Patient satisfaction after endoscopic submucosal dissection under propofol-based sedation: a small premedication makes all the difference

Abstract Background Mesenchymal stem cells (MSCs) are valuable in regenerative medicine, and MSC culture supernatant (MSC-CS) reportedly inhibits inflammation and fibrosis. We investigated whether colorectal luminal stricture develops after circumferential endoscopic submucosal dissection (ESD) in the colorectum, and whether the development of luminal stricture could be prevented by using MSC-CS enema. Methods In the first experiment, we performed circumferential ESD in the rectums or distal colons of pigs (n = 4 in each group). We sacrificed the pigs on Day 22 and measured the degree of luminal stricture. In the second experiment, we performed circumferential ESD in the rectums of pigs and administered an MSC-CS gel or a control gel enema after ESD for 4 days. We sacrificed the pigs on Day 8 (n = 3 in each group) or 22 (n = 3 in each group) to measure the degree of luminal stricture, and performed histological analysis. Results Severe luminal stricture was observed in the rectum but not in the distal colon. Moreover, fiber accumulation in the submucosa and hypertrophy of the muscularis propria were observed in the rectum but not in the distal colon. The degree of luminal stricture in the rectum was significantly lower in the MSC-CS group than in the control group. Furthermore, MSC-CS attenuated myofibroblast activation and hypertrophy of the muscularis propria on Day 22, and reduced inflammatory cell infiltration on Day 8. Conclusions Luminal stricture after ESD developed only in the rectum because of the difference in myofibroblast activation and fiber accumulation. In addition, MSC-CS enema prevented luminal stricture after ESD, possibly by inhibiting the inflammatory reaction and fibrosis.

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Two electrosurgical endo-knives for endoscopic submucosal dissection of colorectal superficial neoplasms: a prospective randomized study

Endoscopy International Open ◽

10.1055/s-0043-111792 ◽

2017 ◽

Vol 05 (08) ◽

pp. E729-E735 ◽

Cited By ~ 1

Author(s):

Yuusaku Sugihara ◽

Keita Harada ◽

Yoshiro Kawahara ◽

Daisuke Takei ◽

Shiho Takashima ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Controlled Trial ◽

Randomized Study ◽

Procedure Time ◽

Related Factors ◽

Submucosal Dissection ◽

Total Procedure Time ◽

Mucosal Incision ◽

The Difference ◽

Total Procedure

Abstract Background and study aims Few studies have directly compared endo-knives for endoscopic submucosal dissection (ESD) in humans. We compared the performances of the Mucosectom2 and SB knife Jr. Patients and methods Two trainee endoscopists performed ESD of 36 lesions in this prospective, randomized controlled trial. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection using the Mucosectom2 were performed in 1 group. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection with a SB knife Jr. were performed in the other group. The primary outcome was the ESD procedure time. Secondary outcomes were total procedure time, self-completion rates, and adverse events. Results ESD time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (57 ± 32 min vs. 61 ± 44 min, respectively; P = 0.94). Total procedure time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (81 ± 42 min vs. 82 ± 51 min, respectively; P = 0.85). The trainee self-completion rate was slightly higher in SB knife Jr. patients than in Mucosectom2 patients, although the difference was not significant (94 % vs. 100 %, respectively; P = 0.959). Fewer hemostatic procedures using the Coagrasper were performed in Mucosectom2 patients than in SB knife Jr. patients, although the difference was not significant (0.62 vs. 0.7, respectively; P = 0.432). Conclusions Mucosectom2 and SB knife Jr. did not significantly differ in performance for colorectal ESD to safely and reliably enhance ESD. Knife selection is not as important for learning colorectal ESD as patient- and lesion-related factors.

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Safety and patient satisfaction of early diet after endoscopic submucosal dissection for gastric epithelial neoplasia: a prospective, randomized study

Surgical Endoscopy ◽

10.1007/s00464-013-3336-2 ◽

2013 ◽

Vol 28 (4) ◽

pp. 1321-1329 ◽

Cited By ~ 9

Author(s):

Sunyong Kim ◽

Kyung Seok Cheoi ◽

Hyun Jik Lee ◽

Choong Nam Shim ◽

Hyun Soo Chung ◽

...

Keyword(s):

Patient Satisfaction ◽

Endoscopic Submucosal Dissection ◽

Randomized Study ◽

Prospective Randomized Study ◽

Gastric Epithelial Neoplasia ◽

Submucosal Dissection

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Tu1297 Pilot Study to Assess the Safety and Patient Satisfaction of Early Diet After Endoscopic Submucosal Dissection for Gastric Neoplasm

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2013.03.778 ◽

2013 ◽

Vol 77 (5) ◽

pp. AB491

Author(s):

Sunyong Kim ◽

Kyung Seok Cheoi ◽

Hyun Jik Lee ◽

Choong Nam Shim ◽

Hyuk Lee ◽

...

Keyword(s):

Patient Satisfaction ◽

Pilot Study ◽

Endoscopic Submucosal Dissection ◽

Gastric Neoplasm ◽

Submucosal Dissection

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The Comparison between Endoscopic Submucosal Dissection and Surgery in Gastric Cancer: A Systematic Review and Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2018/4378945 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Junbi Hu ◽

Yan Zhao ◽

Mudan Ren ◽

Yarui Li ◽

Xinlan Lu ◽

...

Keyword(s):

Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Hospital Stay ◽

Meta Analysis ◽

Treatment Modalities ◽

Adverse Event Rate ◽

Submucosal Dissection ◽

Surgery Group ◽

The Difference

Aims. There are two treatment modalities for early gastric cancer (EGC)—surgery and endoscopic submucosal dissection (ESD). We aimed to compare the safety and efficacy of ESD with surgery. Method. The article was performed by searching PubMed databases. Data were extracted using predefined form and odds ratios (OR) with 95% confidence intervals (CI) calculated and P value. Results. 13 studies were identified. The incidence of perforation in two groups was different [OR = 6.18 (95% CI: 1.37–27.98), P=0.02]. The prevalences of synchronous and metachronous cancer in the ESD group were higher than those in the surgery group [OR = 8.52 (95% CI: 1.99–36.56), P = 0.004 and OR = 7.15 (95% CI: 2.95–17.32), P<0.0001]. The recurrence and complete resection rates were different [OR = 6.93 (95% CI: 2.83–16.96), P<0.0001 and OR = 0.32 (95% CI: 0.20–0.52), P<0.00001]. Compared with the surgery group, the hospital stay was shorter [IV = −7.15 (95% CI: −9.08–5.22), P<0.00001], the adverse event rate was lower, and the quality of life (QOL) was better in the ESD group. The difference of bleeding was not found. Conclusion. ESD appears to be preferable for EGC, due to a lower rate of adverse events, shorter hospital stay, cheaper cost, and higher QOL.

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Usefulness of Acoustic Monitoring of Respiratory Rate in Patients Undergoing Endoscopic Submucosal Dissection

Gastroenterology Research and Practice ◽

10.1155/2016/2964581 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Takayoshi Suzuki ◽

Shingo Tsuda ◽

Hirohiko Nakae ◽

Jin Imai ◽

Kana Sawamoto ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Respiratory Rate ◽

Continuous Monitoring ◽

Past History ◽

Univariate Analysis ◽

Female Gender ◽

Blood Oxygen Saturation ◽

Significant Independent Predictor ◽

Submucosal Dissection ◽

The Difference

Aim. The study assessed the usefulness of a recently developed method for respiratory rate (RR) monitoring in patients undergoing endoscopic submucosal dissection (ESD) under deep sedation.Methods. Study subjects comprised 182 consecutive patients with esophageal cancer or gastric cancer undergoing ESD. The usefulness of acoustic RR monitoring was assessed by retrospectively reviewing the patients’ records for age, gender, height, weight, past history, serum creatinine, RR before ESD, and total dose of sedative.Results. Respiratory suppression was present in 37.9% of (69/182) patients. Continuous monitoring of RR led to detection of respiratory suppression in all these patients. RR alone was decreased in 24 patients, whereas both RR and blood oxygen saturation were decreased in 45 patients. Univariate analysis showed female gender, height, weight, and RR before treatment to be significantly associated with respiratory suppression. Multivariate analysis showed RR before treatment to be the only significant independent predictor [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.73–0.95, andP=0.006] of respiratory suppression.Conclusion. In this study, the difference in RR before treatment between patients with and without respiratory suppression was subtle. Therefore, we suggest that acoustic RR monitoring should be considered in patients undergoing ESD under sedation to prevent serious respiratory complications.

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Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases

Gastroenterology Research and Practice ◽

10.1155/2021/6635704 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Kohei Oka ◽

Naoto Iwai ◽

Takashi Okuda ◽

Tasuku Hara ◽

Yutaka Inada ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Clinical Features ◽

False Negative ◽

City Hospital ◽

Submucosal Dissection ◽

The Difference ◽

Well Differentiated ◽

H Pylori ◽

Lesser Curvature ◽

Experienced Endoscopists

Background. We frequently encounter early gastric cancer (EGC) that could not be detected in the previous esophagogastroduodenoscopy even if the procedure was annually performed. However, little evidence exists regarding the characteristics of false-negative EGCs. Our aim was to reveal the clinical features of false-negative EGCs. Methods. We retrospectively reviewed cases of endoscopic submucosal dissection (ESD) for EGCs in Fukuchiyama City Hospital between January 2013 and May 2019. False-negative EGCs were defined as EGCs within 3 years of negative endoscopy. We evaluated the clinical characteristics of false-negative and initially detected EGCs and the difference in the detected and last missed endoscopy in false-negative EGCs. The miss rates of false-negative EGCs were compared between trainees (nonboard-certified endoscopists) and experienced endoscopists (board-certified endoscopists); thereafter, the characteristics of false-negative EGCs missed by trainees were investigated. Results. Of 219 cases, 119 were classified as false-negative EGCs. False-negative EGCs were characterized as smaller lesions, which presented with normal color or gastritis-like appearance, and were diagnosed after ESD and H. pylori eradication ( P < 0.01 ). The rate of trainees in the last missed endoscopy was significantly higher than that in the detected endoscopy. The miss rate of false-negative EGC by trainees was higher than that of experienced endoscopists but not significantly different (0.70% vs. 0.57%, P = 0.08 ). The false-negative EGCs missed by trainees were characterized as reddish or well-differentiated lesions, which were located in the lower or lesser curvature of the stomach ( P < 0.05 ). Conclusion. The characteristics of false-negative EGCs were similar to those of H. pylori-eradicated EGC. Procedures with shortened examination time and those performed by trainees were risk factors of missing false-negative EGCs. Trainees should pay attention to reddish or well-differentiated EGCs located in the lower or lesser curvature of the stomach.

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