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.

scholarly journals Endoscopic submucosal dissection for rectal neoplastic lesions: experience from a European center.

2021 ◽  
Author(s):  
Michał Spychalski ◽  
Marcin Włodarczyk ◽  
Jakub Włodarczyk ◽  
Igor Dąbrowski ◽  
Piotr Bednarski ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
R0 Resection ◽  
Safe Procedure ◽  
Rectal Tumors ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Case Series Study

IntroductionNowadays, various endoscopic resections including polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) are well known first-line approaches for early neoplastic rectal tumors.Material and methodsIn this case series study, we analyzed 320 ESD procedures performed in a high-volume colorectal center in Poland, Europe. The aim of this study was to retrospectively evaluate ESD procedure in cases of rectal carcinoma performed by a single trained operator in a referral center provided with endoscopy.ResultsOverall, en bloc resection was observed in 92.5% of patients (296/320). The en bloc resection rate was at a similar level in those lesions with involved anal sphincters versus tumors without involvement (93.85% vs. 92.16%; p=0.644). R0 resection was noted in 89.4% of patients (286/320). The overall curative ESD rate was 85.94% (n=275). The curative ESD rate in the invasive cancer group reached 52.6% (n=20). We observed ESD-related adverse events, such as bleeding and perforation, in 3.4 % of patients (n=11).ConclusionsWe have demonstrated that ESD in rectal tumors is an efficient and safe procedure with a high curative rate, even in difficult lesions. Anal sphincter localization and recurrent character of the lesion have no impact on the final outcomes. The ESD approach should have been considered for all rectal tumors, especially those lesions suspected of superficial mucosal invasion, as it can serve as a staging method and may have been curative for adenomas and cancers limited to mucosa.

scholarly journals Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series

2019 ◽  
Vol 07 (05) ◽  
pp. E664-E671 ◽  
Author(s):  
Victoria Jimenez-Garcia ◽  
Masayoshi Yamada ◽  
Hiroaki Ikematsu ◽  
Hiroyuki Takamaru ◽  
Seiichiro Abe ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Case Series ◽  
Clinicopathological Characteristics ◽  
R0 Resection ◽  
Incomplete Resection ◽  
Colorectal Tumors ◽  
Resection Rate ◽  
Retrospective Case ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background and study aims Surgery is the standard treatment for colon tumors associated with diverticulum. Use of endoscopic submucosal dissection (ESD) to treat such tumors is controversial. The aim of this study was to assess the safety and feasibility of ESD in treating superficial colorectal tumors situated near or involving diverticulum. Patients and methods Consecutive patients from two referral centers who had colorectal tumors near or involving diverticulum treated by ESD were retrospectively studied. Clinicopathological characteristics and clinical outcomes were analyzed. Results Of the 12 patients studied, six had tumors near diverticulum and six had tumors involving diverticulum. The overall en-bloc R0 resection rate, median tumor size and procedure time were 67 %, 26.5 mm (range, 15 – 80 mm) and 110 minutes (range, 50 – 220 minutes), respectively. For tumors near diverticulum group, the en-bloc R0 resection rate was 100 % and no adverse events (AEs) or residual/recurrent tumors were observed. In contrast, for intradiverticular tumors group, the en-bloc R0 resection rate was low at 33 %, and one AE (perforation) was observed. The diverticula were ≥ 6 mm in diameter in the patients with incomplete resection. However, all but one diverticulum was unrecognized before ESD. Two residual tumors were detected at the 12-month surveillance and one required surgery. Conclusions This case series indicates that ESD is safe and feasible for treating colorectal tumors near a diverticulum and might be feasible for tumors involving a diverticulum smaller than 6 mm. Selection for smaller diverticulum size may contribute to higher en-bloc R0 resection rates.

Short-term outcomes following endoscopic submucosal dissection of large protruding colorectal neoplasms

Endoscopy ◽  
2017 ◽  
Vol 50 (06) ◽  
pp. 606-612 ◽  
Author(s):  
Taku Sakamoto ◽  
Yutaka Saito ◽  
Fumihiko Nakamura ◽  
Seiichiro Abe ◽  
Hiroyuki Takamaru ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
Clinical Outcomes ◽  
Technical Difficulty ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Procedure Time ◽  
Short Term ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background Although submucosal dissection is useful for treating laterally spreading colorectal tumors, there is little information regarding the endoscopic treatment of large protruding colorectal neoplasms. Here, we aimed to evaluate the clinical outcomes of endoscopic submucosal dissection for protruding colorectal neoplasms ≥ 20 mm in diameter. Methods In total, 112 consecutive patients undergoing treatment between January 2005 and June 2017 were enrolled retrospectively. The study period was divided into six periods to evaluate any changes in outcomes over time. We reviewed all short-term clinical outcomes, including lesion characteristics, procedure time, and percentages of en bloc resection, curative resection, adverse events, and treatment discontinuation. Results The percentages of en bloc, en bloc R0, and en bloc curative resections were 88 %, 82 %, and 59 %, respectively. Perforation occurred in 11 patients (10 %), and the endoscopic procedure was discontinued in five patients (4 %) because of technical difficulty. For lesions ≥ 40 mm in diameter, the procedure time showed a statistically significant decreasing trend in the latter half of the study period. However, the rate of cure did not improve along with enhancements to the procedure’s technological aspects. Conclusions Although endoscopic submucosal dissection for large protruding lesions has advanced in terms of its technical aspects, its ability to cure large protruding neoplasms has not shown gratifying results.

Tu1204 Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Neoplasms in Cervical Esophagus

2016 ◽  
Vol 83 (5) ◽  
pp. AB574
Author(s):  
Ryusuke Ariyoshi ◽  
Takashi Toyonaga ◽  
Yoshiko Ohara ◽  
Tetsuya Yoshizaki ◽  
Fumiaki Kawara ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Cervical Esophagus ◽  
Submucosal Dissection

scholarly journals Multi-loop traction device facilitates gastric endoscopic submucosal dissection: ex vivo pilot study and an inaugural clinical experience

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Hiroaki Matsui ◽  
Naoto Tamai ◽  
Toshiki Futakuchi ◽  
Shunsuke Kamba ◽  
Akira Dobashi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Ex Vivo ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Traction Device

Abstract Background Endoscopic submucosal dissection (ESD) is technically difficult and requires considerable training. The authors have developed a multi-loop traction device (MLTD), a new traction device that offers easy attachment and detachment. We aimed to evaluate the utility of MLTD in ESD. Methods This ex vivo pilot study was a prospective, block-randomized, comparative study of a porcine stomach model. Twenty-four lesions were assigned to a group that undertook ESD using the MLTD (M-ESD group) and a group that undertook conventional ESD (C-ESD group) to compare the speed of submucosal dissection. In addition, the data of consecutive 10 patients with eleven gastric lesions was collected using electronic medical records to clarify the inaugural clinical outcomes of gastric ESD using MLTD. Results The median (interquartile range) speed of submucosal dissection in the M-ESD and C-ESD groups were 141.5 (60.9–177.6) mm2/min and 35.5 (20.8–52.3) mm2/min, respectively; submucosal dissection was significantly faster in the M-ESD group (p < 0.05). The rate of en bloc resection and R0 resection was 100% in both groups, and there were no perforation in either group. The MLTD attachment time was 2.5 ± 0.9 min and the MLTD extraction time was 1.0 ± 1.1 min. Clinical outcomes of MLTD in gastric ESD were almost the same as those of ex vivo pilot study. Conclusions MLTD increased the speed of submucosal dissection in ESD and was similarly effective when used by expert and trainee endoscopists without perforation. MLTD can potentially ensure a safer and faster ESD.

scholarly journals Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Fan ◽  
Qi Sun ◽  
Shouli Cao ◽  
Xiangshan Fan ◽  
Qin Huang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Resection Rate ◽  
En Bloc ◽  
Cardiac Cancer ◽  
Submucosal Dissection ◽  
Metastasis Rate ◽  
Distant Metastasis Rate

Abstract Background Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P = 0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P < 0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P < 0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P = 0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P = 0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

scholarly journals Endoscopic Doppler probe ultrasonography for detecting blood flow at post-endoscopic submucosal dissection ulcers of the stomach

2020 ◽  
Vol 08 (08) ◽  
pp. E1086-E1090
Author(s):  
Yasutoshi Shiratori ◽  
Takashi Ikeya ◽  
Noriaki Oguri ◽  
Ayaka Takasu ◽  
Takeshi Okamoto ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Pulse Wave ◽  
Case Series ◽  
The Novel ◽  
Submucosal Dissection ◽  
Doppler Probe ◽  
Case Series Study ◽  
Rebleeding Rate ◽  
Surgery Department ◽  
Preventive Methods

Abstract Background and study aims The rate of early rebleeding after endoscopic submucosal dissection (ESD) for early gastric cancer ranges from 5 % to 38 %, despite application of preventive methods. Post-ESD rebleeding may be caused by “invisible” vessels that may not be detectable using ultrasonographic techniques. Recently, Doppler probe ultrasonography (DOP) has been used in endoscopy. Because little is known about the usefulness of DOP for decreasing the post-ESD rebleeding rate, we performed a preliminary case series study. Patients and methods Twelve patients underwent DOP for post-ESD ulcer evaluation after visible vessel coagulation. In this study, the novel DOP system used in the vascular surgery department was used. DOP-positive invisible vessels were shown as a pulse wave on the monitor. Results No (0 %) cases of post-ESD rebleeding occurred. Twenty invisible vessels were detected, and 13 were subjected to additional coagulation up to a depth of 3 mm. Mean DOP procedure time was 11.6 minutes (range: 8–18 minutes). In these latter cases, disappearance of the Doppler pulse wave was confirmed. No early rebleeding or other adverse events were experienced. Conclusion DOP is a safe and feasible method for detecting invisible vessels in post-ESD ulcers. Further investigation of the clinical relevance is warranted.

Tu1229 Clinical Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasms of Patients With Head and Neck Cancer

2017 ◽  
Vol 85 (5) ◽  
pp. AB593-AB594
Author(s):  
Joel F. Oliveira ◽  
Ernesto Q. Mendonca ◽  
Bruno da Costa Martins ◽  
Fabio S. Kawaguti ◽  
Marcelo S. de Lima ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Head And Neck ◽  
Clinical Outcomes ◽  
Neck Cancer ◽  
Esophageal Neoplasms ◽  
Submucosal Dissection

scholarly journals Esophageal Endoscopic Submucosal Dissection Assisted by an Overtube with a Traction Forceps: An Animal Study

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Ken Ohata ◽  
Kuangi Fu ◽  
Eiji Sakai ◽  
Kouichi Nonaka ◽  
Tomoaki Tashima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Animal Study ◽  
Ex Vivo ◽  
Target Lesion ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Muscular Injury ◽  
Mucosal Incision ◽  
Novel Method

Esophageal endoscopic submucosal dissection (ESD) is technically difficult. To make it safer, we developed a novel method using overtube with a traction forceps (OTF) for countertraction during submucosal dissection. We conducted anex vivoanimal study and compared the clinical outcomes between OTF-ESD and conventional method (C-ESD). A total of 32 esophageal ESD procedures were performed by four beginner and expert endoscopists. After circumferential mucosal incision for the target lesion, structured as the isolated pig esophagus 3 cm long, either C-ESD or OTF-ESD was randomly selected for submucosal dissection. All the ESD procedures were completed as en bloc resections, while perforation only occurred in a beginner’s C-ESD procedure. The dissection time for OTF-ESD was significantly shorter than that for C-ESD for both the beginner and expert endoscopists (22.8±8.3 min versus7.8±4.5 min,P<0.001, and11.3±4.4 min versus5.9±2.5 min,P=0.01, resp.). The frequency and volume of the submucosal injections were significantly smaller for OTF-ESD than for C-ESD (1.3±0.6times versus2.9±1.5times,P<0.001, and5.3±2.8 mL versus15.6±7.3 mL,P<0.001, resp.). Histologically, muscular injury was more common among the C-ESD procedures (80% versus 13%,P=0.009). Our results indicated that the OTF-ESD technique is useful for the safe and easy completion of esophageal ESD.

Pulley Traction-Assisted Colonic Endoscopic Submucosal Dissection: A Retrospective Case Series

2019 ◽  
Vol 37 (6) ◽  
pp. 473-477 ◽  
Author(s):  
Satoki Shichijo ◽  
Yoji Takeuchi ◽  
Kenshi Matsuno ◽  
Noriya Uedo ◽  
Mitsuhiro Kono ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Case Series ◽  
Technical Difficulty ◽  
En Bloc Resection ◽  
Colorectal Polyps ◽  
Submucosal Layer ◽  
Retrospective Case ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Good Visibility

Background and Study Aims: We have reported the usefulness of traction-assisted colorectal endoscopic submucosal dissection (TAC-ESD) to overcome the technical difficulty of colorectal ESD. However, the direction of traction is toward the anal side only. We retrospectively evaluate the safety and efficacy of “pulley” TAC-ESD. Patients and Methods: We retrospectively analyzed patients diagnosed with colorectal polyps and treated by “pulley” TAC-ESD at Osaka International Cancer Institute from December 2017 to June 2018. Results: During the study period, 79 patients with 81 lesions were treated by ESD, and 54 of these patients were treated by traction-assisted ESD. Among them, 7 underwent “pulley” traction-assisted ESD (6 men, 1 woman; age, 48–69 years), resulting in en bloc resection with no complications. This afforded good visibility of the submucosal layer in 6 patients, but it was not effective in the remaining patient with the muscle-retracting sign. Conclusion: The “pulley” method affords good visibility of the submucosal layer by changing the traction direction in cases that are difficult to manage by conventional traction-assisted ESD.

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