scholarly journals Preserving the Mucosa to the Maximum Possible Extent for Endoscopic Submucosal Dissection of Subcircumferential Superficial Esophageal Carcinoma

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Masaya Uesato ◽  
Kentarou Murakami ◽  
Yoshihiro Nabeya ◽  
Kazunori Fugo ◽  
Hisahiro Matsubara
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Balloon Dilation ◽  
Median Number ◽  
Submucosal Dissection ◽  
Mucosal Defect ◽  
Preservation Method ◽  
Rapid Healing ◽  
Superficial Esophageal Carcinoma ◽  
The Mean ◽  
Endoscopic Balloon

Aim. To show our unique strategy of endoscopic submucosal dissection (ESD) for esophageal squamous cell carcinoma larger than the subcircumference. Methods. From April 2011, we used a mucosal preservation method called the log bridge (LB) method for the lesion larger than the subcircumference. The patients in whom the circumference of the mucosal defect was 5/6 to <1 were classified into the LB group; those who underwent whole circumferential ESD were classified into the non-LB group. The data were collected retrospectively and were compared between the two groups. Results. Eighteen patients into the LB group and 7 into the non-LB group were classified. The median number of endoscopic balloon dilation sessions after ESD in the LB group tended to be lower than that in the non-LB group. The mean period until complete epithelialization after ESD was significantly shorter in the LB group. The rates of curative resection were 100% (7/7) in the non-LB group and 61.1% (11/18) in the LB group. However, there was no local recurrence in either group for approximately two years. Conclusion. In cases involving subcircumferential esophageal lesions, the LB method is useful for achieving rapid healing and might be related to a reduced degree of esophageal stricture.

Su1486 Locoregional Mitomycin C Injection for Post-Endoscopic Submucosal Dissection Strictures Refractory to Endoscopic Balloon Dilation

2011 ◽  
Vol 73 (4) ◽  
pp. AB279-AB280
Author(s):  
Hiroaki Minamino ◽  
Hirohisa Machida ◽  
Kazunari Tominaga ◽  
Yasuaki Nagami ◽  
Masami Nakatani ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Mitomycin C ◽  
Balloon Dilation ◽  
Endoscopic Balloon Dilation ◽  
Submucosal Dissection ◽  
Endoscopic Balloon

scholarly journals Endoscopic submucosal dissection to relieve a flexure of the gastric conduit after esophagectomy

2018 ◽  
Vol 06 (03) ◽  
pp. E350-E353
Author(s):  
Katsumi Yamamoto ◽  
Hiroshi Noro ◽  
Yu Sato ◽  
Akira Kusakabe ◽  
Nobuyuki Tatsumi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Balloon Dilation ◽  
Endoscopic Examination ◽  
Gastric Conduit ◽  
Endoscopic Balloon Dilation ◽  
Effective Treatment Option ◽  
Submucosal Dissection ◽  
First Case ◽  
Posterior Mediastinal ◽  
Endoscopic Balloon

Abstract Background and study aims A 70-year-old-man underwent an esophagectomy and posterior mediastinal reconstruction for esophageal cancer that was curatively resected. Although the patient was allowed to eat after surgery, he repeatedly vomited after drinking water or eating meals and required continuous hospitalization. An upper gastrointestinal series and endoscopic examination revealed an obstruction due to the flexure of the gastric conduit, which was repeatedly treated with endoscopic balloon dilation. Endoscopic balloon dilation was completely ineffective, however, because the obstruction was not due to a small lumen diameter, but rather to severe flexure. We hypothesized that the power of contraction provided by ulcer scar formation after mucosal resection could straighten the flexure, and thus removed a piece of the mucosa 8 cm in diameter on the oral side of the flexure by endoscopic submucosal dissection (ESD) 4 months after the esophagectomy. Endoscopic examination on post-ESD Day 10 revealed that the gastric conduit flexure was straightened due to ulcer scarring, and obstruction at the flexure opened over time. Meals were restarted and the patient could eat without vomiting. He was discharged from the hospital 5 weeks after ESD. This is the first case report of obstruction due to flexure of the gastric conduit after esophagectomy that was successfully treated with mucosectomy using ESD. Mucosectomy using ESD may be an effective treatment option for obstruction due to flexure of the gastric conduit after esophagectomy.

Radial incision and cutting for dilation before endoscopic submucosal dissection in patients with esophageal cancer on the distal side of severe benign esophageal strictures

2020 ◽  
Author(s):  
Keiichiro Nakajo ◽  
Yusuke Yoda ◽  
Tomohiro Kadota ◽  
Tatsuro Murano ◽  
Kensuke Shinmura ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Balloon Dilation ◽  
Endoscopic Balloon Dilation ◽  
Submucosal Dissection ◽  
Radial Incision ◽  
Distal Side ◽  
Dilation Group ◽  
Esophageal Squamous Cell Carcinomas ◽  
Procedural Success ◽  
Endoscopic Balloon

ABSTRACT We investigated the efficacy and safety of radial incision and cutting as a novel dilation method for strictures just before endoscopic submucosal dissection in patients with metachronous esophageal cancer localized on the distal side of strictures and determined the optimal dilation method. Consecutive patients who underwent endoscopic submucosal dissection for superficial esophageal squamous cell carcinomas localized on the distal side of severe strictures were investigated retrospectively and assigned to a radial incision and cutting (19 patients; 23 lesions) or an endoscopic balloon dilation (20 patients; 20 lesions) group. We evaluated the passage success rates of cap-wearing endoscopes with diameters ≥8.9 mm, the procedural success, en bloc resection, complete resection, major adverse event rates, and total procedure times. Compared to the endoscopic balloon dilation group, the passage success rate of a conventional endoscope with a transparent cap (87% vs. 50%) and procedural success rate (96% vs. 63%) were significantly higher in the radial incision and cutting group. The mean procedure time of ‘dilation and ESD’ was significantly shorter in the radial incision and cutting group than in the endoscopic balloon dilation group. Neither group experienced any serious adverse events. Radial incision and cutting followed by endoscopic submucosal dissection was effective and safe in patients with superficial esophageal squamous cell carcinomas localized on the distal side of severe benign esophageal strictures. Endoscopic submucosal dissection using a cap-wearing endoscope was possible with radial incision and cutting, and the procedure time was shorter than that for endoscopic balloon dilation.

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.

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