Quantitative analysis of submucosal excision depth in endoscopic resection for early Barrett’s cancer

Endoscopy ◽  
2021 ◽  
Author(s):  
Jenny Krause ◽  
Thomas Rösch ◽  
Stefan Steurer ◽  
Till Clauditz ◽  
Susanne Sehner ◽  
...  

Background Following endoscopic resection of early-stage Barrett’s esophageal adenocarcinoma (BEA), further oncologic management then fundamentally relies upon the accurate assessment of histopathologic risk criteria, which requires there to be sufficient amounts of submucosal tissue in the resection specimens. Methods In 1685 digitized tissue sections from endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) performed for 76 early BEA cases from three experienced centers, the submucosal thickness was determined, using software developed in-house. Neoplastic lesions were manually annotated. Results No submucosa was seen in about a third of the entire resection area (mean 33.8 % [SD 17.2 %]), as well as underneath cancers (33.3 % [28.3 %]), with similar results for both resection methods and with respect to submucosal thickness. ESD results showed a greater variability between centers than EMR. In T1b cancers, a higher rate of submucosal defects tended to correlate with R1 resections. Conclusion The absence of submucosa underneath about one third of the tissue of endoscopically resected BEAs should be improved. Results were more center-dependent for ESD than for EMR. Submucosal defects can potentially serve as a parameter for standardized reports.

2020 ◽  
Vol 21 (12) ◽  
Author(s):  
Kazuya Akahoshi ◽  
Masaru Kubokawa ◽  
Kazuki Inamura ◽  
Kazuaki Akahoshi ◽  
Yuki Shiratsuchi ◽  
...  

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.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zhi-Yi Zhou ◽  
Jie Sun ◽  
Qing Guo ◽  
Hai-Bin Zhao ◽  
Zhi-Hua Zhou

Abstract Background Certain gastric cancers exhibit some primitive phenotypes, which may indicate a high malignancy. In histologically differentiated early gastric cancer (EGC), the presence and the clinicopathological significance of the primitive phenotype remain unclear. Methods Using immunohistochemical staining we detected the expression of three primitive phenotypic markers SALL4, Glypican-3(GPC3), and AFP in whole tissue sections of differentiated EGC (gastrectomy specimens, n = 302). For those cases with primitive phenotypes, we analyzed their clinicopathological features and evaluated whether the criteria for endoscopic resection were met. Results We found that 9.3% (28/302) of all differentiated EGC cases have primitive phenotypes, and most of these cases (25/28) exhibit a histomorphology similar to conventional differentiated EGC. Patients with primitive phenotypes had a deeper invasion, a higher rate of ulcer and lymphatic invasion than cases without primitive phenotype. Moreover, patients with primitive phenotypes displayed a significantly higher frequency of LNM than those without (57.1% vs 8.8%, P < 0.001). Multivariate analysis revealed that presence of primitive phenotypes was an independent risk factor for LNM (P = 0.001, HR 6.977, 95% CI: 2.199–22.138). Interestingly, we found 2 cases with primitive phenotypes developed LNM, and they both met the expanded indications of endoscopic resection for differentiated EGC. Conclusions A small number of differentiated EGC have primitive phenotypes, which were closely related to LNM and were an independent risk factor for LNM. Given its highly aggressive behavior, differentiated EGC with primitive phenotypes should be evaluated with stricter criteria before endoscopic resection, or considered to give an additional surgical operation after endoscopic resection.


2021 ◽  
Vol 10 (11) ◽  
pp. 2511
Author(s):  
Yoshitsugu Misumi ◽  
Kouichi Nonaka

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.


2016 ◽  
Vol 48 (4) ◽  
pp. 399-403 ◽  
Author(s):  
Giovanna Margagnoni ◽  
Stefano Angeletti ◽  
Giancarlo D’Ambra ◽  
Cristiano Pagnini ◽  
Maurizio Ruggeri ◽  
...  

2014 ◽  
Vol 79 (5) ◽  
pp. AB576-AB577 ◽  
Author(s):  
Yutaka Saito ◽  
Mitsuhiro Fujishiro ◽  
Shinji Tanaka ◽  
Hiroyasu Iishi ◽  
Tomohiko Miyata ◽  
...  

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nicole G. Jawitz ◽  
Vignesh Raman ◽  
Oliver K. Jawitz ◽  
Rahul A. Shimpi ◽  
Richard K. Wood ◽  
...  

Author(s):  
Marco de Sá ◽  
Carlos Duarte ◽  
Luís Carriço ◽  
Tiago Reis

In this chapter we describe a set of techniques and tools that aim at supporting designers while creating mobile multimodal applications. We explain how the additional difficulties that designers face during this process, especially those related to multimodalities, can be tackled. In particular, we present a scenario generation and context definition framework that can be used to drive design and support evaluation within realistic settings, promoting in-situ design and richer results. In conjunction with the scenario framework, we detail a prototyping tool that was developed to support the early stage prototyping and evaluation process of mobile multimodal applications, from the first sketch-based prototypes up to the final quantitative analysis of usage results. As a case study, we describe a mobile application for accessing and reading rich digital books. The application aims at offering users, in particular blind users, means to read and annotate digital books and it was designed to be used on Pocket PCs and Smartphones, including a set of features that enhance both content and usability of traditional books.


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