrossRef - Comparison of endoscopic ultrasonography and magnifying endoscopy for assessment of the invasion depth of shallow gastrointestinal neoplasms: a systematic review and meta-analysis
Zhang Tao, Chen Yan, He Zhao, Jiawei Tsauo, Xiaowu Zhang, Bing Qiu, Yanqing Zhao, Xiao Li
Surgical Endoscopy.2017; 31(12): 4923. CrossRef - Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasm: A Growing Body of Evidence
Eun Jeong Gong, Hwoon-Yong Jung
Clinical Endoscopy.2016; 49(2): 101. CrossRef - Esophageal subepithelial tumor: why tunneling?
Jong-Jae Park
Gastroenterology & Hepatology: Open Access.2016;[Epub] CrossRef
- A Perioperative Hydrogel Platform for Integrated Endoscopic Submucosal Dissection Management
- 12,860 View
- 142 Download
- 34 Web of Science
- 34 Crossref
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