Endoscopic submucosal dissection using sodium hyaluronate, a new technique for en bloc resection of a large superficial tumor in the colon

Endoscopic submucosal dissection (ESD) is a promising procedure that enables en bloc resection of large superficial tumors in the upper gastrointestinal tract. On the other hand, ESD in the colon and rectum is technically difficult to perform because of its anatomical features. At our institution, 137 consecutive superficial colorectal tumors larger than 20 mm in diameter in 137 patients were treated by ESD between April 2007 and October 2010, and 132 lesions were successfully resected. The average procedure time was 79.2 minutes, and the rate of en bloc resection was 89.1% (122/137). The rate of complete resection, defined as en bloc resection with tumor-free lateral and vertical margins, was 85.4% (117/137). The rate of perforation was 3.6% (5/137). Colorectal ESD achieved a high rate of en bloc resection and complete resection and is applicable in the colorectum.

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Fibrin glue: Novel submucosal injection agent for endoscopic submucosal dissection

Endoscopy International Open ◽

10.1055/a-1315-0059 ◽

2021 ◽

Vol 09 (03) ◽

pp. E319-E323

Author(s):

Madoka Takao ◽

Yoshitaka Takegawa ◽

Toshitatsu Takao ◽

Hiroya Sakaguchi ◽

Yoshiko Nakano ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Fibrin Glue ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Submucosal Injection ◽

Submucosal Dissection ◽

Vitro Model ◽

Histopathologic Findings

Abstract Background and study aims Adequate mucosal elevation by submucosal injection is crucial for patient safety and efficiency during endoscopic submucosal dissection (ESD). This study aimed to evaluate the efficacy of fibrin glue (FG) as a long-lasting submucosal injection agent and to evaluate the technical feasibility of FG injection for ESD. Materials and methods To compare the capabilities of different agents in maintaining submucosal evaluation, we injected FG, hyaluronic acid solution, and normal saline into the porcine gastric specimen that was incised into approximately 5 × 5 cm squares. Then, we measured the height of submucosal elevations over time. Moreover, three hypothetical lesions from the resected porcine stomach underwent ESD with FG injection. Thereafter, we conducted macroscopic and histopathologic analyses. Results FG maintained the greatest submucosal elevation among all the injection agents. Three ESD procedures were performed with en bloc resection. Both macroscopic and histopathologic findings showed a thick FG clot on the ulcers. Conclusions The FG solution can be potentially used as an ESD submucosal injection agent in an in vitro model.

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Colorectal endoscopic submucosal dissection using the pocket-creation method with single clip traction: a feasibility study

Endoscopy International Open ◽

10.1055/a-1372-3740 ◽

2021 ◽

Vol 09 (05) ◽

pp. E653-E658

Author(s):

Tatsuma Nomura ◽

Yoshikazu Hayashi ◽

Takaaki Morikawa ◽

Masahiro Okada ◽

Hisashi Fukuda ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Major Axis ◽

En Bloc Resection ◽

Bloc Resection ◽

Success Rates ◽

En Bloc ◽

Submucosal Dissection ◽

Mucosal Incision ◽

Axis Length ◽

Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims The pocket-creation method (PCM) facilitates dissection of the central part of a tumor. We previously developed the PCM with clip traction (PCM-CT) to facilitate opening the mucosal pocket, which otherwise could become cumbersome. In the present study, we aimed to examine the feasibility of PCM-CT for colorectal endoscopic submucosal dissection (ESD). Patients and methods PCM-CT was performed on 30 patients with early colorectal tumors from October 2019 to April 2020. PCM-CT allows efficient opening of the mucosal pocket by using the PCM to dissect the center of the lesion and then apply traction with a single clip after making a circumferential mucosal incision. Results The median specimen major axis length, ESD time, ESD speed, and en bloc resection rate were 48 mm, 84 minutes, 20 mm2/min, and 100 % (30/30), respectively. The success rates for the traction clip and median single-clip-traction time were 100 % (30/30) and 1.5 minutes, respectively. Conclusions Colorectal ESD using PCM-CT is a simple and promising method.

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Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

Journal of Clinical Medicine ◽

10.3390/jcm10112511 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2511

Author(s):

Yoshitsugu Misumi ◽

Kouichi Nonaka

Keyword(s):

Endoscopic Submucosal Dissection ◽

Endoscopic Mucosal Resection ◽

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Educational Methods ◽

Submucosal Dissection ◽

Management Of Complications

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.

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Endoscopic Submucosal Dissection in Naive Colorectal Neoplasm Performed With a Water Jet System-Assisted Knife: Higher EN Bloc Resection Rate Than Conventional Technique

10.1055/s-0041-1724730 ◽

2021 ◽

Author(s):

P Cecinato ◽

M Campanale ◽

M Lucarini ◽

F Azzolini ◽

C Tioli ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Colorectal Neoplasm ◽

En Bloc Resection ◽

Conventional Technique ◽

Bloc Resection ◽

Water Jet ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection

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Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

Endoscopy International Open ◽

10.1055/a-0733-3668 ◽

2018 ◽

Vol 06 (11) ◽

pp. E1340-E1348 ◽

Cited By ~ 9

Author(s):

Carl-Fredrik Rönnow ◽

Noriya Uedo ◽

Ervin Toth ◽

Henrik Thorlacius

Keyword(s):

Learning Curve ◽

Endoscopic Submucosal Dissection ◽

Colorectal Neoplasia ◽

En Bloc Resection ◽

Bloc Resection ◽

High Rate ◽

R0 Resection ◽

En Bloc ◽

Submucosal Dissection ◽

Immediate Bleeding

Abstract Background and study aims Endoscopic submucosal dissection (ESD) allows en bloc resection of large colorectal lesions but ESD experience is limited outside Asia. This study evaluated implementation of ESD in the treatment of colorectal neoplasia in a Western center. Patients and methods Three hundred and one cases of colorectal ESD (173 rectal and 128 colonic lesions) were retrospectively evaluated in terms of outcome, learning curve and complications. Results Median size was 4 cm (range 1 – 12.5). En bloc resection was achieved in 241 cases amounting to an en bloc resection rate of 80 %. R0 resection was accomplished in 207 cases (69 %), RX and R1 were attained in 83 (27 %) and 11 (4 %) cases, respectively. Median time was 98 min (range 10 – 588) and median proficiency was 7.2 cm2/h. Complications occurred in 24 patients (8 %) divided into 12 immediate perforations, five delayed perforations, one immediate bleeding and six delayed bleedings. Six patients (2 %), all with proximal lesions, had emergency surgery. Two hundred and four patients were followed up endoscopically and median follow-up time was 13 months (range 3 – 53) revealing seven recurrences (3 %). En bloc rate improved gradually from 60 % during the first period to 98 % during the last period. ESD proficiency significantly improved between the first study period (3.6 cm2/h) and the last study period (10.8 cm2/h). Conclusions This study represents the largest material on colorectal ESD in the west and shows that colorectal ESD can be implemented in clinical routine in western countries after appropriate training and achieve a high rate of en bloc and R0 resection with a concomitant low incidence of complications. ESD of proximal colonic lesions should be attempted with caution during the learning curve because of higher risk of complications.

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