scholarly journals Extensive perforation of the esophagus caused by a localized muscle layer defect during endoscopic submucosal dissection

2022 ◽  
Author(s):  
Yohei Koyama ◽  
Seiichiro Abe ◽  
Takao Itoi
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Muscle Layer ◽  
Submucosal Dissection ◽  
Layer Defect

A large muscle-layer defect of the stomach caused by endoscopic submucosal dissection is closed by using the endoloop-clips technique

2016 ◽  
Vol 83 (6) ◽  
pp. 1282-1283
Author(s):  
Motohiko Kato ◽  
Toshio Uraoka ◽  
Michiko Wada ◽  
Shigeo Banno ◽  
Satoshi Kinoshita ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Muscle Layer ◽  
Submucosal Dissection ◽  
Layer Defect ◽  
Large Muscle

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.

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.

scholarly journals Clinical effectiveness of the pocket-creation method for colorectal endoscopic submucosal dissection

2017 ◽  
Vol 05 (12) ◽  
pp. E1299-E1305 ◽  
Author(s):  
Akira Kanamori ◽  
Masakazu Nakano ◽  
Masayuki Kondo ◽  
Takanao Tanaka ◽  
Keiichiro Abe ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Conventional Method ◽  
Clinical Effectiveness ◽  
Muscle Layer ◽  
En Bloc Resection ◽  
Control Group ◽  
Colorectal Tumors ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is a technically advanced procedure for colorectal tumors. Hayashi et al. invented the “pocket-creation method (PCM),” and reported that Is-type lesions with fibrosis could be efficaciously and safely resected. However, only case studies have been published, and there are no previous reports on the usefulness of PCM in colorectal ESD for all lesions, as compared with the conventional method. This study aimed to evaluate the effectiveness and safety of PCM in colorectal ESD. Patients and methods Ninety-six colorectal tumors were treated: 47 using the PCM and the other 49, considered the control group, using the conventional method. Therapeutic effectiveness and safety were retrospectively assessed. Results The comparison between the PCM and control groups revealed higher rates of en bloc resection (100 % vs. 88 %, P = 0.015) and curative endoscopic resection (100 % vs. 84 %, P = 0.0030) with PCM. There was no significant difference in perforation as an adverse event (AE) between the two groups, though perforation was observed in only 6 % of the control group and none of the PCM group. Compared with the control group, the PCM group had lower incidences of perforation and post-ESD coagulation syndrome, and both AEs were associated with excessive thermal denaturation of the muscle layer (2 % vs. 16 %, P = 0.018). Conclusions This study demonstrated the effectiveness and safety of ESD with PCM for colorectal tumors. Although there is a possible learning curve, PCM enables the endoscopist to safely perform ESD in most cases without encountering the difficulties associated with conventional ESD.

scholarly journals Two Cases of Rectal Neuroendocrine Tumor Resection Combined with Dissection of the Circular Muscle Layer Using the Endoscopic Submucosal Dissection Technique

2016 ◽  
Vol 10 (3) ◽  
pp. 693-700 ◽  
Author(s):  
Kumpei Honjo ◽  
Kazumasa Kure ◽  
Ryosuke Ichikawa ◽  
Hisashi Ro ◽  
Rina Takahashi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Therapy ◽  
Tumor Resection ◽  
Circular Muscle ◽  
Muscle Layer ◽  
En Bloc ◽  
Lower Rectum ◽  
Longitudinal Muscle Layer ◽  
Circular Muscle Layer ◽  
Submucosal Dissection

Generally, lesions of rectal neuroendocrine tumors (NETs) 10 mm or smaller are less malignant and are indicated for endoscopic therapy. However, the vertical margin may remain positive after conventional endoscopic mucosal resection (EMR) because NETs develop in a way similar to submucosal tumors (SMTs). The usefulness of EMR with a ligation device, which is modified EMR, and endoscopic submucosal dissection (ESD) was reported, but no standard treatment has been established. We encountered 2 patients in whom rectal NETs were completely resected by combined dissection and resection of the circular muscle layer using the ESD technique. Case 1 was an 8-mm NET of the lower rectum. Case 2 was NET of the lower rectum treated with additional resection for a positive vertical margin after EMR. In both cases, the circular muscle layer was dissected applying the conventional ESD technique, followed by en bloc resection while conserving the longitudinal muscle layer. No problems occurred in the postoperative course in either case. Rectal NETs are observed in the lower rectum in many cases, and it is less likely that intestinal perforation by endoscopic therapy causes peritonitis. The method employed in these cases, namely combined dissection and resection of the circular muscle layer using the ESD technique, can be performed relatively safely, and it is possible to ensure negativity of the vertical margin. In addition, it may also be useful for additional treatment of cases with a positive vertical margin after EMR.

scholarly journals Pay attention to a “window-blind” appearance of the distal rectal muscle layer during endoscopic submucosal dissection

Endoscopy ◽  
2018 ◽  
Vol 50 (03) ◽  
pp. E67-E68
Author(s):  
Yoshikazu Hayashi ◽  
Masahiro Okada ◽  
Hisashi Fukuda ◽  
Yoshimasa Miura ◽  
Keijiro Sunada ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Muscle Layer ◽  
Submucosal Dissection ◽  
Rectal Muscle

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

PS01.041: REMOVAL OF ESOPHAGEAL HEMANGIOMA USING ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT AND REVIEW

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 61-61
Author(s):  
Yukiko Tani ◽  
Masanobu Nakajima ◽  
Hiroto Muroi ◽  
Junki Fujita
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Muscle Layer ◽  
Injection Sclerotherapy ◽  
Endoscopic Sclerotherapy ◽  
Health Examination ◽  
Incomplete Resection ◽  
Muscularis Mucosa ◽  
Submucosal Layer ◽  
Less Invasive ◽  
Submucosal Dissection

Abstract Background Esophageal hemangiomas are rare, representing around 3% of all benign esophageal tumors. Esophagectomy or tumor enucleation has been performed to treat esophageal hemangiomas, but recently the use of endoscopic therapy, such as endoscopic mucosal resection or endoscopic injection sclerotherapy, is increasing. We describe removal of a hemangioma using endoscopic submucosal dissection. Methods A 59-year-old woman underwent endoscopic examination after an esophageal lesion was found during a general health examination. Endoscopy identified a broad-based, elevated, dark purple lesion located 17 cm distal from the incisor teeth. It measured approximately 25 mm and was rounded and soft.Endoscopic ultrasonography using a 20-MHz catheter probe and the water filling method identified a tumor 25 mm in diameter located in the mucosal and submucosal layers. The border was unclear, but the bottom of the tumor was demarcated from the adjacent normal muscle layer. Compared with the adjacent muscle layer, the tumor was hyperechoic. On the basis of these endoscopic findings, the lesion was diagnosed as a hemangioma. Because the tumor was broad-based and relatively large, we thought that polypectomy or EMR should be avoided to prevent incomplete resection and postoperative hemorrhage from the residual stump. We therefore decided that ESD was the best treatment modality for this lesion. Results Approximately 2 mL of the solution was injected into the submucosal layer at intervals, which was repeated until the mucosa became elevated. After lifting the lesion, the mucosa including the tumor was gently cut with the Flush knife using the Endocut mode. The submucosal layer was highly fibrous, so lifting the lesion was somewhat difficult. The histopathological findings showed formation of a vascular lumen with irregular dilatation just below the lamina muscularis mucosa, suggesting a cavernous hemangioma. The patient was discharged 5 days after surgery without complications. Conclusion Until quite recently, large or broad-based esophageal hemangiomas had been treated by esophagectomy or sclerotherapy. Esophagectomy is associated with a high mortality rate [19], and endoscopic sclerotherapy may cause hemorrhage upon puncture, side effects due to the infused agents, and other complications. Endoscopic resection is less invasive than sclerotherapy, and further advances in endoscopic treatment and instruments may reduce the risk of several complications. ESD has being established as a safer, less invasive therapy than esophagectomy, it is perhaps the best therapeutic option for treating large or broad-based submucosal esophageal hemangiomas. Disclosure All authors have declared no conflicts of interest.

scholarly journals Esophageal muscle layer tear during endoscopic submucosal dissection treated by polyglycolic acid sheets and fibrin glue

Endoscopy ◽  
2019 ◽  
Vol 52 (06) ◽  
pp. E211-E212
Author(s):  
Hiroki Yukimoto ◽  
Kyosuke Tanaka ◽  
Yuhei Umeda ◽  
Junya Tsuboi ◽  
Aiji Hattori ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
Muscle Layer ◽  
Polyglycolic Acid ◽  
Submucosal Dissection ◽  
Esophageal Muscle
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