scholarly journals P656 Clinical implications of endoscopic submucosal dissection in management of patients with ulcerative colitis-associated dysplasia

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S540-S541
Author(s):  
T Sakurai ◽  
R Nezu ◽  
A Okada ◽  
Y Komeda ◽  
T Nagai ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Endoscopic Submucosal Dissection ◽  
Tp53 Mutation ◽  
Magnifying Endoscopy ◽  
Clinical Implications ◽  
Low Grade ◽  
Submucosal Dissection ◽  
Metachronous Colorectal Cancer ◽  
Gene Mutation Analysis

Abstract Background Colectomy has been recommended for patients presenting ulcerative colitis (UC)-associated dysplasia because of the risk of metachronous recurrence. However, it has been recently proposed that endoscopic submucosal dissection (ESD) of dysplasia, combined with subsequent surveillance, may contribute to avoiding colectomy. This study assessed clinical implications of ESD in UC-associated dysplasia. Methods We investigated 30 lesions (27 patients) of UC-associated dysplasia/cancer treated with ESD and surgery (15 ESD and 16 surgery) including a patient who underwent surgery following ESD. Among them, paraffin-embedded tissues of 15 lesions (6 cancers, 7 high-grade dysplasia: HGDs, 2 low-grade dysplasia: LGDs) and 11 surrounding mucosae were available and gene mutation analysis was performed. Indications for ESD were determined according to the criteria applied for sporadic colorectal neoplasms that are based on magnifying endoscopy. Results The median follow-up duration was 40 months. Three out of 27 patients (11%) developed metastasis. Although no serious complications, local recurrence, or metastasis occurred in 13 patients undergoing ESD, one out of them (7.7%) had metachronous colorectal cancer 3 years after ESD in the rectum, where TP53 mutation and diffuse p53 staining was found at non-dysplastic mucosae. Based on magnifying endoscopy, we underestimated the invasion depth in two cases: in a case of deeply submucosal invasive mucinous cancer, endoscopic ultrasonography exhibited thickening of the submucosal layer exclusively at the lesion. Conclusion The proposed indication for ESD in UC-associated dysplasia is that a lesion is well-demarcated and surrounding mucosa is not actively inflamed and does not exhibit diffuse p53 staining. ESD would contribute to advances in the management of UC-associated dysplasia.

scholarly journals First experience of one and two-step endoscopic submucosal dissection of colorectal neoplasms

2020 ◽  
Vol 101 (3) ◽  
pp. 446-451
Author(s):  
I M Sayfutdinov ◽  
L E Slavin ◽  
R N Khayrullin ◽  
M S Mukharyamov ◽  
R T Zimagulov ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
Intraoperative Complications ◽  
Intraepithelial Neoplasia ◽  
Intestinal Wall ◽  
Colorectal Polyps ◽  
Low Grade ◽  
En Bloc ◽  
Submucosal Dissection

Aim. To analyze the results of one and two-step endoscopic submucosal dissection in the treatment of colorectal neoplasms. Methods. Between 2018 and 2019, 17 patients (6 men and 11 women) aged 33 to 79 years underwent 21 endoscopic submucosal dissections of colorectal neoplasms ranging in size from 1.0 to 6.0 cm. Submucosal fibrosis was identified in 2 (11.8%) patients, epithelial neoplasms in 15 (88.2%) patients including laterally spreading tumors in 9 (60%), and large sessile colorectal polyps in 6 (40%) patients. Histological examination revealed a carcinoid tumor (11.8%), adenoma with low-grade (64.7%) and high-grade (23.5%) intraepithelial neoplasia. 13 patients were subjected to the one-step operation, and 4 patients required the two-step operation with a 1-day interval. Follow-up examinations after the operation were performed, on average, between 2 and 6 months. Results. En bloc endoscopic submucosal dissection was performed in 11 (64.7%) patients, 4 of them in combination with mucosal resection. Endoscopic piecemeal resection of the neoplasia was performed in 6 (35.3%) patients. The average operative time was 15573 minutes (range 40320 min). Intraoperative complications, which were eliminated endoscopically, occurred during 8 (38.1%) of 21 operations: intensive bleeding in 6 (75%) patients, diastasis of muscle fibers in 1 (12.5%) patient, perforation of the intestinal wall in 1 (12.5%) patient. At the follow-up at 6 months, all patients formed the scar at the surgical area, while 3 patients required endoscopic removal of residual adenoma 2 months after the operation. Conclusion. Endoscopic submucosal dissection is an effective method for removing colorectal neoplasms, while two-step dissection is a promising approach to the development of the technique.Keywords: one and two-step dissection, endoscopic submucosal dissection (ESD), colorectal neoplasms.

Incidence of metachronous gastric neoplasia after endoscopic submucosal dissection for gastric dysplasia.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 20-20
Author(s):  
Jae Gyu Kim ◽  
Jae Yong Park ◽  
Young-Il Kim
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
University Hospital ◽  
Secondary Outcome ◽  
Low Grade ◽  
Gastric Cancers ◽  
Submucosal Dissection ◽  
Gastric Dysplasia ◽  
Gastric Neoplasia ◽  
One Year

20 Background: Endoscopic submucosal dissection (ESD) has been usually performed to treat gastric high-grade dysplasia (HGD) and selected lesions of low-grade dysplasia (LGD). However, HGD was classified into the same category of non-invasive carcinoma which were different from LGD in the Vienna classification of gastrointestinal epithelial neoplasia. We investigated whether the incidence of metachonous gastric neoplasia after ESD for gastric dysplasia is different between patients with LGD and HGD. Methods: Between March 2011 and December 2016, 508 patients underwent ESD for 545 gastric dysplasias or cancers at the Chung-Ang University Hospital. Of them, 198 patients with LGD (LGD group) and 46 with HGD (HGD group) who had been followed up for at least one year were included. The primary outcome was the incidence of gastric neoplasia occurred at 1-year follow-up or later after ESD. The secondary outcome was the composite incidence of metachronous HGD and gastric cancers. Results: During a median follow-up of 2.5 years, overall cumulative incidence of metachronous gastric neoplasm was 33.2 cases/1000 person-years. The metachronous neoplasms developed in 17 patients (8.6%; 11 LGD, 2 HGD and 4 gastric cancers) in the LGD group and in 6 patients (13.0%; 3 LGD, 1 HGD and 3 gastric cancers) in the HGD group. The incidence of metachronous gastric neoplasia in LGD group was not significantly different from that in HGD group (hazard ratio [HR] in the LGD group, 0.56; 95% confidence interval [CI], 0.22-1.43; P = 0.229). The composite incidences of metachronous HGD and gastric cancers were not also different between the two groups (HR for the composite incidences in the LGD group, 0.42; 95% CI, 0.10-1.68; P = 0.218). Conclusions: After ESD for gastric LGD, the incidence of metachronous gastric neoplasia was not different from that after ESD for HGD. Thus, similar surveillance strategies are needed for patients who underwent ESD for LGD and HGD.

scholarly journals Polypoid nodule scar after gastric endoscopic submucosal dissection: results from a multicenter study

2018 ◽  
Vol 06 (10) ◽  
pp. E1198-E1203
Author(s):  
Vitor Arantes ◽  
Noriya Uedo ◽  
Yoshinori Morita ◽  
Takashi Toyonaga ◽  
Yoshiko Nakano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Multicenter Study ◽  
Case Series ◽  
R0 Resection ◽  
Clinical Implications ◽  
Distal Stomach ◽  
Submucosal Dissection ◽  
Neoplastic Lesions ◽  
Tissue Histology

Abstract Background and study aims A post-endoscopic submucosal dissection (ESD) scar is expected to look homogeneous, however, some patients develop benign polypoid nodule scar (PNS). Incidence of PNS is unknown, yet these scars have direct clinical implications because they may render evaluation of post-ESD neoplastic recurrence difficult. Therefore, we reviewed the clinical experience of 5 ESD referral centers and evaluated their PNS incidence and clinical management. Patients and methods This was a retrospective multicenter case series enrolling patients that underwent R0, curative gastric ESD from 2003 to 2015 in 5 academic centers. PNS was defined as ESD site nodularity with hyperplastic or regenerative tissue histology. Results A total of 2275 patients underwent gastric ESD with endoscopy control and 28 patients (18 men/10 women) developed PNS for overall incidence of 1.2 %. Incidence of PNS ranged from 0.15 % to 11.4 % between centers. All patients that developed PNS had primary neoplastic lesions located in the distal stomach. Considering only lesions situated in the antrum (n = 912), incidence of PNS was 3.1 %. After mean follow-up of 43 months (range 6 – 192), no malignant recurrence in the PNS has been identified. In five patients (17.8 %) PNS disappeared after a mean of 18 months. Conclusion PNS occurs exclusively after ESD in the distal stomach in approximately 3.1 % of patients. Although PNS appearance can be concerning, no malignant recurrence was observed after curative R0 resection. Therefore, PNS should be viewed as a benign alteration that does not require any type of intervention, other than endoscopic surveillance.

OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) DURING LIVE ENDOSCOPY EVENTS – A 12- YEAR FOLLOW-UP

2019 ◽  
Author(s):  
A Ebigbo ◽  
S Freund ◽  
A Probst ◽  
C Römmele ◽  
S Gölder ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection

scholarly journals Su1688 COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR PATIENTS WITH ULCERATIVE COLITIS

2018 ◽  
Vol 87 (6) ◽  
pp. AB369-AB370
Author(s):  
Ryosuke Kobayashi ◽  
Kingo Hirasawa ◽  
Chiko Sato ◽  
Masafumi Nishio ◽  
Tsuyoshi Ogashiwa ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection

PS02.035: CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION OF A LARGE SUPERFICIAL OESOPHAGUS SQUAMOUS CELL CANCER WITHOUT STRICTURES ON FOLLOW-UP

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 129-130
Author(s):  
Francisco Baldaque-Silva ◽  
Magnus Konradsson ◽  
Naning Wang ◽  
Masami Omae
Keyword(s):  
Hyaluronic Acid ◽  
Endoscopic Submucosal Dissection ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
High Volume ◽  
Stricture Formation ◽  
Submucosal Dissection ◽  
Oral Steroids

Abstract Description The optimal treatment for oesophageal superficial squamous cell cancer (SCC) is end bloc resection, that in large lesions is only possible with endoscopic submucosal dissection (ESD). Resections larger than 3cm, in the upper esophagus and encompassing more than 3/4 of the luminal circumference, are associated with high stricture rate. That risk is virtually 100% in cases of circumferential ESD. High focus had been given to preventive measurements such as steroids injection, oral steroids or cell sheet transplantation. Usually highly osmotic substances such as Glicerol ® are used for subepitelial lifting. Hyaluronic acid has high viscosity and anti-inflammatory proprieties, that due to its high cost is not widely used in ESD or is used in low concentration formulas and low volume. We report a case of a 7.5 cm long circumferential oesophageal ESD performed with injection of a high volume and concentration of hyaluronic acid that was not associated with stricture in the follow-up. A 73 years-old male patient was referred to our clinic due to the presence of a long superficial lesion and biopsies positive for SCC. We performed chromoendoscopy with lugol that revealed the presence of a ca 6cm long Paris IIa-b, circumferential SCC in the middle esophagus with ‘Tatami-no-me ‘and ‘pink-color’ signs, without ulcers or other endoscopic signs of deep invasion. The PET-CT was negative for metastasis. After multidisciplinary conference and patient's consent an ESD was performed under full narcosis using Dualknife ® and hyaluronic acid for subepitelial injection. A 7.5 cm circumferential ESD specimen was resected and the patient was discharged at day 3 without complications under proton pump Inhibitors and a step-down dose of 30mg/d of oral prednisolone. The pathological result revealed R0 resection of a SCC with invasion of the superficial muscularis mucosae (T1a) and no lymphovascular engagement. The follow-up at 2, 5, 8 weeks and 6, 9 and 12 months revealed the absence of stricture. There was no cancer recurrence in the last follow-up (1 year). Long circumferential ESD of oesophageal SCC is possible with curative intent. The combination of PPI, oral steroids and high volume/concentration of hyaluronic acid, avoided stricture formation in this case. Disclosure All authors have declared no conflicts of interest.

Histopathologic Change of a Case of Gastric Oxyntic Neoplasm (Gastric Adenocarcinoma of Fundic Gland Mucosa Type) Through 5 Years With Concurrent Other Oxyntic Gland Lesions

2020 ◽  
pp. 106689692096257
Author(s):  
Yoko Sato ◽  
Taiki Sato ◽  
Jun Matsushima ◽  
Akiko Fujii ◽  
Yuko Ono ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Gastric Adenocarcinoma ◽  
Chief Cell ◽  
Fundic Gland ◽  
Submucosal Dissection ◽  
Epithelial Neoplasms ◽  
Oxyntic Gland ◽  
Gland Type ◽  
Histological Progression

Some gastric epithelial neoplasms show predominant chief cell differentiation (oxyntic gland neoplasms), in which the entity of “gastric adenocarcinoma of fundic gland type” was firstly designated, whereas a possible more aggressive subgroup “gastric adenocarcinoma of fundic gland mucosa type” (GA-FGM) was subsequently proposed. However, the histopathologic progression mode of these neoplasms has not been sufficiently reported. In this article, we describe a case of GA-FGM in which we could observe its progression during 5 years. The tumor was removed by endoscopic submucosal dissection 5 years after the first biopsy, which had already shown a feature of oxyntic gland neoplasm. During the follow-up period, the endoscopy revealed little change in the tumor appearance. However, the histology of endoscopic submucosal dissection showed submucosal extension with its histological progression. Besides, other oxyntic gland neoplasms of the stomach were observed metachronously or synchronously, giving an implication about a common pathogenetic basis of these lesions.

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