scholarly journals Clinical Features of False-Negative Early Gastric Cancers: A Retrospective Study of Endoscopic Submucosal Dissection Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Kohei Oka ◽  
Naoto Iwai ◽  
Takashi Okuda ◽  
Tasuku Hara ◽  
Yutaka Inada ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Features ◽  
False Negative ◽  
City Hospital ◽  
Submucosal Dissection ◽  
The Difference ◽  
Well Differentiated ◽  
H Pylori ◽  
Lesser Curvature ◽  
Experienced Endoscopists

Background. We frequently encounter early gastric cancer (EGC) that could not be detected in the previous esophagogastroduodenoscopy even if the procedure was annually performed. However, little evidence exists regarding the characteristics of false-negative EGCs. Our aim was to reveal the clinical features of false-negative EGCs. Methods. We retrospectively reviewed cases of endoscopic submucosal dissection (ESD) for EGCs in Fukuchiyama City Hospital between January 2013 and May 2019. False-negative EGCs were defined as EGCs within 3 years of negative endoscopy. We evaluated the clinical characteristics of false-negative and initially detected EGCs and the difference in the detected and last missed endoscopy in false-negative EGCs. The miss rates of false-negative EGCs were compared between trainees (nonboard-certified endoscopists) and experienced endoscopists (board-certified endoscopists); thereafter, the characteristics of false-negative EGCs missed by trainees were investigated. Results. Of 219 cases, 119 were classified as false-negative EGCs. False-negative EGCs were characterized as smaller lesions, which presented with normal color or gastritis-like appearance, and were diagnosed after ESD and H. pylori eradication ( P < 0.01 ). The rate of trainees in the last missed endoscopy was significantly higher than that in the detected endoscopy. The miss rate of false-negative EGC by trainees was higher than that of experienced endoscopists but not significantly different (0.70% vs. 0.57%, P = 0.08 ). The false-negative EGCs missed by trainees were characterized as reddish or well-differentiated lesions, which were located in the lower or lesser curvature of the stomach ( P < 0.05 ). Conclusion. The characteristics of false-negative EGCs were similar to those of H. pylori-eradicated EGC. Procedures with shortened examination time and those performed by trainees were risk factors of missing false-negative EGCs. Trainees should pay attention to reddish or well-differentiated EGCs located in the lower or lesser curvature of the stomach.

Mo1403 Clinical Features and Predictive Factors of Perforation During Endoscopic Submucosal Dissection for Colorectal Tumors

2012 ◽  
Vol 75 (4) ◽  
pp. AB414
Author(s):  
Toshifumi Mitani ◽  
Shu Hoteya ◽  
Toshiro Iizuka ◽  
Osamu Ogawa ◽  
Masanori Nakamura ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Features ◽  
Predictive Factors ◽  
Colorectal Tumors ◽  
Submucosal Dissection

Vonoprozan: potentially new first-line treatment for delayed upper gastrointestinal bleeds following endoscopic procedures? A letter to the editor

2022 ◽  
Vol 71 (12) ◽  
pp. 2838-2838
Author(s):  
Muhammad Umer ◽  
Syed Wasif Bukhari
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Gastrointestinal Diseases ◽  
High Dose ◽  
First Line ◽  
Gastroesophageal Varices ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
H Pylori ◽  
Line Of Therapy

Endoscopy nowadays is widely used as a diagnostic and therapeutic tool for various gastrointestinal diseases due to it being less invasive and safer. However, amongst some adverse events is delayed bleeding. The definition of delayed bleeding requires endoscopic hemostasis and/or blood transfusion after at least two days of treatment. (1) Oesophageal cancer is comparatively more common in Pakistan, being 7th most common malignancy in men and 6th most common in women in Karachi. (2) Oesophageal endoscopic submucosal dissection (E-ESD) employed in the treatment of the above- mentioned cancer has an incidence of delayed bleeding of about 1.3-6.7%. (1) The prevalence of gastric cancer across Pakistan was about 2-18% (3), for which endoscopic submucosal dissection is often used has an incidence of delayed bleeding of 4.7-15.6%. (1) Endoscopic therapy for gastroesophageal varices can also result in delayed bleeding, the incidence of which easily reaches up to 10%. (1) In a retrospective cohort study of 124,422 patients conducted in Japan, it was found that vonoprazan was more effective in reducing the risk of delayed bleeding compared to omeprazole. (OR= 0.75) (1) Vonoprazan works by competitively inhibiting the potassium-acid channel resulting in strong and sustained acid inhibition. (4) It was also found to have a superior effect in the eradication of H Pylori and an equal effect in acid-related disorders. (5)  In the retrospective study mentioned above, it is also worth noting that the efficacy of vonoprazan was variable with respect to procedures and was most prominent with gastroduodenal endoscopic submucosal dissection (OR=0.70). (1) Other procedures did not elicit any significant difference. In addition, standard/high dose vonoprazan proved to be most efficacious in reducing the risk of delayed bleeding compared with standard/high-dose PPI and low-dose vonoprazan. It was also observed that patients taking anti-thrombotic medications at a higher risk of delayed bleeding also benefited from high-dose vonoprazan. (OR=0.74) (1) The findings above compel the conclusion that high dose vonoprazan should be ideal for reducing the risk of delayed bleeding in patients who have undergone gastroduodenal endoscopic submucosal dissection and/or are on anti-thrombotics. Though high-dose vonoprazan does look promising, it is imperative that more randomized controlled trials on more diverse populations be conducted to further explore its efficacy and safety as the drug might be a potential first line of therapy.

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 Endoscopic submucosal dissection of early gastric cancer via inverted overtube in a patient with situs inversus totalis: a case report

2018 ◽  
Vol 06 (05) ◽  
pp. E625-E629
Author(s):  
Youichi Miyaoka ◽  
Shinsuke Suemitsu ◽  
Aya Fujiwara ◽  
Satoshi Kotani ◽  
Kosuke Tsukano ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Situs Inversus ◽  
Gastric Fluid ◽  
Situs Inversus Totalis ◽  
Endoscopic View ◽  
Submucosal Dissection ◽  
The Right ◽  
Lesser Curvature

Abstract Background and study aims A 72-year-old man with complete situs inversus presented with early gastric cancer on the lesser curvature wall of the antrum of the stomach. Endoscopic submucosal dissection (ESD) was selected as a treatment. When the patient was positioned in the left decubitus position, the lesion was hidden by blood and gastric fluid because it was located on the gravitational side. Therefore, we decided to perform ESD with the patient in the right lateral decubitus position and use an inverted overtube, which provided a good endoscopic view without the need to rearrange the endoscopist, assistants, or endoscopic system. ESD was safe and feasible using the inverted overtube.

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.

Reliability of endoscopic biopsy compared with endoscopic submucosal dissection histopathologic diagnosis.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 15-15
Author(s):  
Kyuwon Lee ◽  
Tae Ho Kim
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Signet Ring Cell ◽  
Endoscopic Biopsy ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
Simple Method ◽  
Submucosal Dissection ◽  
Screening Endoscopy ◽  
H Pylori

15 Background: Endoscopic biopsy is the most convenient and simple method for approaching gastric neoplasm. Aim of our study was to determine the diagnostic accuracy of biopsy during screening endoscopy compared to endoscopic submucosal dissection (ESD). Methods: 175 patients who underwent both screening endoscopic biopsy and ESD from 2015.01 to 2017.12 in Bucheon St. Mary’s hospital were retrospectively reviewed. Results: Seventeen lesions had different histopathological ESD findings compared with endoscopic biopsy. Among six endoscopic biopsies that showed atypia, four were diagnosed with adenocarcinoma and two maintained the results. 64 out of the 175 lesions showed low grade dysplasia by endoscopic biopsy. After ESD, two cases were diagnosed with high grade dysplasia and two cases were diagnosed with adenocarcinoma. Of 12 lesions which showed high grade dysplasia on endoscopic biopsy, four lesions turned out to be adenocarcinoma (three well differentiated, one moderately differentiated) after ESD. Of 91 adenocarcinoma lesions on endoscopic biopsy, three lesions had discrepancy on differentiation level and one lesion turned out to be signet ring cell carcinoma after all. Patients who were infected with Helicobacter pylori (H. pylori) had tendency to have discrepancy between initial biopsy and ESD histopathology result. (OR 3.68, 95% CI 1.08-11.955, P = 0.018). Conclusions: Discrepancy between endoscopic biopsy and post-ESD histopathology were found. Possibility of coexistence or progression to high grade neoplasm should be considered regarding endoscopic biopsy results especially if infected with H. pylori and active ESD histopathological confirmation needs to be done if necessary.

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

186 Clinical Features of Delayed Bleeding After Gastric Endoscopic Submucosal Dissection Associated With Heparin Bridge Therapy

2015 ◽  
Vol 81 (5) ◽  
pp. AB121
Author(s):  
Takuya Inoue ◽  
Masahiko Tsujii ◽  
Hideki Lijima ◽  
Yoshito Hayashi ◽  
Kengo Nagai ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Features ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Bridge Therapy

scholarly journals Usefulness of the Modified Clip-with-Line Method for Endoscopic Mucosal Treatment Procedure

2018 ◽  
Vol 27 (3) ◽  
pp. 317-320 ◽  
Author(s):  
Koichi Soga ◽  
Takahito Shimomura ◽  
Toshio Suzuki ◽  
Tesshin Tei ◽  
Tomohiko Usui ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Normal Mucosa ◽  
Submucosal Layer ◽  
Procedure Time ◽  
Treatment Procedure ◽  
Dental Floss ◽  
Line Method ◽  
Submucosal Dissection ◽  
Cutting Line ◽  
Experienced Endoscopists

Endoscopic submucosal dissection (ESD) might be difficult to perform in some cases even for experienced endoscopists. Recently, various traction methods have been introduced to facilitate ESD procedures, such as clip-with-line (CL), external forceps, clip and snare, internal traction, double scope, and magnetic anchor.The traction procedure using the CL method enhances the visibility of the operation field during ESD. The original CL method is performed as follows: the clip with the line (e.g., dental floss) is attached to the edge of the lesion. Traction can be produced by pulling the line gently, thus achieving a sufficient visualization of the submucosal layer to identify an accurate cutting line. Herein, we present a useful modified two-CL method by pulling the appropriate normal mucosa to enhance the visibility of the operation field during ESD procedure. Thus, the traction methods, including our modified CL technique, might reduce the procedure time and complications.

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