Single- and double-tunnel endoscopic submucosal tunnel dissection for large superficial esophageal squamous cell neoplasms

Endoscopy ◽  
2017 ◽  
Vol 50 (05) ◽  
pp. 505-510 ◽  
Author(s):  
Wengang Zhang ◽  
Yaqi Zhai ◽  
Ningli Chai ◽  
Enqiang Linghu ◽  
Huikai Li ◽  
...  
Keyword(s):  
Clinical Data ◽  
Squamous Cell ◽  
Operative Time ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Tunnel ◽  
Endoscopic Submucosal Tunnel Dissection ◽  
Squamous Cell Neoplasms

Abstract Background and study aim Single-tunnel endoscopic submucosal tunnel dissection (ESTD) has shown promising preliminary efficacy for large superficial esophageal squamous cell neoplasms (SESCNs). This study reports the outcomes of both single- and double-tunnel ESTD for large SESCNs, and compares the efficiency of the two techniques for treating circumferential SESCNs. Patients and methods 46 patients with large SESCNs underwent ESTD at a single hospital between October 2011 and March 2016. Relevant clinical data were retrospectively collected and analyzed. Results For all patients, the en bloc and R0 resection rates were 95.7 % and 82.6 %, respectively. Perforation and cardiac mucosal laceration were detected in 2.2 % (1/46) and 6.5 % (3/46) of the procedures, respectively. Postoperative stenosis occurred in 12 patients (26.1 %). Of the 18 patients with circumferential lesions, those who received a double-tunnel ESTD procedure (n = 6) underwent dissection faster than those who had a single-tunnel ESTD procedure (n = 12) (0.32 vs. 0.12 cm2/min; P = 0.02). Conclusion ESTD was effective for large SESCNs. The double-tunnel ESTD appeared to decrease operative time compared with single-tunnel ESTD for circumferential lesions.

scholarly journals Endoscopic Submucosal Single- or Multi-tunnel Dissection for Near-Circumferential and Circumferential Superficial Esophageal Neoplastic Lesions

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Lin-Lin Zhu ◽  
Jun-Chao Wu ◽  
Yi-Ping Wang ◽  
Du He ◽  
Wen-Yan Zhang ◽  
...  
Keyword(s):  
Balloon Dilation ◽  
R0 Resection ◽  
Large Sample Size ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Tunnel ◽  
Neoplastic Lesions ◽  
Endoscopic Submucosal Tunnel Dissection ◽  
The Mean

This study reports the outcomes of endoscopic submucosal single-tunnel dissection or endoscopic submucosal multi-tunnel dissection for the treatment of esophageal neoplastic lesions of at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions. From July 2014 to February 2018, a total of 124 lesions underwent endoscopic submucosal tunnel dissection at our hospital. One to four submucosal tunnels were created in the oral to anal direction. Of the 124 lesions, there were 83 noncomplete circumferential lesions and 41 circumferential lesions. Endoscopic submucosal single-tunnel dissection was performed in 54 patients, two-tunnel dissection in 43 patients, three-tunnel dissection in 19 patients, and four-tunnel dissection in 8 patients. The mean dissection speed was 22.8±12.7 mm2/min. En bloc dissection was achieved in all lesions, and the R0 resection rate was 70.2 percent. No matter how large the lesion area was, there were no significant differences in the dissection speed and the R0 resection rate when lesions were at least three-quarters of the esophageal circumference. Esophageal stricture was observed in 54 patients and was relieved by placement of a retrievable metal stent or by endoscopic water balloon dilation. No recurrence was noted after 19.1±12.4 months of follow-up. Our large sample size study showed that endoscopic submucosal tunnel dissection showed effectiveness and safety for the treatment of large superficial esophageal neoplastic lesions at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions.

scholarly journals Does a history of head and neck cancer affect outcome of endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma?

2020 ◽  
Vol 08 (07) ◽  
pp. E900-E910
Author(s):  
Renata Nobre Moura ◽  
Vitor Nunes Arantes ◽  
Tarso Magno Leite Ribeiro ◽  
Roberto Gardone Guimarães ◽  
Joel Fernandez de Oliveira ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Endoscopic Submucosal Dissection ◽  
Squamous Cell ◽  
R0 Resection ◽  
Procedure Time ◽  
Resection Rate ◽  
En Bloc ◽  
History Of

Abstract Background and study aims Esophageal squamous cell carcinoma (ESCC) is the most common secondary tumor in patients with head and neck squamous cell cancer (HNSCC). Currently, endoscopic submucosal dissection (ESD) is the preferred approach to manage superficial ESCC, however, it remains to be elucidated whether patients with HNSCC and early ESCC managed by ESD have different outcomes. Patients and methods We retrospectively analyzed esophageal ESD for early ESCC from September 2009 to September 2017 and the following variables: demographics, tumor and specimen size, Paris classification, location, en bloc and R0 resection rates, overall survival (OS) and adverse events (AEs). To reduce selection bias, propensity score matching was applied to compare the results. Results Eighty-nine ESDs were performed in 81 consecutive patients (47 with HNSCC and 34 without HNSCC). Patients with HNSCC who developed superficial ESCC were found to be younger and to refer a more frequent history of alcohol ingestion and smoking. There was no difference in lesion size, number of lesions, procedure time, en bloc resection rate, R0 resection rate, local recurrence and adverse event rate between the two groups. The histological depth of invasion for patients with HNSCC was significantly shallower before (P = 0.016) and after (P = 0.047) matching. The overall survival rate was similar in both groups. Conclusions Patients with HNSCC have earlier detection of ESCC, probably due to endoscopic screening. Previous history of chemoradiation and surgery for HNSCC does not affect procedure time, AEs and OS.

Clinical availability of endoscopic submucosal dissection for patients with local failure after chemoradiotherapy for esophageal squamous cell carcinoma.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 118-118
Author(s):  
Kyoko Inadomi ◽  
Masayuki Watanabe ◽  
Yohei Nagai ◽  
Koichi Nonaka ◽  
Koichi Sakurai ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Squamous Cell Carcinoma ◽  
Endoscopic Submucosal Dissection ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Local Failure ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Salvage Esophagectomy

118 Background: Local failure after chemoradiotherapy (CRT) remains a major problem for patients with esophageal squamous cell carcinoma (ESCC), and there are few curative treatment options available in such cases except salvage esophagectomy. The aim of this study is to demonstrate the clinical efficacy and safety of endoscopic submucosal dissection as a salvage therapy (salvage ESD) for local failure after CRT. Methods: Between 2007 and 2011, 66 patients underwent ESD for superficial ESCC in our hospital. Five of these patients underwent salvage ESD for local failure after CRT, and were reviewed retrospectively. They were treated with CRT, consisting of 60 Gy irradiation and concurrent chemotherapy. The indications for salvage ESD were as follows: 1) absence of lymph-node or distant metastasis after CRT; 2) superficial and endoscopically resectable lesion after CRT; 3) refusal by patient to undergo salvage esophagectomy; 4) written informed consent. Salvage ESD was performed using a flush knife or hook knife with a hyaluronic acid injection into the submucosal layer. Results: The baseline stage before CRT was as follows: T1b/T2/T3 in 3/1/1, N0/1 in 4/1, and M0/1 in 4/1 patients, respectively. These 5 patients had histologically proven local failure, and the stage after CRT was as follows: T1a/T1b in 1/4, N0/1 in 5/0, and M0/1 in 5/0 patients, respectively. Salvage ESD was performed in all patients who had en bloc resection with no complications and pathologically R0 resection. In 5 patients, 2 had a pT1a lesion, and 3 had a pT1b lesion. 1 lesion recurred in other site 3 months after salvage ESD, which was resected successfully by a second ESD procedure. Conclusions: Salvage ESD is an available option for patients with local failure after CRT for ESCC.

scholarly journals Endoscopic Submucosal Tunnel Dissection as a Novel Therapeutic Technique in Patients With Barrett’s Esophagus

2020 ◽  
Vol 8 ◽  
pp. 232470962094131
Author(s):  
Faisal Inayat ◽  
Simcha Weissman ◽  
Adnan Malik ◽  
Badria Munir ◽  
Shahzad Iqbal
Keyword(s):  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Future Research ◽  
En Bloc ◽  
Therapeutic Technique ◽  
Endoscopic Techniques ◽  
Submucosal Tunnel ◽  
Endoscopic Submucosal Tunnel Dissection

With the ameliorated resectability prowess of endoscopic techniques, a myriad of diseases previously treated by major ablative surgeries are now endoscopically curable. Endoscopic submucosal tunnel dissection (ESTD) is a relatively new technique that has diversified endoscopic application. Although ESTD has frequently been used for the resection of esophageal neoplastic lesions, the clinical evidence pertaining to its efficacy in the treatment of circumferential Barrett’s esophagus remains sparse. In this study, we evaluated ESTD as a potential therapeutic technique in patients with Barrett’s esophagus-related high-grade dysplasia. The tunneling strategy helped achieve complete en bloc resection at an increased dissection speed, without any procedural complications. This article illustrates that ESTD can be a feasible, safe, and effective treatment for dysplastic Barrett’s esophagus. Future research should aim to stratify the potential risks and complications associated with this optimization of endoscopic submucosal dissection in patients with superficial esophageal lesions.

scholarly journals Endoscopic Submucosal Tunnel Dissection for Large Gastric Neoplastic Lesions: A Case-Matched Controlled Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Xiuxue Feng ◽  
Enqiang Linghu ◽  
Ningli Chai ◽  
Zhongsheng Lu ◽  
Xiangdong Wang ◽  
...  
Keyword(s):  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Gastric Body ◽  
Controlled Study ◽  
Resected Specimen ◽  
En Bloc ◽  
Submucosal Tunnel ◽  
Endoscopic Submucosal Tunnel Dissection ◽  
The Mean

Aim. To evaluate the efficacy and safety of endoscopic submucosal tunnel dissection (ESTD) for resection of large superficial gastric lesions (SGLs). Methods. The clinicopathological records of patients performed with ESTD or endoscopic submucosal dissection (ESD) for SGLs between January 2012 and January 2014 were retrospectively reviewed. 7 cases undergoing ESTD were enrolled to form the ESTD group. The cases were individually matched at a 1 : 1 ratio to other patients performed with ESD according to lesion location, ulcer or scar findings, resected specimen area, operation time and operators, and the matched cases constituting the ESD group. The treatment outcomes were compared between the two groups. Results. The mean specimen size was 46 mm. 10 lesions were located in the cardia and 4 lesions in the lesser curvature of the lower gastric body. En bloc resection was achieved for all lesions. The mean ESTD resection time was 69 minutes as against 87.7 minutes for the ESD (P=0.01). The mean resection speed was faster for ESTD than for ESD (18.86 mm2/min versus 13.76 mm2/min, P=0.03). There were no significant differences regarding the safety and curability during the endoscopic follow-up (mean 27 months). Conclusions. ESTD is effective and safe for the removal of SGLs and appears to be an optimal option for patients with large SGLs at suitable sites.

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