Conscious transnasal hybrid endoscopic submucosal dissection enables safe and painless en bloc resection in elderly patients with early gastric cancer

91 Background: Gastric cancer is in the top three most common cancers in Vietnam and the disease is mainly detected in late stage. There is a lack of evaluation of the pre-neoplasia stage of gastric cancer and selection an appropriate and effective treatment remains still in debate. Hence, the study aims to evaluate, for the first time, the safety and efficacy of the application of endoscopic submucosal dissection (ESD) technique on Vietnamese patients with pre-neoplasia lesion in stomach. Methods: We included all patients diagnosed with lower or high-grade gastric dysplasia and hopitalized in the Department of Endoscopic and Functional Exploration in K Hospital from March 2018 to June 2019. Eligible patients were applied by the ESD technique as the standard treatment. We evaluated the efficacy and safety of after the intervention of ESD by the neoplasia recurrence rate after 3 months and the occurrence of adverse events during and after the ESD procedure described in frequency and percentage. Results: During the investigational period, we chose 65 pre-neoplasia gastric patients for the application of ESD technique. The male/female ratio was 1.09 and the mean age of patients was 58.07 years. The duration of hospitalization was about 3 days. We found 57 patients (87.69%) with location of the lesions in pylorus. The average of tumor sizes was 20.46 mm. All patients were treated with curative en bloc resection and no case was found as failure. Out of 65 patients, we found 2 patients (3%) with bleeding complication, no perforation and other post-surgery complication were identified. The average of procedure time was short (67.53 minutes). The histopathological specimen results revealed that 20 patients (30.76%) were diagnosed as cancer and 40 patients (61.53%) were diagnosed as high-grade dysplasia, all patients had a margin negative after ESD. After 3 months of treatment, all patients have no pre-neoplastic recurrence. Conclusions: Our result showed that the ESD technique is relatively safe and effective for Vietnamese patients with pre-neoplasia at stomach.

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Impact of Comorbidities, Sarcopenia, and Nutritional Status on the Long-Term Outcomes after Endoscopic Submucosal Dissection for Early Gastric Cancer in Elderly Patients Aged ≥ 80 Years

Cancers ◽

10.3390/cancers13143598 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3598

Author(s):

Ga Hee Kim ◽

Kee Don Choi ◽

Yousun Ko ◽

Taeyong Park ◽

Kyung Won Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Early Gastric Cancer ◽

Nutritional Status ◽

Elderly Patients ◽

Endoscopic Submucosal Dissection ◽

Term Survival ◽

Factors Associated ◽

Submucosal Dissection

Background/Aim: We investigated the oncologic outcomes in elderly patients who underwent endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) by focusing on the impact of comorbidities, sarcopenia, and nutritional status. Methods: Between 2005 and 2016, 280 patients aged ≥ 80 years with 289 EGCs underwent ESD at a tertiary care center. The short- and long-term survival outcomes were assessed. Cox regression analysis was used to identify factors associated with survival, including clinicopathologic factors and abdominal muscle area measured by computed tomography. Results: The rates of en bloc, R0, and, curative resection were 99.3%, 90.0%, and 69.2%, respectively. The rates of post-ESD bleeding and perforation rates were 2.1% and 3.1%, respectively, and no cases showed significant life-threatening adverse events. Over a median follow-up period of 70.5 months, the 3- and 5-year overall survival (OS) rates were 89.5% and 77.1%, respectively; of the114 patients who died, only four (3.5%) were due to gastric cancer. A total of 173 (61.8%) had sarcopenia, and they had lower rates of 3-year (88.4% vs. 91.4%) and 5-year (73.1% vs. 84.0%; p = 0.046) OS than did those without sarcopenia. In multivariable analyses, prognostic nutritional index (hazard ratio [HR], 0.93; 95% confidence interval [CI]: 0.90–0.98; p = 0.002) and Charlson comorbidity index (HR 1.19; 95% CI: 1.03–1.37; p = 0.018) were significant factors associated with overall survival. Conclusions: ESD was a feasible and safe therapeutic method to use in elderly patients, whose long-term survival was significantly associated with nutritional status and comorbidities. These results suggest the need for a possible extension of the curative criteria for ESD in elderly patients with EGC.

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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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