scholarly journals Usefulness of Acoustic Monitoring of Respiratory Rate in Patients Undergoing Endoscopic Submucosal Dissection

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Takayoshi Suzuki ◽  
Shingo Tsuda ◽  
Hirohiko Nakae ◽  
Jin Imai ◽  
Kana Sawamoto ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Respiratory Rate ◽  
Continuous Monitoring ◽  
Past History ◽  
Univariate Analysis ◽  
Female Gender ◽  
Blood Oxygen Saturation ◽  
Significant Independent Predictor ◽  
Submucosal Dissection ◽  
The Difference

Aim. The study assessed the usefulness of a recently developed method for respiratory rate (RR) monitoring in patients undergoing endoscopic submucosal dissection (ESD) under deep sedation.Methods. Study subjects comprised 182 consecutive patients with esophageal cancer or gastric cancer undergoing ESD. The usefulness of acoustic RR monitoring was assessed by retrospectively reviewing the patients’ records for age, gender, height, weight, past history, serum creatinine, RR before ESD, and total dose of sedative.Results. Respiratory suppression was present in 37.9% of (69/182) patients. Continuous monitoring of RR led to detection of respiratory suppression in all these patients. RR alone was decreased in 24 patients, whereas both RR and blood oxygen saturation were decreased in 45 patients. Univariate analysis showed female gender, height, weight, and RR before treatment to be significantly associated with respiratory suppression. Multivariate analysis showed RR before treatment to be the only significant independent predictor [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.73–0.95, andP=0.006] of respiratory suppression.Conclusion. In this study, the difference in RR before treatment between patients with and without respiratory suppression was subtle. Therefore, we suggest that acoustic RR monitoring should be considered in patients undergoing ESD under sedation to prevent serious respiratory complications.

scholarly journals Preventive effect of mesenchymal stem cell culture supernatant on luminal stricture after endoscopic submucosal dissection in the rectum of pigs

Endoscopy ◽  
2018 ◽  
Vol 50 (10) ◽  
pp. 1001-1016 ◽  
Author(s):  
Momoko Tsuda ◽  
Shunsuke Ohnishi ◽  
Takeshi Mizushima ◽  
Hidetaka Hosono ◽  
Kenichi Yamahara ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Inflammatory Cell ◽  
Culture Supernatant ◽  
Muscularis Propria ◽  
Distal Colon ◽  
Cell Culture Supernatant ◽  
Control Group ◽  
Mesenchymal Stem Cell Culture ◽  
Submucosal Dissection ◽  
The Difference

Abstract Background Mesenchymal stem cells (MSCs) are valuable in regenerative medicine, and MSC culture supernatant (MSC-CS) reportedly inhibits inflammation and fibrosis. We investigated whether colorectal luminal stricture develops after circumferential endoscopic submucosal dissection (ESD) in the colorectum, and whether the development of luminal stricture could be prevented by using MSC-CS enema. Methods In the first experiment, we performed circumferential ESD in the rectums or distal colons of pigs (n = 4 in each group). We sacrificed the pigs on Day 22 and measured the degree of luminal stricture. In the second experiment, we performed circumferential ESD in the rectums of pigs and administered an MSC-CS gel or a control gel enema after ESD for 4 days. We sacrificed the pigs on Day 8 (n = 3 in each group) or 22 (n = 3 in each group) to measure the degree of luminal stricture, and performed histological analysis. Results Severe luminal stricture was observed in the rectum but not in the distal colon. Moreover, fiber accumulation in the submucosa and hypertrophy of the muscularis propria were observed in the rectum but not in the distal colon. The degree of luminal stricture in the rectum was significantly lower in the MSC-CS group than in the control group. Furthermore, MSC-CS attenuated myofibroblast activation and hypertrophy of the muscularis propria on Day 22, and reduced inflammatory cell infiltration on Day 8. Conclusions Luminal stricture after ESD developed only in the rectum because of the difference in myofibroblast activation and fiber accumulation. In addition, MSC-CS enema prevented luminal stricture after ESD, possibly by inhibiting the inflammatory reaction and fibrosis.

scholarly journals Two electrosurgical endo-knives for endoscopic submucosal dissection of colorectal superficial neoplasms: a prospective randomized study

2017 ◽  
Vol 05 (08) ◽  
pp. E729-E735 ◽  
Author(s):  
Yuusaku Sugihara ◽  
Keita Harada ◽  
Yoshiro Kawahara ◽  
Daisuke Takei ◽  
Shiho Takashima ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Controlled Trial ◽  
Randomized Study ◽  
Procedure Time ◽  
Related Factors ◽  
Submucosal Dissection ◽  
Total Procedure Time ◽  
Mucosal Incision ◽  
The Difference ◽  
Total Procedure

Abstract Background and study aims Few studies have directly compared endo-knives for endoscopic submucosal dissection (ESD) in humans. We compared the performances of the Mucosectom2 and SB knife Jr. Patients and methods Two trainee endoscopists performed ESD of 36 lesions in this prospective, randomized controlled trial. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection using the Mucosectom2 were performed in 1 group. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection with a SB knife Jr. were performed in the other group. The primary outcome was the ESD procedure time. Secondary outcomes were total procedure time, self-completion rates, and adverse events. Results ESD time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (57 ± 32 min vs. 61 ± 44 min, respectively; P = 0.94). Total procedure time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (81 ± 42 min vs. 82 ± 51 min, respectively; P = 0.85). The trainee self-completion rate was slightly higher in SB knife Jr. patients than in Mucosectom2 patients, although the difference was not significant (94 % vs. 100 %, respectively; P = 0.959). Fewer hemostatic procedures using the Coagrasper were performed in Mucosectom2 patients than in SB knife Jr. patients, although the difference was not significant (0.62 vs. 0.7, respectively; P = 0.432). Conclusions Mucosectom2 and SB knife Jr. did not significantly differ in performance for colorectal ESD to safely and reliably enhance ESD. Knife selection is not as important for learning colorectal ESD as patient- and lesion-related factors.

Patient satisfaction after endoscopic submucosal dissection under propofol-based sedation: a small premedication makes all the difference

2016 ◽  
Vol 31 (6) ◽  
pp. 2636-2644 ◽  
Author(s):  
Seokyung Shin ◽  
Chan Hyuk Park ◽  
Hyun Ju Kim ◽  
Sang Hun Park ◽  
Sang Kil Lee ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection ◽  
The Difference

scholarly journals Effect of Nalbuphine Combined With Intravenous Propofol for Anesthesia During Intestinal Endoscopic Submucosal Dissection in the Elderly

2021 ◽  
Author(s):  
Jingjing Liu ◽  
Biwei Zhan ◽  
Yongjun Zeng
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Dose Group ◽  
Total Duration ◽  
The Elderly ◽  
Neurocognitive Function ◽  
High Dose ◽  
Blood Oxygen Saturation ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Medium Dose

Abstract Objective: To investigate the effects of different doses of nalbuphine combined with an intravenous propofol pump for anesthesia during intestinal endoscopic submucosal dissection (ESD) in the elderly.Methods: A total of 85 elderly patients attending the Hanchuan People's Hospital from January 2016 to January 2018 were divided into low, medium, and high dose groups according to the intravenous dosing of nalbuphine given with a continuous propofol pump.The heart rate (HR), mean arterial pressure (MAP), and blood oxygen saturation (SaO2) were evaluated at five different time points (T1-T2).The levels of norepinephrine (NE), cortisol and blood glucose were intervals recorded. The occurrence of adverse reactions, hospitalization days, visual analogue scale (VAS) score, Ramsay sedation, and wake score after waking from anesthesia were assessed. Neurocognitive function was assessed at discharge and after surgery using the Montreal Cognitive Assessment (MoCA). Results: MR, MAP and SaO2 decreased significantly at T0-T4 in tested groups. The levels of NE, Cor, and Glu were significantly increased in three groups at T1-T3 and decreased among the medium-dose group. There was no statistically significant difference between the three groups in the total duration of anesthesia and the operative duration. The medium-dose group was performing significantly better than the low and high dose groups in clinical indicators. The postoperative VAS and Ramsay scores were higher in the low dose group (P＜0.05). There was a significant difference in neurocognitive function scores and no significant differences in postoperative anesthesia satisfaction and hospitalization days were observed amongst the three groups (P>0.05).Conclusions: The use of nalbuphine (0.1 mg/kg) combined with propofol for anesthesia during intestinal ESD in the elderly can shorten recovery times and reduce the incidence of postoperative adverse events and neurocognitive disorders.

scholarly journals Predicting outcomes of gastric endoscopic submucosal dissection using a Bayesian approach: a step for individualized risk assessment

2017 ◽  
Vol 05 (07) ◽  
pp. E563-E572 ◽  
Author(s):  
Diogo Libânio ◽  
Mário Dinis-Ribeiro ◽  
Pedro Pimentel-Nunes ◽  
Cláudia Dias ◽  
Pedro Rodrigues
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Bayesian Model ◽  
Curative Resection ◽  
Cross Validation ◽  
Univariate Analysis ◽  
Clinical Decision ◽  
Lesion Size ◽  
Derivation Cohort ◽  
Submucosal Dissection ◽  
Risk Matrices

Abstract Background and study aims Efficacy and adverse events probabilities influence decisions regarding the best options to manage patients with gastric superficial lesions. We aimed at developing a Bayesian model to individualize the prediction of outcomes after gastric endoscopic submucosal dissection (ESD). Patients and methods Data from 245 gastric ESD were collected, including patient and lesion factors. The two endpoints were curative resection and post-procedural bleeding (PPB). Logistic regression and Bayesian networks were built for each outcome; their predictive value was evaluated in-sample and validated through leave-one-out and cross-validation. Clinical decision support was enhanced by the definition of risk matrices, direct use of Bayesian inference software and by a developed online platform. Results ESD was curative in 85.3 % and PPB occurred in 7.7 % of patients. In univariate analysis, male sex, ASA status, carcinoma histology, polypoid or depressed morphology, and lesion size ≥ 20 mm were associated with non-curative resection, while ASA status, antithrombotics and lesion size ≥ 20 mm were associated with PPB. Naïve Bayesian models presented AUROCs of ~80 % in the derivation cohort and ≥ 74 % in cross-validation for both outcomes. Risk matrices were computed, showing that lesions with cancer at biopsies, ≥ 20 mm, proximal or in the middle third, and polypoid are more prone to non-curative resection. PPB risk was < 5 % in lesions < 20 mm in the absence of antithrombotics. Conclusions The derived Bayesian model presented good discriminative power in the prediction of ESD outcomes and can be used to predict individualized probabilities, improving patient information and supporting clinical and management decisions.

scholarly journals Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study

2018 ◽  
Vol 06 (03) ◽  
pp. E342-E349 ◽  
Author(s):  
Jun Arimoto ◽  
Takuma Higurashi ◽  
Shingo Kato ◽  
Akiko Fuyuki ◽  
Hidenori Ohkubo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Submucosal Dissection ◽  
Early Stage ◽  
Significant Risk ◽  
Operation Time ◽  
Female Gender ◽  
Tumor Location ◽  
Lesion Size ◽  
Submucosal Dissection ◽  
Duration Of Hospitalization

Abstract Background and study aims Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS). Patients and methods This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure. Results PECS occurred in 15/106 (14.2 %), and 10 were women (P = 0.01, OR: 7.74 [1.6 – 36.4]), 7 had lesions in the cecum (P < 0.001, OR: 20.6 [3.7 – 115.2]), and 9 in whom ESD operation time was > 90 min (P = 0.002, OR: 10.3 [2.4 – 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P < 0.001, OR: 38.9 [6.9 – 219.6]), and hospital stay was significantly longer in the PECS group.  Conclusions Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS. 

scholarly journals Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Yoshinobu Yamamoto ◽  
Hogara Nishisaki ◽  
Hideki Sakai ◽  
Nagahiro Tokuyama ◽  
Hiroaki Sawai ◽  
...  
Keyword(s):  
Risk Factor ◽  
Endoscopic Submucosal Dissection ◽  
Conservative Management ◽  
Univariate Analysis ◽  
Severe Complication ◽  
Gastric Neoplasms ◽  
Clinicopathological Factors ◽  
Clinical Factors ◽  
Submucosal Dissection ◽  
Delayed Perforation

Background. Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD) for early gastric neoplasm (EGN). The aim of this study was to clarify clinical factors related to delayed perforation after ESD. Methods. A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation. Results. Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%). All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation (P<0.01). Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s) than at nonperforated points (3.5 s) in five patients. Conclusions. Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.

scholarly journals Clinical significance of additional gastrectomy after non-curative endoscopic submucosal dissection for early gastric cancer: a retrospective single-center study

2021 ◽  
Vol 17 (2) ◽  
pp. 68-72
Author(s):  
Uicheon Jeong ◽  
Ho Yoon Bang ◽  
Pyeong Su Kim
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Univariate Analysis ◽  
Lymphatic Invasion ◽  
Residual Cancer ◽  
Clinicopathologic Characteristics ◽  
Submucosal Dissection ◽  
Additional Surgery ◽  
Single Center Study ◽  
Additional Gastrectomy ◽  
Significant Factors

Purpose: Additional surgery is recommended for patients after a non-curative endoscopic submucosal dissection (ESD) to prevent residual cancer (RC) or lymph node metastasis (LNM). We aimed to evaluate the clinicopathologic characteristics of patients who underwent an additional gastrectomy after a non-curative ESD procedure and identify the risk factors of RC and LNM.Methods: We retrospectively assessed the clinicopathological factors of 73 patients who underwent additional gastrectomy following a non-curative ESD between January 2009 and December 2019 at our center.Results: RC and LNM rates after additional gastrectomy were 9.6% and 8.2%, respectively. Invasion deeper than 500 μm (P = 0.045), positive horizontal resection margin (P < 0.001), and positive ESD margin (P = 0.001) were identified as statistically significant factors in univariate analysis for RC, but not in multivariate analysis. Lymphatic invasion was the only risk factor found to be significant in both univariate and multivariate analyses (P = 0.005 and P = 0.012).Conclusion: Additional gastrectomy is necessary to prevent RC or LNM after non-curative ESD. Lymphatic invasion was also associated with LNM in patients who underwent an additional gastrectomy after a non-curative ESD, and in such cases, active treatment is required.

scholarly journals The Comparison between Endoscopic Submucosal Dissection and Surgery in Gastric Cancer: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Junbi Hu ◽  
Yan Zhao ◽  
Mudan Ren ◽  
Yarui Li ◽  
Xinlan Lu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Hospital Stay ◽  
Meta Analysis ◽  
Treatment Modalities ◽  
Adverse Event Rate ◽  
Submucosal Dissection ◽  
Surgery Group ◽  
The Difference

Aims. There are two treatment modalities for early gastric cancer (EGC)—surgery and endoscopic submucosal dissection (ESD). We aimed to compare the safety and efficacy of ESD with surgery. Method. The article was performed by searching PubMed databases. Data were extracted using predefined form and odds ratios (OR) with 95% confidence intervals (CI) calculated and P value. Results. 13 studies were identified. The incidence of perforation in two groups was different [OR = 6.18 (95% CI: 1.37–27.98), P=0.02]. The prevalences of synchronous and metachronous cancer in the ESD group were higher than those in the surgery group [OR = 8.52 (95% CI: 1.99–36.56), P = 0.004 and OR = 7.15 (95% CI: 2.95–17.32), P<0.0001]. The recurrence and complete resection rates were different [OR = 6.93 (95% CI: 2.83–16.96), P<0.0001 and OR = 0.32 (95% CI: 0.20–0.52), P<0.00001]. Compared with the surgery group, the hospital stay was shorter [IV = −7.15 (95% CI: −9.08–5.22), P<0.00001], the adverse event rate was lower, and the quality of life (QOL) was better in the ESD group. The difference of bleeding was not found. Conclusion. ESD appears to be preferable for EGC, due to a lower rate of adverse events, shorter hospital stay, cheaper cost, and higher QOL.

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