scholarly journals Feasibility of endoscopic suturing to prevent adverse events and hospitalization after endoscopic submucosal dissection

2020 ◽  
Vol 08 (09) ◽  
pp. E1212-E1217
Author(s):  
Samuel Han ◽  
Sachin Wani ◽  
Steven A. Edmundowicz ◽  
Roy Soetikno ◽  
Hazem Hammad
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Insertion Site ◽  
Lesion Size ◽  
Endoscopic Suturing ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Mucosal Defect ◽  
Same Day Discharge

Abstract Background and study aim Endoscopic submucosal dissection (ESD) enables en bloc removal of gastrointestinal epithelial lesions but can leave a large mucosal defect, which can lead to inpatient observation and delayed bleeding or perforation. The aim of this study was to examine the safety and effectiveness of endoscopic suturing in closing ESD defects to prevent adverse events. Patients and methods In this single-center prospective cohort study, endoscopic suturing was performed to close ESD defects in the stomach or rectum. Suturing was performed in the antegrade position starting from the edge most distal to the endoscope insertion site, moving from right to left, left to right manner before ending at the edge most proximal to the endoscope insertion site. Results In total, 31 patients (mean age 65.6, 71 % male) received endoscopic suturing after gastric (58.1 %) or rectal (41.9 %) ESD. Mean lesion size was 27.4 ± 16.2 mm and mean suturing time was 13.4 ± 5.9 min. Complete closure was achieved in all patients. Same-day discharge occurred in 58.1 % of patients; the remainder were hospitalized with mean length of stay of 1 ± 0.6 day. There were no instances of delayed bleeding or delayed perforation (0 %, 95 % CI: 0–11.5 %). No recurrences were found on surveillance endoscopy. Conclusions Based on this small prospective study, endoscopic suturing of post-ESD defects in the stomach and rectum appears to be feasible, safe, and potentially effective in preventing bleeding or perforation. Further larger controlled studies, however, are needed to validate these findings.

scholarly journals Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile

2021 ◽  
pp. 1-9
Author(s):  
João Santos-Antunes ◽  
Margarida Marques ◽  
Rui Morais ◽  
Fátima Carneiro ◽  
Guilherme Macedo
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Safety Profile ◽  
En Bloc Resection ◽  
R0 Resection ◽  
Hybrid Technique ◽  
Resection Rate ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Introduction:</i></b> Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. <b><i>Methods:</i></b> We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. <b><i>Results:</i></b> Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (<i>n</i> = 24) and rectum (<i>n</i> = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). <b><i>Conclusion:</i></b> Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.

scholarly journals Clinical Practice of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms by a Colonoscopist with Limited Gastric Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Wen-Hsin Hsu ◽  
Meng-Shun Sun ◽  
Hoi-Wan Lo ◽  
Ching-Yang Tsai ◽  
Yu-Jou Tsai
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
R0 Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Limited Experience ◽  
Mean Size ◽  
Delayed Perforation ◽  
The Mean

Objectives. Endoscopic submucosal dissection (ESD) for early colorectal neoplasms is regarded as a difficult technique and should commence after receiving the experiences of ESD in the stomach. The implementation of colorectal ESD in countries where early gastric cancer is uncommon might therefore be difficult. The aim is to delineate the feasibility and the learning curve of colorectal ESD performed by a colonoscopist with limited experience of gastric ESD.Methods. The first fifty cases of colorectal ESD, which were performed by a single colonoscopist between July 2010 and April 2013, were enrolled.Results. The mean of age was 64 (±9.204) years with mean size of neoplasm at 33 (±12.63) mm. The mean of procedure time was 70.5 (±48.9) min. The rates ofen blocresection, R0 resection, and curative resection were 86%, 86%, and 82%, respectively. Three patients had immediate perforation, but no patient developed delayed perforation or delayed bleeding.Conclusion. Our result disclosed that it is feasible for colorectal ESD to be performed by a colonoscopist with little experience of gastric ESD through satisfactory training and adequate case selection.

Endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: short- to long-term outcomes

Endoscopy ◽  
2017 ◽  
Vol 49 (09) ◽  
pp. 913-918 ◽  
Author(s):  
Toshio Kuwai ◽  
Toshiki Yamaguchi ◽  
Hiroki Imagawa ◽  
Yuki Sumida ◽  
Takeshi Takasago ◽  
...  
Keyword(s):  
Survival Rate ◽  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
En Bloc Resection ◽  
Long Term Outcomes ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Short And Long Term

Abstract Background and study aims Endoscopic submucosal dissection (ESD) for colorectal neoplasms remains challenging because of technical issues imposed by the complex anatomical features of the large intestine. We evaluated the feasibility, and the short- and long-term clinical outcomes of ESD for early colorectal neoplasms performed using the Stag-beetle Knife Jr. (SB Knife Jr.) Patients and methods We retrospectively assessed 228 patients who underwent ESD for 247 colorectal lesions with the SB Knife Jr. Clinicopathological characteristics of the neoplasms, complications, and various short- and long-term outcomes were evaluated. Results Mean tumor size was 34.3 mm and median procedure time was 76 minutes. The SB Knife Jr. achieved 98.4 % en bloc resection, 93.9 % complete resection, and 85.4 % curative resection. No perforations occurred during the procedure, and a delayed bleeding rate of 2.4 % was observed. Long-term outcomes were favorable with no distant recurrence, 1.1 % local recurrence, a 5-year overall survival rate of 94.1 % and 5-year tumor-specific survival rate of 98.6 % in patients with cancer. Conclusions ESD using the SB Knife Jr. is technically efficient and safe in treating early colorectal neoplasms and is associated with favorable short- and long-term outcomes.

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 Endoscopic Submucosal Dissection of Gastric Epithelial Neoplasms after Partial Gastrectomy: A Single-Center Experience

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Byeong Gu Song ◽  
Gwang Ha Kim ◽  
Bong Eun Lee ◽  
Hye Kyung Jeon ◽  
Dong Hoon Baek ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Partial Gastrectomy ◽  
Remnant Stomach ◽  
Complete Resection ◽  
Incomplete Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Single Center Experience ◽  
Epithelial Neoplasms

Aims. To investigate the feasibility and safety of endoscopic submucosal dissection (ESD) of gastric epithelial neoplasms in the remnant stomach (GEN-RS) after various types of partial gastrectomy. Methods. This study included 29 patients (31 lesions) who underwent ESD for GEN-RS between March 2006 and August 2016. Clinicopathologic data were retrieved retrospectively to assess the therapeutic ESD outcomes, including en bloc and complete resection rates and procedure-related adverse events. Results. The en bloc, complete, and curative resection rates were 90%, 77%, and 71%, respectively. The types of previous gastrectomy, tumor size, macroscopic type, and tumor histology were not associated with incomplete resection. Only tumors involving the suture lines from the prior partial gastrectomy were significantly associated with incomplete resection. The procedure-related bleeding and perforation rates were 6% and 3%, respectively; none of the adverse events required surgical intervention. During a median follow-up period of 25 months (range, 6–58 months), there was no recurrence in any case. Conclusions. ESD is a safe and feasible treatment for GEN-RS regardless of the previous gastrectomy type. However, the complete resection rate decreases for lesions involving the suture lines.

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 Usefulness of a multifunctional snare designed for colorectal hybrid endoscopic submucosal dissection (with video)

2018 ◽  
Vol 06 (02) ◽  
pp. E249-E253 ◽  
Author(s):  
Ken Ohata ◽  
Takashi Muramoto ◽  
Yohei Minato ◽  
Hideyuki Chiba ◽  
Eiji Sakai ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Therapeutic Option ◽  
Cost Effective ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Tumors ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Needle Knife

AbstractSince colorectal endoscopic submucosal dissection (ESD) remains technically difficult, hybrid ESD was developed as an alternative therapeutic option to achieve en bloc resection of relatively large lesions. In this feasibility study, we evaluated the safety and efficacy of hybrid colorectal ESD using a newly developed multifunctional snare. From June to August 2016, we prospectively enrolled 10 consecutive patients with non-pedunculated intramucosal colorectal tumors 20 – 30 mm in diameter. All of the hybrid ESD steps were performed using the “SOUTEN” snare. The knob-shaped tip attached to the loop top helps to stabilize the needle-knife, making it less likely to slip during circumferential incision and enables partial submucosal dissection. All of the lesions were curatively resected by hybrid ESD, with a short mean procedure time (16.1 ± 4.8 minutes). The mean diameters of the resected specimens and tumors were 30.5 ± 4.9 and 26.0 ± 3.5 mm, respectively. No perforations occurred, while delayed bleeding occurred in 1 patient. In conclusion, hybrid ESD using a multifunctional snare enables easy, safe, and cost-effective resection of relatively large colorectal tumors to be achieved.Study registration: UMIN000022545

scholarly journals Local Recurrence After Endoscopic Submucosal Dissection of Early Gastric Cancer

2022 ◽  
Author(s):  
Cheol Woong Choi ◽  
Su Jin Kim ◽  
Dae Gon Ryu ◽  
Dae Hwan Kang ◽  
Hyung Wook Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Local Recurrence ◽  
Endoscopic Submucosal Dissection ◽  
Lesion Size ◽  
Tertiary Referral Hospital ◽  
En Bloc ◽  
Factors Associated ◽  
Submucosal Dissection ◽  
Undifferentiated Adenocarcinoma

Abstract Background: Endoscopic submucosal dissection (ESD) is considered the treatment of choice for early gastric cancer (EGC) with a negligible risk of lymph node metastasis. However, locally recurrent lesions on artificial ulcer scars are difficult to manage. Therefore, predicting the risk of local recurrence after ESD is important to manage and prevent the event. This study aimed to elucidate risk factors associated with local recurrence after ESD of EGC.Methods: Between November 2008 and February 2016, consecutive patients (n=641; mean age, 69.3±9.5 years; men, 77.2%) with EGC who underwent ESD at a single tertiary referral hospital were retrospectively analyzed to evaluate the incidence and factors associated with local recurrence. Local recurrence was defined as the development of neoplastic lesions at or adjacent to the site of the post-ESD scar.Results: En bloc and complete resection rates were 97.8% and 93.6%, respectively. The local recurrence rate after ESD was 3.1%. The mean follow-up period after ESD was 50.7±32.5 months. One case of gastric cancer-related death (0.15%) was noted, wherein the patient had refused additive surgical resection after ESD for EGC with lymphatic and deep submucosal invasion. Lesion size ≥15 mm, incomplete histologic resection, undifferentiated adenocarcinoma, scar, and absence of erythema of the surface were associated with a higher risk of local recurrence. Conclusions: Predicting local recurrence during regular endoscopic surveillance after ESD is important, especially in patients with a larger lesion size (≥15 mm), incomplete histologic resection, surface changes of scars, and no erythema of the surface.

Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms extending to the cervical esophagus

Endoscopy ◽  
2017 ◽  
Vol 50 (06) ◽  
pp. 613-617 ◽  
Author(s):  
Ryusuke Ariyoshi ◽  
Takashi Toyonaga ◽  
Shinwa Tanaka ◽  
Hirofumi Abe ◽  
Yoshiko Ohara ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Esophageal Neoplasms ◽  
Balloon Dilation ◽  
Case Series ◽  
Cervical Esophagus ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Mucosal Defect ◽  
Case Series Study

Abstract Background The feasibility and safety of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms extending to the cervical esophagus currently remain unknown because of the limited number of cases. We aimed to clarify the clinical outcomes of these cases. Methods This was a case series study conducted at a single institution that enrolled 26 consecutive patients with superficial esophageal neoplasms extending to the cervical esophagus who underwent ESD between July 2003 and December 2015. Results En bloc and complete resection rates were both 100 % and no major intraprocedural complications occurred. Thirteen patients were treated with prophylactic steroid therapy. The incidence of postoperative stricture in patients with a circumferential mucosal defect of more than three-quarters was 72.7 %. Four patients required entire circumferential resection, with perforation occurring after endoscopic balloon dilation (EBD) in two and EBD being required for more than 1 year in the other two. Conclusions ESD including the cervical esophagus is technically feasible. Circumferential resection may cause refractory postoperative stricture or post-EBD perforation, so needs to be avoided where possible.

Sign in / Sign up

Export Citation Format

Share Document