scholarly journals Evaluating the effect of injecting triamcinolone acetonide in two sessions for preventing esophageal stricture after endoscopic submucosal dissection

2019 ◽  
Vol 07 (06) ◽  
pp. E764-E770 ◽  
Author(s):  
Satoru Hashimoto ◽  
Ken-ichi Mizuno ◽  
Kazuya Takahashi ◽  
Hiroki Sato ◽  
Junji Yokoyama ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Triamcinolone Acetonide ◽  
Esophageal Stricture ◽  
Control Group ◽  
Study Group ◽  
Stricture Formation ◽  
Endoscopic Injection ◽  
Submucosal Dissection ◽  
Stricture Rate ◽  
Significant Difference

Abstract Background and study aims Several previous reports indicate that endoscopic injection of triamcinolone acetonide (TA) after widespread endoscopic submucosal dissection (ESD) is effective for preventing esophageal stricture. We investigated the efficacy of injecting TA in two sessions for preventing stricture formation post-ESD. Patients and methods Sixty-six consecutive patients with widespread mucosal defects that affected more than three-fourths of the circumference of the esophagus were included. The study group (n = 40) received TA injections over two sessions: immediately after and 14 days after ESD. The control group (n = 26) did not receive a TA injection. This study was performed retrospectively against historical controls. The primary endpoint of this study was frequency of stricture after TA injection. The secondary endpoint was number of required endoscopic balloon dilations (EBDs) after TA injection. Results The post-ESD stricture rate among patients who had subcircumferential mucosal defects was 45.7 % in the study group (16/35 patients), which was significantly lower than the rate of 73.9 % in the control group (17/23 patients; P = 0.031). The number of EBD procedures required was significantly lower in the study group (median 0, range 0 – 7) than in the control group (median 4, range 0 – 20; P < 0.001). There was no significant difference between the study and control groups among the patients who had full circumferential mucosal defects. Conclusion This study showed that performing two sessions of TA injection is an effective and safe treatment for prevention of esophageal stricture following subcircumferential ESD.

scholarly journals Comparative Analysis on the Curative Effect of Endoscopic Submucosal Dissection and Mucosal Resection in the Treatment of Gastric Neuroendocrine Tumor

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Nannan Zhao ◽  
Nan Li
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Neuroendocrine Tumor ◽  
Reference Group ◽  
Tumor Resection ◽  
Operation Time ◽  
Control Group ◽  
Study Group ◽  
Resection Rate ◽  
Mucosal Resection ◽  
Submucosal Dissection

Objective: To study the therapeutic effect of endoscopic submucosal dissection and mucosal resection on gastric neuroendocrine tumor. Methods: A hundred patients with gastric neuroendocrine tumor that were treated in the Affiliated Hospital of Chifeng University from January 2016 to May 2021 were randomly selected for this research. They were divided into two groups, which were the control group (endoscopic mucosal resection) and the study group (endoscopic submucosal dissection), by the digital table method. The curative effects of the two groups were observed and compared. Results: Before operation, there were no significant differences in serum CgA, TNF-?, and IL-6 between the two groups, p > 0.05. After surgical treatment, the operation time and hospital stay of the patients in the study group were shorter than those in the control group, the amount of surgical bleeding was also less compared to the control group, and the complete tumor resection rate was higher than that in the control group (p < 0.05); the levels of IL-6 and CgA of the study group were lower than those in the control group, while the levels of TNF-? were higher than those of the control group, p < 0.05; the postoperative complication rate of the study group was lower than that of the reference group (p < 0.05). Conclusion: Endoscopic submucosal dissection is more effective for gastric neuroendocrine tumors. The resection rate of the tumor is high, and the operation risk is low.

PS02.208: THE SHIELDING METHOD WITH POLYGLYCOLIC ACID SHEETS AND FIBRIN GLUE FOR PREVENTING ESOPHAGEAL STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION: A HISTORICAL CONTROL STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 181-181
Author(s):  
Toshiro Iizuka ◽  
Daisuke Kikuchi ◽  
Yugo Suzuki ◽  
Shu Hoteya
Keyword(s):  
Fibrin Glue ◽  
Esophageal Stricture ◽  
Steroid Injection ◽  
Polyglycolic Acid ◽  
Control Group ◽  
Study Group ◽  
Group 4 ◽  
Stricture Rate ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Abstract Background There have been several reports that steroid administration are effective at preventing strictures after ESD. However, adverse events after steroid use are of great concern. We have reported that shielding with polyglycolic acid (PGA) sheets and fibrin glue can be useful for prevention of stricture after ESD. We conducted a retrospective analysis of efficiency of shielding with PGA sheets and fibrin glue for prevention of esophageal stricture compared with intralesional steroid injection. Methods ESD was performed on a total of 608 lesions in 553 patients for superficial esophageal cancer from January 2012 to March 2017. Of these, 45 lesions were enrolled in the study group (PGA sheets and fibrin glue) and 40 lesions were enrolled in the control group (intralesional steroid injection). The incidence of postoperative stricture at 6 weeks and the number of sessions of endoscopic balloon dilatation (EBD) required to resolve any strictures were evaluated. Among them, patients with additional surgery were excluded in both groups when investing the outcome. Results The post-ESD stricture rate was 10.5% in the study group (4/38 patients), which was not significantly lower than the stricture rate of 10.8% in the historical control group (4/37 patients; P = 0.63). The mean number of EBD was 1.2 ± 4.2 in the study group and 0.68 ± 2.2 in the control group, which was not significant (P = 0.47). Conclusion PGA sheets and fibrin glue appear to be a promising option for the prevention of esophageal stricture similar to the effect of intralesional steroid injection. Disclosure All authors have declared no conflicts of interest.

scholarly journals Clinical effectiveness of the pocket-creation method for colorectal endoscopic submucosal dissection

2017 ◽  
Vol 05 (12) ◽  
pp. E1299-E1305 ◽  
Author(s):  
Akira Kanamori ◽  
Masakazu Nakano ◽  
Masayuki Kondo ◽  
Takanao Tanaka ◽  
Keiichiro Abe ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Conventional Method ◽  
Clinical Effectiveness ◽  
Muscle Layer ◽  
En Bloc Resection ◽  
Control Group ◽  
Colorectal Tumors ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is a technically advanced procedure for colorectal tumors. Hayashi et al. invented the “pocket-creation method (PCM),” and reported that Is-type lesions with fibrosis could be efficaciously and safely resected. However, only case studies have been published, and there are no previous reports on the usefulness of PCM in colorectal ESD for all lesions, as compared with the conventional method. This study aimed to evaluate the effectiveness and safety of PCM in colorectal ESD. Patients and methods Ninety-six colorectal tumors were treated: 47 using the PCM and the other 49, considered the control group, using the conventional method. Therapeutic effectiveness and safety were retrospectively assessed. Results The comparison between the PCM and control groups revealed higher rates of en bloc resection (100 % vs. 88 %, P = 0.015) and curative endoscopic resection (100 % vs. 84 %, P = 0.0030) with PCM. There was no significant difference in perforation as an adverse event (AE) between the two groups, though perforation was observed in only 6 % of the control group and none of the PCM group. Compared with the control group, the PCM group had lower incidences of perforation and post-ESD coagulation syndrome, and both AEs were associated with excessive thermal denaturation of the muscle layer (2 % vs. 16 %, P = 0.018). Conclusions This study demonstrated the effectiveness and safety of ESD with PCM for colorectal tumors. Although there is a possible learning curve, PCM enables the endoscopist to safely perform ESD in most cases without encountering the difficulties associated with conventional ESD.

scholarly journals Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Tachikawa ◽  
Hideyuki Chiba ◽  
Naoya Okada ◽  
Jun Arimoto ◽  
Keiichi Ashikari ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Control Group ◽  
Obese Patients ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Overweight Group ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background When performing colorectal endoscopic submucosal dissection (ESD) in obese patients, technically difficult cases are sometimes experienced because of difficulty with the insertion of the colonoscope, poor scope maneuverability, or an abundance of fat tissue in the submucosal layer. Since the association between obesity and colorectal ESD has not been investigated, we evaluated the clinical impact of obesity in patients who underwent colorectal ESD. Methods We retrospectively reviewed 535 patients who underwent colorectal ESD between April 2012 and February 2019. Patients were divided into three groups based on their body mass index (BMI): a control group (BMI < 25 kg/m2), an overweight group (25 kg/m2 ≤ BMI < 30 kg/m2), and an obese group (BMI ≥ 30 kg/m2), and the short-term clinical outcomes were analyzed to assess the safety and difficulty of colorectal ESD. Results No significant difference in the procedure times, en bloc resection rates, pathological diagnoses, or complications were seen among the groups. While the amount of sedative per body weight was significantly lower in the group with a higher BMI (flunitrazepam: 1.75 × 10−2 [1.27 × 10−2–2.34 × 10−2] mg/kg vs. 1.48 × 10−2 [1.08 × 10−2–2.03 × 10−2] mg/kg vs. 1.16 × 10−2 [0.98 × 10−2–1.54 × 10−2] mg/kg, P < 0.001; pethidine: 0.63 [0.55–0.72] mg/kg vs. 0.50 [0.46–0.56] mg/kg vs. 0.39 [0.32–0.45] mg/kg, P < 0.001), a reduction in percutaneous arterial oxygen saturation occurred significantly more frequently in the group with a higher BMI (123 [30.2%] vs. 43 [43.9%] vs. 10 [55.6%], P = 0.005). When the procedures were performed by trainees, the number of cases that required a procedure time of longer than 90 min was significantly larger in the group with a higher BMI (27 [10.8%] vs. 14 [21.9%] vs. 3 [25.0%], P = 0.033). Conclusions This study showed that colorectal ESD could be performed safely and effectively in obese patients. However, ESD in obese patients requires attention, particularly to changes in respiratory conditions.

Local Thymosin β4 Gel Injection Prevents Esophageal Stricture after Circumferential Endoscopic Submucosal Dissection in a Porcine Model

2018 ◽  
Vol 37 (2) ◽  
pp. 87-92 ◽  
Author(s):  
Hua Wang ◽  
Qun Shuai ◽  
Jian Tang ◽  
Dan Long ◽  
Chen Xu ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Esophageal Stricture ◽  
Porcine Model ◽  
Balloon Dilation ◽  
Control Group ◽  
Thymosin Β4 ◽  
Early Esophageal Cancer ◽  
Submucosal Dissection ◽  
Gel Injection ◽  
Experimental Group

Background: Endoscopic submucosal dissection (ESD) is widely used in the treatment of early esophageal cancer. However, the incidence of postoperative esophageal stricture is relatively high, especially after full circumferential ESD. Previous studies have shown that thymosin β4 (Tβ4) has anti-fibrotic activity and prevents scar formation. In this study, we investigated the safety and therapeutic effect of Tβ4 injection in preventing esophageal stricture after circumferential ESD in a porcine model. Methods: A total of 8 Bama pigs underwent esophageal circumferential ESD under anesthesia (n = 4 for experimental and control group). Local injection of Tβ4 gel was administered in the experimental group. Follow-up endoscopy was conducted, and balloon dilation (EBD) was performed to prevent the occurrence of esophageal stricture. Results: Esophageal stricture developed after circumferential ESD in all pigs. Local Tβ4 gel injection has shortened resolution of the stricture (p = 0.012) and was associated with a lesser number of EBD sessions (p = 0.002). The severity of esophageal stricture was milder in the experimental group (p = 0.046 vs. control group). No adverse events occurred in the study. Conclusions: Local Tβ4 gel injection appeared to be safe and effective for the prevention of esophageal stricture after circumferential ESD in a porcine model.

scholarly journals Does Adjuvant Intracameral Triamcinolone Acetonide Increase the Effectiveness of Phacotrabeculectomy? A Case-Control Study

2020 ◽  
Vol 76 (2) ◽  
pp. 68-76
Author(s):  
Fatih Aslan ◽  
Çağlar Öktem
Keyword(s):  
Triamcinolone Acetonide ◽  
Case Control Study ◽  
Anterior Segment ◽  
Study Groups ◽  
Control Group ◽  
Study Group ◽  
Surgical Success ◽  
Significant Difference ◽  
Intracameral Injection ◽  
Control Study

Aims: To investigate the effect of intracameral triamcinolone acetonide (TA) on surgical success in 5-fluorouracil (5-FU) supported primary phacotrabeculectomy (PT) cases. Material and Methods: This retrospective study included 23 eyes (study group) of 23 patients who underwent TA during PT and 26 eyes (control group) of 26 patients without TA. PT patients in the study group received 1 mg TA intraoperatively at the end of surgery. Pre- and postoperative visual acuity, intraocular pressure (IOP), and number of antiglaucoma drugs used were compared. Postoperative complications and need for 5-FU injection were evaluated for both groups. Results: Mean age was 64.1 2 ± 1.91 (48–86) years in the control group and 66.52 ± 2.02 (52–86) years in the study group (p = 0.824). Comparison of pre- and postoperative IOP values showed significant decreases in postoperative IOP levels at all-time points in both the control and study groups (p < 0.001). The only significant difference between groups was on postoperative first day (study group: 9.22 ± 1.41 mmHg; control group: 6.35 ± 2.17 mmHg, p < 0.001). Need for postoperative 5-FU injection was significantly more common in the control group (p = 0.023). Conclusion: Intracameral injection of 1 mg TA at the end of PT surgery did not yield superior results in postoperative IOP compared to PT alone, and the two groups showed similar IOP reduction. When given as an adjunct to PT, 1 mg TA suppresses anterior segment inflammation and reduces the need for 5-FU injection.

Endoscopic tissue shielding to prevent bleeding after endoscopic submucosal dissection: a prospective multicenter randomized controlled trial

Endoscopy ◽  
2019 ◽  
Vol 51 (07) ◽  
pp. 619-627 ◽  
Author(s):  
Yosuke Kataoka ◽  
Yosuke Tsuji ◽  
Kingo Hirasawa ◽  
Kengo Takimoto ◽  
Tomonori Wada ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
Controlled Trial ◽  
Polyglycolic Acid ◽  
Control Group ◽  
Randomized Controlled ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Multicenter Randomized Controlled Trial

Abstract Background Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Recent reports have described the efficacy of the endoscopic shielding method with polyglycolic acid (PGA) sheets and fibrin glue for the prevention of adverse events after ESD. The aim of the present study was to investigate whether the PGA shielding method provides additional benefit in preventing post-ESD bleeding compared with standard care. Methods This was a prospective, multicenter, randomized controlled trial. Patients at high risk of post-ESD bleeding were enrolled in the study. Before ESD, patients were randomized to either the PGA group or the control group. After completing ESD in the PGA group, PGA sheets were placed onto the ulcer floor and adhered with fibrin glue. The primary end point was the post-ESD bleeding rate. Results 140 eligible patients were enrolled from September 2014 to September 2016, and 137 were included in the intention-to-treat analysis (67 in the PGA group and 70 in the control group). Post-ESD bleeding occurred in three patients (4.5 %) in the PGA group and in four patients (5.7 %) in the control group; there was no significant difference between the two groups (P > 0.99). Post-ESD bleeding tended to occur later in the control group than in the PGA group (median 12.5 days [range 8 – 14] vs. 2 days [range 0 – 7], respectively). Conclusion The PGA shielding method did not demonstrate a significant effect on the prevention of post-ESD bleeding.

The safety and efficacy of radiofrequency ablation following endoscopic submucosal dissection for Barrett's neoplasia

2017 ◽  
Vol 31 (3) ◽  
Author(s):  
S Subramaniam ◽  
K Kandiah ◽  
F Chedgy ◽  
P Meredith ◽  
G Longcroft-Wheaton ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Stricture Formation ◽  
Complication Rates ◽  
Safety And Efficacy ◽  
Submucosal Dissection ◽  
Increased Risk ◽  
Tertiary Center ◽  
Significant Difference

SUMMARY The current standard of treating early Barrett's neoplasia is resection of visible lesions using endoscopic mucosal resection (EMR) followed by ablative therapy to the Barrett's segment. There is increasing evidence to support the use of endoscopic submucosal dissection (ESD) where en-bloc resection and lower recurrence rates may be achieved. However, ESD is associated with deep submucosal dissection when compared to EMR. This may increase the risk of complications including stricture formation with subsequent radiofrequency ablation (RFA) therapy. The aim of this study is to compare the safety and efficacy of RFA following EMR and ESD as well as when RFA was used without prior endoscopic resection. The primary outcome measure was complication rates. Clearance of dysplasia (CRD) and clearance of intestinal metaplasia (CRIM) were secondary outcomes. A retrospective analysis of a cohort of 91 patients referred for RFA from a single academic tertiary center was performed. The choice of endoscopic resection method was tailored according to the lesion type and morphology. Focal and circumferential ablation was performed after initial follow up endoscopy postresection. Patients proceeded straight to RFA in the absence of any visible lesions. In this study, the ESD group had a higher proportion of cancers compared to the EMR cohort (74.1% vs. 30.2%, P < 0.01) prior to RFA. All complications post RFA occurred in the groups with previous endoscopic resection. There was no significant difference in the total complication rate (7.4% vs. 9.3%, P = 0.78) and stricture formation rate (3.7% vs. 9.3%, P = 0.38) between the ESD and EMR groups. CRD was achieved in 96.3% in the ESD group, 88.4% in the EMR group, and all patients in the RFA alone group. CRIM rates were similar in the EMR and ESD groups (81.4% vs. 85.2%) but higher in the RFA alone group (90.5%). In conclusion, RFA following ESD is very effective and not associated with an increased risk of complications compared to EMR. This supports the application of RFA in the treatment algorithm of patients undergoing ESD for Barrett's neoplasia.

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