scholarly journals Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors

2020 ◽  
Vol 21 (12) ◽  
Author(s):  
Kazuya Akahoshi ◽  
Masaru Kubokawa ◽  
Kazuki Inamura ◽  
Kazuaki Akahoshi ◽  
Yuki Shiratsuchi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Early Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Epithelial Tumors

Opinion statement With the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.

scholarly journals Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

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.

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

2018 ◽  
Vol 06 (11) ◽  
pp. E1340-E1348 ◽  
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.

scholarly journals Endoscopic Submucosal Dissection of Papillary Gastric Adenocarcinoma; Systematic Review

2020 ◽  
Vol 9 (5) ◽  
pp. 1465
Author(s):  
Chang Seok Bang ◽  
Jae Jun Lee ◽  
Gwang Ho Baik
Keyword(s):  
Systematic Review ◽  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
Submucosal Invasion ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection

This study evaluated the possibility of endoscopic submucosal dissection (ESD) for early gastric cancer with papillary adenocarcinoma (EGC-PAC). PAC, an uncommon pathologic type of stomach cancer, is classified into differentiated-type histology. However, aggressive features, including a high rate of submucosal invasion, lymphovascular invasion (LVI), and lymph node metastasis (LNM), have been reported in studies with surgical specimens. Treatment outcomes of ESD for EGC-PAC have not been precisely demonstrated. Core databases were sought for the following inclusion criteria: studies of endoscopic resection or surgery of EGC-PAC presenting the following therapeutic indicators; en bloc resection, complete resection, curative resection, recurrence, complications associated with procedures, LVI, or LNM that enabled an analysis of ESD possibility. Overall, 15 studies were included for systematic review. Frequent submucosal invasion and high LVI were noted in EGC-PAC. However, PAC was not significantly associated with LNM. Pooled en bloc resection, complete resection, and curative resection rates were 89.7% (95% confidence interval: 55.3%–98.4%), 85.3% (67.7%–94.2%), and 67% (43%–84.5%), respectively. No LNM was observed if EGC-PAC satisfied the curative resection criteria. ESD seems technically feasible, although a high LVI rate results in a lower rate of curative resection.

Ten year experience of esophageal endoscopic submucosal dissection of superficial esophageal neoplasms in a single center.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 104-104
Author(s):  
Hyungchul Park ◽  
Do Hoon Kim ◽  
Eun Jeong Gong ◽  
Hee Kyong Na ◽  
Ji Yong Ahn ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Survival Rates ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Female Ratio ◽  
Submucosal Dissection ◽  
Difficult Procedure ◽  
Male To Female

104 Background: Endoscopic submucosal dissection (ESD) of a superficial esophageal neoplasm (SEN) is a technically difficult procedure. We investigated the clinical outcomes of ESD to determine its feasibility and effectiveness for the treatment of SEN. Methods: Patients who underwent ESD for SEN between August 2005 and June 2014 were eligible for this study. The clinical features of patients and tumors, histopathologic characteristics, adverse events, results of endoscopic resection, and survival were investigated. Results: ESD was performed in 225 patients with 261 lesions, including 70 cases (26.8%) of dysplasias and 191 cases (73.2%) of squamous cell carcinomas. The median age was 65 years (range: 44–86 years), and the male to female ratio was 21.5:1. Median tumor size was 37 mm (range: 5–85 mm) and median procedure time was 45 minutes (range: 9–160 minutes). En bloc resection was performed in 245 of 261 lesions (93.9%), with complete resection in 234 lesions (89.7%) and curative resection in 201 lesions (77.0%). Adverse events occurred in 33 cases (12.6%), including bleeding (1.5%), perforation (4.6%), and stricture (6.5%). During a median follow-up period of 35.0 months (interquartile range: 18–62 months), none of the patients showed local recurrence. The 5-year overall and disease-specific survival rates were 89.7% and 100%, respectively. Conclusions: ESD is a feasible and effective procedure for the treatment of SEN based on our 10-year experience, which showed favorable outcomes.

scholarly journals Scissor-type knife improves the safety of endoscopic submucosal dissection (ESD) among endoscopists without experience in ESD: a randomized ex vivo study

2021 ◽  
Vol 09 (08) ◽  
pp. E1207-E1213
Author(s):  
Kavel Visrodia ◽  
Tarek Sawas ◽  
Liam Zakko ◽  
Juan Reyes Genere ◽  
Cadman Leggett ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Muscle Injury ◽  
Ex Vivo ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Lower Proportion ◽  
Procedure Time ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is technically challenging, difficult to learn, and carries a substantial risk of perforation, all of which remain significant barriers to its adoptability. We aimed to determine whether use of a novel scissor-type knife improved efficacy and safety among novice performers of ESD. Materials and methods Following a brief didactic session on ESD, participants performed ESD of two lesions (2 cm diameter) in an ex vivo porcine gastric model. One resection was performed with a conventional knife and the other with the scissor knife (order of knife randomized). We recorded procedure time, successful en bloc resection, and adverse events (including full-thickness perforation and muscle injury) for each dissection. Participants completed a post-study survey. Results 10 endoscopists (8 trainees, 2 staff) considered novices in ESD participated. Compared with the conventional knife, use of the scissor knife was associated with a significantly shorter time to completion of submucosal dissection (mean 6.2 [SD 5.6] vs. 15.6 [SD 15.6] minutes; P = 0.04) and total procedure time was not significantly different (22.1 [SD 13.3] vs. 24.9 [SD 26.5] minutes; P = 0.65). Scissor knife use was also associated with a significantly lower proportion of perforation and/or muscle injury (10.0 % vs. 70.0 %; P < 0.01) and proportion of muscle injury alone (10.0 % vs. 60.0 %; P  = 0.02). Conclusions Among novices performing ESD on an ex vivo animal model, use of a scissor knife was associated with a significantly lower proportion of adverse events without prolonging procedure time. Scissor-type knives may improve ESD safety, at least among novices.

scholarly journals Endoscopic submucosal dissection and tunneling procedures using a novel all-in-one bipolar device

2020 ◽  
Vol 08 (10) ◽  
pp. E1302-E1307
Author(s):  
Zaheer Nabi ◽  
Radhika Chavan ◽  
Mohan Ramchandani ◽  
Zacharias Tsiamoulos ◽  
Jahanqeer Basha ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Rectal Polyp ◽  
En Bloc ◽  
Epithelial Tumor ◽  
Submucosal Tunneling Endoscopic Resection ◽  
Submucosal Dissection ◽  
Bipolar Device

Abstract Background and study aims Recent innovations in devices and techniques have revolutionized the field of endoscopic resection procedures. In this study, we evaluated the safety and feasibility of endoscopic submucosal dissection and tunneling procedures with a novel, multipurpose bipolar device. Patients and methods Data from consecutive patients who underwent per-oral endoscopic myotomy (POEM), submucosal tunneling endoscopic resection (STER), and endoscopic submucosal dissection (ESD) using a novel bipolar device (December 2019 to February 2020) were analyzed retrospectively. Procedure duration, technical success, and adverse events (AEs) were recorded. Results A total of 10 procedures were performed using the novel bipolar device during the study period. The procedures included POEM (n = 7), STER for esophageal sub-epithelial tumor (n = 1), ESD for rectal polyp (n = 1), and gastric neuroendocrine tumor (n = 1). POEM was successfully completed in all patients. In patients who underwent STER and ESD, en-bloc resection was achieved in all. Mean procedure time for submucosal tunneling procedures (POEM and STER) was 59.12 ± 31.12 minutes. The procedures were completed without the requirement for exchange of accessories in eight cases (80 %). There were no major AEs. Mild and moderate AEs occurred during POEM and included capno-peritoneum (n = 1), retroperitoneal CO2 (n = 1), and empyema (n = 1). Conclusion ESD and tunneling procedures can be safely performed without the need for exchange of accessories using a novel bipolar device. Randomized comparison with conventional knives isrequired to confirm the utility of this device.

Endoscopic Submucosal Dissection for Early-Stage Neuroendocrine Carcinoma of The Esophagus ：A Case Report

2021 ◽  
Author(s):  
Nan Tang ◽  
Zhonghua Cheng ◽  
Zhen Fen
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Neuroendocrine Carcinoma ◽  
Histopathological Examination ◽  
Early Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Muscularis Mucosa ◽  
En Bloc ◽  
Carcinoma Of The Esophagus ◽  
Submucosal Dissection

Abstract Background: Neuroendocrine carcinoma (NEC) of the esophagus is rare, highly aggressive and lacks biological features. Case presentation: In this report, we describe a patient with Esophageal NEC who was successfully treated using endoscopic submucosal dissection (ESD). A 55-year-old woman presented with intermittent mild dysphagia for 2 months. Gastroscopy revealed a disc-shaped protruding lesion about 18mm×18mm in size on the upper esophagus, 25cm from the incisors. Endoscopic ultrasonography (EUS) demonstrated the bulged lesion was highly echoic and homogeneous, originating from the muscularis mucosa. We assessed en bloc resection by ESD for therapeutic diagnosis to be a safe and appropriate treatment. The tumor was removed using ESD. Histopathological examination revealed a poorly differentiated neoplasm comprising large cells with marked nuclear atypia and multifocal necrosis Immunohistochemistry staining revealed tumor tissue that was positive for Ki67, CgA, Syn, CD56, but negative for P40, P63, S-100 protein. These histopathological results were consistent with a diagnosis of esophageal NEC, large cell type, derived from the muscularis mucosae. After comprehensive consideration, we adopted the combination treatments (ESD plus an adjuvant chemotherapy). The patient has been followed up till now with no recurrence. Conclusions: En bloc resection approach by ESD play a vital role in the early therapeutic diagnosis of esophageal NEC.

scholarly journals Feasibility of Endoscopic Submucosal Dissection: A New Technique for En Bloc Resection of a Large Superficial Tumor in the Colon and Rectum

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
T. Shono ◽  
K. Ishikawa ◽  
Y. Ochiai ◽  
M. Nakao ◽  
O. Togawa ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colon And Rectum ◽  
A New Technique ◽  
Average Procedure Time

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.

scholarly journals Compared the effectiveness and safety of different methods of colorectal endoscopic submucosal dissection: a systematic review and network meta-analysis

2021 ◽  
Author(s):  
Xueping Wu ◽  
Chenglong Ye ◽  
Zhongsheng Cao ◽  
Xiangcheng Hu ◽  
Wensheng Pan ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Meta Analysis ◽  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cochrane Library ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection

Background: Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method(P-ESD), traction-assisted method(T-ESD) and Hybrid method(H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. Study design: Studies comparing different methods of colorectal ESD were searched by PubMed, Embase, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and Newcastle-Ottawa Scale. Results: Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than C-ESD, P-ESD and T-ESD [RR=0.28, 95%CI (0.12, 0.65); RR = 0.11, 95% CI (0.03, 0.44); RR = 8.28, 95% CI (2.50, 27.42)]. Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter [MD=-21.83, 95%CI (-34.76, -8.90); MD=-23.8, 95%CI (-32.55, -15.06)]. Meanwhile, the operation time of T-ESD was also significantly shorter than P-ESD [MD=-18.74, 95%CI (-31.93, -5.54)]. The dissection speed of T-ESD was significantly faster than C-ESD [MD=6.26, 95%CI (2.29, 10.23)]. Conclusion: P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time.

scholarly journals Fibrin glue: Novel submucosal injection agent for endoscopic submucosal dissection

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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