Proper muscle layer damage affects ulcer healing after gastric endoscopic submucosal dissection

2015 ◽  
Vol 27 (7) ◽  
pp. 748-754 ◽  
Author(s):  
Yohei Horikawa ◽  
Nobuya Mimori ◽  
Hiroya Mizutamari ◽  
Yuhei Kato ◽  
Kazuhiro Shimazu ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Ulcer Healing ◽  
Muscle Layer ◽  
Submucosal Dissection

scholarly journals Stricture Prevention after Extensive Endoscopic Submucosal Dissection of Neoplastic Barrett’s Esophagus: Individualized Oral Steroid Prophylaxis

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Andreas Probst ◽  
Alanna Ebigbo ◽  
Bruno Märkl ◽  
Tina Schaller ◽  
Matthias Anthuber ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Barrett’S Esophagus ◽  
Ulcer Healing ◽  
Barrett's Esophagus ◽  
Healing Process ◽  
Oral Prednisolone ◽  
Oral Steroid ◽  
Submucosal Dissection ◽  
The Individual ◽  
Steroid Regimen

Introduction. Endoscopic resection (ER) exceeding ≥75% of the esophageal circumference is accompanied with a high stricture risk regardless of the resection method. The ideal strategy for stricture prevention is not well defined today. Different approaches have been reported but data are limited to the resection of squamous cell neoplasia. The aim of this study was to assess the efficacy of an individualized oral steroid regimen to prevent strictures after extensive ER in neoplastic Barrett’s esophagus (NBE). Materials and Methods. Over a 50-month period, endoscopic submucosal dissection (ESD) was performed in 193 patients with NBE. 23 patients with resections exceeding 75% of the circumference were included. 19 resection ulcers were noncircumferential (NCR) while 4 were circumferential (CR). Stricture prevention was performed using oral prednisolone starting with a daily dose of 50 mg and standard tapering over 8 weeks (50/40/30/25/20/15/10/5 mg). Tapering was individualized according to the ulcer healing process (assessed endoscopically in the first tapering period and before stopping the steroids). Data were analyzed retrospectively. Results. Stricture rates were 5.3% (1/19) for NCR and 100% (4/4) for CR (p<0.001). The only stricture in the NCR group was seen in a patient who had stopped steroids without any reason after few days. 12/19 patients received standard tapering over 8 weeks (63.1%). According to the individual ulcer healing, treatment was prolonged to 9-10 weeks in 4/19 (21.1%) and shortened to 7 weeks in another 2/19 (10.5%). After CR, all patients needed endoscopic balloon dilatation (median 6.5 sessions; range 3-14 sessions for 8-40 weeks). Side effects of the steroid therapy were not noted. Conclusion. Oral prednisolone therapy with an endoscopy-based individualized tapering regimen is effective in avoiding strictures after NCR of Barrett’s neoplasia. After CR, the stricture risk is not sufficiently decreased. CR should be restricted to circumferential neoplasia which is a very rare scenario in neoplastic BE.

Clinical benefit of the multibending endoscope for gastric endoscopic submucosal dissection: a randomized controlled trial

Endoscopy ◽  
2020 ◽  
Author(s):  
Koichi Hamada ◽  
Yoshinori Horikawa ◽  
Yoshiki Shiwa ◽  
Kae Techigawara ◽  
Takayuki Nagahashi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Treatment Guidelines ◽  
Controlled Trial ◽  
Complete Removal ◽  
Muscle Layer ◽  
Gastrointestinal Neoplasms ◽  
Procedure Time ◽  
Operator Experience ◽  
Submucosal Dissection

Abstract Background Endoscopic submucosal dissection (ESD) is a technically difficult and time-consuming procedure. We aimed to investigate the efficacy and safety of ESD using a multibending endoscope to treat superficial gastrointestinal neoplasms. Methods Patients with a single early gastric cancer who met the absolute or expanded indications for ESD according to the Japanese gastric cancer treatment guidelines were enrolled and randomly assigned to undergo ESD using a conventional endoscope (C-ESD) or a multibending endoscope (M-ESD). Randomization was stratified by ESD operator experience and tumor location. The primary outcome was ESD procedure time, calculated as the time from the start of submucosal injection to complete removal of the tumor. Results 60 patients were analyzed (30 C-ESD, 30 M-ESD). The mean (standard deviation [SD]) ESD procedure times for M-ESD and C-ESD were 34.6 (SD 17.2) and 47.2 (SD 26.7) minutes, respectively (P = 0.03). Muscle layer damage occurred significantly less frequently with M-ESD (0.2 [SD 0.7] vs. 0.7 [SD 1.0]; P = 0.04). There were no significant differences between the two techniques in procedure time or damage to muscle layers for tumors located in the lower third of the stomach. Conclusions ESD procedure time was significantly shorter with the multibending endoscope and fewer muscles were damaged. We recommend multibending endoscopy for ESD in the upper and middle thirds of the stomach to reduce procedure time and incidence of complications.

Sa1614 A Randomized Controlled Trial of Rebamipide Plus Rabeprazole for Artificial Ulcer Healing After Endoscopic Submucosal Dissection

2011 ◽  
Vol 73 (4) ◽  
pp. AB224
Author(s):  
Shoko Fujiwara ◽  
Yoshinori Morita ◽  
Takashi Toyonaga ◽  
Fumi Kawakami ◽  
Tomoo Itoh ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Endoscopic Submucosal Dissection ◽  
Ulcer Healing ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Submucosal Dissection

The accuracy of endoscopic ultrasonography for identifying stomach neoplasm before endoscopic submucosal dissection.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 22-22
Author(s):  
Pil Hun Song ◽  
Hyun Sung ◽  
Jeonghun Lee ◽  
Won Jae Yoon ◽  
You Sun Kim ◽  
...  
Keyword(s):  
Lymph Node ◽  
Retrospective Study ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Ultrasonography ◽  
Tumor Size ◽  
Stomach Neoplasm ◽  
Muscle Layer ◽  
Lymphatic Invasion ◽  
Submucosal Layer ◽  
Submucosal Dissection

22 Background: The treatment of stomach neoplasm was determined by the identification on of invasion extent and perigastric lymph node through endoscopic ultrasonography (EUS). In this study, we investigated diagnostic accuracy of EUS examination before endoscopic submucosal dissection (ESD). Methods: A retrospective study was conducted to both EUS and ESD for stomach neoplasms that were performed at Seoul Paik Hospital between January 2006 and July 2015. We compared the accuracy of EUS according to the location of lesion, tumor size and ulcer presence or absence on lesion. Results: 49 patients were enrolled in this study; their mean age was 64.14 ± 11.33 years. There were 40 male (81.6%) and 9 female (18.4%) patients. The cases of confined to the mucosa on pathology finding were 41 (83.6%) and involved to submucosal layer(sm) 1 were 3 (6.1%) and sm2 were 2 (4%) and sm3 were 1 (2%) and proper muscle layer were 2 (4%). The cases of lymphatic invasion were 2 (4%). The sensitivity and accuracy of antrum were 91.6 % (95% CI: 0.81-1.03) and 83.3 % (95% CI: 0.70-0.97), body of stomach were 92.3 % (CI: 0.78-1.07) and 83.3% (CI: 0.66-1.00), respectively. Whether lesions were no significant differences in any location. The tumor size was divided by smaller than 20 mm group, 20-30 mm group and more than 30 mm group. The smaller than 20 mm group, 20-30 mm group and more than 30 mm group were 36, 9, 2 patients. The remaining 2 patients were not described. The sensitivity and accuracy of smaller than 20 mm group were 96.6 % (95% CI: 0.90-1.03) and 83.3 % (CI: 0.71-0.95) and 2-30 mm group were 66.7 % (CI: 0.29-1.04) and 77.8 % (CI: 0.51-1.04), respectively. All patients were divided by ulcer presence or not. 27 patients were ulcer presence and 22 patients were not. The sensitivity and accuracy of ulcer presence group were 77.3 % (CI : 0.60-0.95) and 74 % (CI : 0.57-0.90), ulcer absence group were 95 % (CI : 0.85-1.04) and 91 % (CI : 0.79-1.02). Conclusions: The EUS for stomach neoplasm was reliable of lesion without ulcerous finding, smaller than 20 mm in diameter and irrespective of stomach neoplasm location.

Risk Factors for Delayed Ulcer Healing after Endoscopic Submucosal Dissection of Gastric Neoplasms

2017 ◽  
Vol 26 (4) ◽  
pp. 363-368 ◽  
Author(s):  
Akihiro Shimozato ◽  
Makoto Sasaki ◽  
Naotaka Ogasawara ◽  
Yasushi Funaki ◽  
Masahide Ebi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Submucosal Dissection ◽  
Proton Pump ◽  
Ulcer Healing ◽  
Case Series ◽  
Gastric Neoplasms ◽  
Ulcer Size ◽  
Submucosal Dissection ◽  
Delayed Healing ◽  
Independent Risk Factors

Background & Aims: With improved technology, the size of artificial ulcers after endoscopic submucosal dissection (ESD) has increased. The aim of our study was to examine the risk factors for delayed gastric ulcer healing after ESD, including the possible benefit of potassium-competitive acid blocker (P-CAB) treatment.Methods: The primary outcome was the rate of healing of the artificial ulcers induced by ESD at 8 weeks post intervention. Design: retrospective case series. Setting: Aichi Medical University Hospital. Patients: patients who underwent ESD for gastric neoplasm, between April 2015 and March 2017. Intervention: ESD, with a follow-up endoscopic examination at 8 weeks post-ESD. Univariate and multivariate analyses were used to identify the independent risk factors for delayed healing.Results: Of the 73 gastric neoplasms included in the analysis, delayed ulcer healing was identified in 21.9%. Dyslipidemia (p=0.04), ESD procedure time (p=0.003) and artificial ulcer size (p<0.001) were identified as risk factors for delayed healing, with location in the lower third of the stomach [Odds ratio (OR) 6.76; p=0.016] and artificial ulcer size (OR, 1.18; p=0.024) retained as independent risk factors. A cut-off ulcer size of 854 mm2 was predictive of delayed healing, with a sensitivity of 29.8% and specificity of 87.5%. For large ulcers, the rate of healing of 70% with vonoprazan was higher than the rate of 47.6% with proton pump inhibitors (PPIs), although this difference was not significant.Conclusion: For artificial ulcers after ESD with a resection diameter >35 mm, it might be desirable to use PPIs for >8 weeks or P-CAB.Abbreviations: EGC: early gastric cancers; EMR: endoscopic mucosal resection; ESD: endoscopic submucosal dissection; H. pylori: Helicobacter pylori; H2RA: H2-receptor antagonist: PRP: platelet rich plasma; PGA: polyglycolic acid; P-CAB: potassium-competitive acid blocker; PPI: proton pump inhibitor.

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