scholarly journals Don’t Interrupt! A Case Report of Continuing Peritoneal Dialysis After Endoscopic Gastric Tumor Resection

2019 ◽  
Vol 6 ◽  
pp. 205435811988714 ◽  
Author(s):  
William K. Silverstein ◽  
Christopher Teshima ◽  
Simran Jolly ◽  
Jeffrey Perl
Keyword(s):  
Peritoneal Dialysis ◽  
Endoscopic Submucosal Dissection ◽  
Tumor Resection ◽  
Posterior Wall ◽  
Lymph Node Involvement ◽  
Gastric Tumor ◽  
Deficiency Anemia ◽  
Low Grade ◽  
En Bloc ◽  
Submucosal Dissection

Rationale: The evidence supporting the safety of restarting peritoneal dialysis (PD) immediately after abdominal surgery and interventions is scant. In particular, there are no reported cases characterizing periprocedural management of PD for patients undergoing endoscopic submucosal dissection for gastric intramucosal tumor removal. Presenting concerns of the patient: A 66-year-old female with end-stage kidney disease secondary to diabetic nephropathy, currently on nocturnal automatic PD, presented with new iron-deficiency anemia. Workup revealed an intramucosal gastric lesion proximal to the pylorus, without surrounding lymph node involvement. Endoscopic submucosal dissection was performed with en bloc endoscopic resection of a 5-cm, partially flat, partially sessile mass along the posterior wall and lesser curvature of the gastric antrum. Pathology revealed low-grade dysplasia without features of malignancy. There was no evidence of hemorrhage or leak post-dissection. Diagnoses: The clinical presentation was consistent with an uncomplicated endoscopic submucosal dissection. Interventions: Peritoneal dialysis was held for 48 hours and restarted thereafter with no complications. The patient did not require bridging with hemodialysis. Outcomes: The patient had an uncomplicated post-endoscopic course, with no subsequent episodes of PD-associated peritonitis after at least 6-month follow-up. Novel finding: This is the first reported case of PD reinitiation after endoscopic submucosal dissection of a gastric tumor.

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 First experience of one and two-step endoscopic submucosal dissection of colorectal neoplasms

2020 ◽  
Vol 101 (3) ◽  
pp. 446-451
Author(s):  
I M Sayfutdinov ◽  
L E Slavin ◽  
R N Khayrullin ◽  
M S Mukharyamov ◽  
R T Zimagulov ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
Intraoperative Complications ◽  
Intraepithelial Neoplasia ◽  
Intestinal Wall ◽  
Colorectal Polyps ◽  
Low Grade ◽  
En Bloc ◽  
Submucosal Dissection

Aim. To analyze the results of one and two-step endoscopic submucosal dissection in the treatment of colorectal neoplasms. Methods. Between 2018 and 2019, 17 patients (6 men and 11 women) aged 33 to 79 years underwent 21 endoscopic submucosal dissections of colorectal neoplasms ranging in size from 1.0 to 6.0 cm. Submucosal fibrosis was identified in 2 (11.8%) patients, epithelial neoplasms in 15 (88.2%) patients including laterally spreading tumors in 9 (60%), and large sessile colorectal polyps in 6 (40%) patients. Histological examination revealed a carcinoid tumor (11.8%), adenoma with low-grade (64.7%) and high-grade (23.5%) intraepithelial neoplasia. 13 patients were subjected to the one-step operation, and 4 patients required the two-step operation with a 1-day interval. Follow-up examinations after the operation were performed, on average, between 2 and 6 months. Results. En bloc endoscopic submucosal dissection was performed in 11 (64.7%) patients, 4 of them in combination with mucosal resection. Endoscopic piecemeal resection of the neoplasia was performed in 6 (35.3%) patients. The average operative time was 15573 minutes (range 40320 min). Intraoperative complications, which were eliminated endoscopically, occurred during 8 (38.1%) of 21 operations: intensive bleeding in 6 (75%) patients, diastasis of muscle fibers in 1 (12.5%) patient, perforation of the intestinal wall in 1 (12.5%) patient. At the follow-up at 6 months, all patients formed the scar at the surgical area, while 3 patients required endoscopic removal of residual adenoma 2 months after the operation. Conclusion. Endoscopic submucosal dissection is an effective method for removing colorectal neoplasms, while two-step dissection is a promising approach to the development of the technique.Keywords: one and two-step dissection, endoscopic submucosal dissection (ESD), colorectal neoplasms.

scholarly journals Endoscopic submucosal dissection (ESD) for Barrett’s esophagus (BE)-related early neoplasia after standard endoscopic management is feasible and safe

2020 ◽  
Vol 08 (04) ◽  
pp. E498-E505
Author(s):  
Yutaka Tomizawa ◽  
Shai Friedland ◽  
Joo Ha Hwang
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Endoscopic Management ◽  
R0 Resection ◽  
Low Grade ◽  
En Bloc ◽  
Submucosal Dissection

Abstract Background and study aims There is little data on the feasibility and safety of endoscopic submucosal dissection (ESD) as a salvage treatment for Barrett’s esophagus (BE)-related neoplasia after standard endoscopic treatments. Patients and methods A multicenter retrospective analysis on patients who underwent ESD for BE was performed. The primary endpoint was effectiveness of obtaining en-bloc resection in salvage as compared to non-salvage treatments. Results Median age was 71 (IQR 55 – 79) years. Twelve (37%) of 32 patients underwent salvage ESD. Median resection time was 100 (IQR 60 – 136) minutes. En-bloc resection was achieved in 31 patients (97 %). Complete R0 resection was obtained in 75 % in the salvage group and 80 % in the non-salvage group (P = 1.00). In seven patients (22 %), the pre-ESD diagnosis was upgraded on post-ESD histopathology (1 low-grade dysplasia to high grade dysplasia [HGD], 4 HGD to early esophageal carcinoma (EAC), and 2 intramucosal EAC to invasive EAC). No perforations occurred in either group. Two late adverse events occurred, both in the salvage group (P = 0.133). Delayed bleeding occurred in a patient who had just resumed warfarin and stricture occurred in a patient who had a circumferential resection requiring serial dilation and stent placement. Conclusions Our cohort study demonstrated that ESD as salvage therapy for BE related neoplasia is feasible and safe, achieving similar high rates of en-bloc resection and complete R0 resection as in treatment-naïve patients. Referral to an expert center performing ESD should be considered for patients with recurrence or progression following endoscopic mucosal resection or ablation therapy.

scholarly journals The first case of endoscopic submucosal dissection of cecal adenoma in Serbia

2009 ◽  
Vol 62 (1-2) ◽  
pp. 27-30 ◽  
Author(s):  
Dejan Ivanov ◽  
Takaski Toyonaga
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Screening Program ◽  
Histopathological Examination ◽  
Early Stage ◽  
Ileocecal Valve ◽  
Low Grade ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Elevated Type ◽  
First Case

Endoscopic submucosal dissection is a therapeutic procedure for the removal of early stage gastrointestinal cancer. In 2006, we performed a colonic ESD in Serbia. ESD had never been performed until then in Serbia, nor do we have a written report, so this article is a document of the first performed procedure of this kind. On the 21st of October 2006, the patient was admitted to the General Hospital MC in Novi Sad for the performance of ESD of the cecal lesion. A flat-elevated type of lesion on the upper lip of ileocecal valve with a size of 8 mm was found on the colonoscopy. The adenoma was removed en bloc and prepared for further histopathological examination. Histopathological examination showed that the tumor was a 'flat adenoma' of the colon mucosa with a low grade dysplasia. The procedure lasted for 30 minutes and went without complications. The first case of ESD in Serbia was performed in 2006, only four years after it was developed in Japan. To have more ESD cases in our country a screening program for detection of early cancers is needed as well as education of endoscopists in performing ESD.

scholarly journals Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions

2020 ◽  
Vol 08 (12) ◽  
pp. E1832-E1839
Author(s):  
Yuichiro Kuroki ◽  
Toshiyuki Endo ◽  
Kenta Iwahashi ◽  
Naoki Miyao ◽  
Reika Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Tumor Location ◽  
Proximal Colon ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Serrated Lesions

Abstract Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm2/h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.

scholarly journals Fibrin glue: Novel submucosal injection agent for endoscopic submucosal dissection

2021 ◽  
Vol 09 (03) ◽  
pp. E319-E323
Author(s):  
Madoka Takao ◽  
Yoshitaka Takegawa ◽  
Toshitatsu Takao ◽  
Hiroya Sakaguchi ◽  
Yoshiko Nakano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Injection ◽  
Submucosal Dissection ◽  
Vitro Model ◽  
Histopathologic Findings

Abstract Background and study aims Adequate mucosal elevation by submucosal injection is crucial for patient safety and efficiency during endoscopic submucosal dissection (ESD). This study aimed to evaluate the efficacy of fibrin glue (FG) as a long-lasting submucosal injection agent and to evaluate the technical feasibility of FG injection for ESD. Materials and methods To compare the capabilities of different agents in maintaining submucosal evaluation, we injected FG, hyaluronic acid solution, and normal saline into the porcine gastric specimen that was incised into approximately 5 × 5 cm squares. Then, we measured the height of submucosal elevations over time. Moreover, three hypothetical lesions from the resected porcine stomach underwent ESD with FG injection. Thereafter, we conducted macroscopic and histopathologic analyses. Results FG maintained the greatest submucosal elevation among all the injection agents. Three ESD procedures were performed with en bloc resection. Both macroscopic and histopathologic findings showed a thick FG clot on the ulcers. Conclusions The FG solution can be potentially used as an ESD submucosal injection agent in an in vitro model.

scholarly journals Colorectal endoscopic submucosal dissection using the pocket-creation method with single clip traction: a feasibility study

2021 ◽  
Vol 09 (05) ◽  
pp. E653-E658
Author(s):  
Tatsuma Nomura ◽  
Yoshikazu Hayashi ◽  
Takaaki Morikawa ◽  
Masahiro Okada ◽  
Hisashi Fukuda ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Major Axis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Success Rates ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Mucosal Incision ◽  
Axis Length ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims The pocket-creation method (PCM) facilitates dissection of the central part of a tumor. We previously developed the PCM with clip traction (PCM-CT) to facilitate opening the mucosal pocket, which otherwise could become cumbersome. In the present study, we aimed to examine the feasibility of PCM-CT for colorectal endoscopic submucosal dissection (ESD). Patients and methods PCM-CT was performed on 30 patients with early colorectal tumors from October 2019 to April 2020. PCM-CT allows efficient opening of the mucosal pocket by using the PCM to dissect the center of the lesion and then apply traction with a single clip after making a circumferential mucosal incision. Results The median specimen major axis length, ESD time, ESD speed, and en bloc resection rate were 48 mm, 84 minutes, 20 mm2/min, and 100 % (30/30), respectively. The success rates for the traction clip and median single-clip-traction time were 100 % (30/30) and 1.5 minutes, respectively. Conclusions Colorectal ESD using PCM-CT is a simple and promising method.

scholarly journals Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile

2021 ◽  
pp. 1-9
Author(s):  
João Santos-Antunes ◽  
Margarida Marques ◽  
Rui Morais ◽  
Fátima Carneiro ◽  
Guilherme Macedo
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Safety Profile ◽  
En Bloc Resection ◽  
R0 Resection ◽  
Hybrid Technique ◽  
Resection Rate ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Introduction:</i></b> Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. <b><i>Methods:</i></b> We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. <b><i>Results:</i></b> Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (<i>n</i> = 24) and rectum (<i>n</i> = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). <b><i>Conclusion:</i></b> Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.

scholarly journals Effective use of the “clip-flap” method for the endoscopic submucosal dissection of a difficult-to-approach superficial gastric tumor

Endoscopy ◽  
2015 ◽  
Vol 47 (S 01) ◽  
pp. E318-E319 ◽  
Author(s):  
Katsumi Yamamoto ◽  
Shiro Hayashi ◽  
Tsutomu Nishida ◽  
Hirotsugu Saiki ◽  
Masafumi Naito ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Gastric Tumor ◽  
Submucosal Dissection ◽  
Effective Use

scholarly journals Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

2021 ◽  
Vol 10 (11) ◽  
pp. 2511
Author(s):  
Yoshitsugu Misumi ◽  
Kouichi Nonaka
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Educational Methods ◽  
Submucosal Dissection ◽  
Management Of Complications

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.

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