scholarly journals Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Tachikawa ◽  
Hideyuki Chiba ◽  
Naoya Okada ◽  
Jun Arimoto ◽  
Keiichi Ashikari ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Control Group ◽  
Obese Patients ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Overweight Group ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background When performing colorectal endoscopic submucosal dissection (ESD) in obese patients, technically difficult cases are sometimes experienced because of difficulty with the insertion of the colonoscope, poor scope maneuverability, or an abundance of fat tissue in the submucosal layer. Since the association between obesity and colorectal ESD has not been investigated, we evaluated the clinical impact of obesity in patients who underwent colorectal ESD. Methods We retrospectively reviewed 535 patients who underwent colorectal ESD between April 2012 and February 2019. Patients were divided into three groups based on their body mass index (BMI): a control group (BMI < 25 kg/m2), an overweight group (25 kg/m2 ≤ BMI < 30 kg/m2), and an obese group (BMI ≥ 30 kg/m2), and the short-term clinical outcomes were analyzed to assess the safety and difficulty of colorectal ESD. Results No significant difference in the procedure times, en bloc resection rates, pathological diagnoses, or complications were seen among the groups. While the amount of sedative per body weight was significantly lower in the group with a higher BMI (flunitrazepam: 1.75 × 10−2 [1.27 × 10−2–2.34 × 10−2] mg/kg vs. 1.48 × 10−2 [1.08 × 10−2–2.03 × 10−2] mg/kg vs. 1.16 × 10−2 [0.98 × 10−2–1.54 × 10−2] mg/kg, P < 0.001; pethidine: 0.63 [0.55–0.72] mg/kg vs. 0.50 [0.46–0.56] mg/kg vs. 0.39 [0.32–0.45] mg/kg, P < 0.001), a reduction in percutaneous arterial oxygen saturation occurred significantly more frequently in the group with a higher BMI (123 [30.2%] vs. 43 [43.9%] vs. 10 [55.6%], P = 0.005). When the procedures were performed by trainees, the number of cases that required a procedure time of longer than 90 min was significantly larger in the group with a higher BMI (27 [10.8%] vs. 14 [21.9%] vs. 3 [25.0%], P = 0.033). Conclusions This study showed that colorectal ESD could be performed safely and effectively in obese patients. However, ESD in obese patients requires attention, particularly to changes in respiratory conditions.

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 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 Effectiveness of S-O Clip-Assisted Colorectal Endoscopic Submucosal Dissection

2021 ◽  
Vol 11 (1) ◽  
pp. 141
Author(s):  
Haruka Fujinami ◽  
Akira Teramoto ◽  
Saeko Takahashi ◽  
Takayuki Ando ◽  
Shinya Kajiura ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
Right Colon ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection ◽  
The Right ◽  
Surgery Duration

This study aimed to assess the utility of the S-O clip during colorectal endoscopic submucosal dissection (ESD). We conducted a retrospective study on 185 patients who underwent colorectal ESD from January 2015 to January 2020. The patients were divided into two groups: before and after the introduction of the S-O clip. Forty-two patients underwent conventional ESD (CO group) and 29 patients underwent ESD using the S-O clip (SO group). We compared the surgery duration, dissection speed, en bloc resection rate, and complication rate between both groups. Compared with the CO group, the SO group had a significantly shorter surgery duration (70.7 ± 37.9 min vs. 51.2 ± 18.6 min; p = 0.017), a significantly higher dissection speed (15.1 ± 9.0 min vs. 26.3 ± 13.8 min; p < 0.001), a significantly higher en bloc resection rate (80.9% vs. 98.8%; p ≤ 0.001), and a significantly lower perforation rate (4.3% vs. 1.3%). In the right colon, the surgery duration was significantly shorter and the dissection speed was significantly higher in the SO group than in the CO group. Moreover, the rate of en bloc resection improved significantly in the right colon. S-O clip-assisted ESD reduces the procedure time and improves the treatment effects, especially in the right colon.

scholarly journals Effectiveness of Inner Traction Facilitated Endoscopic Submucosal Dissection using Rubber Band and Clips for Colorectal Neoplasms: A Propensity Score-matched Study

2021 ◽  
Author(s):  
Guanyi Liu ◽  
Xinyue Guo ◽  
Yunlong Cai ◽  
Long Rong ◽  
Weidong Nian ◽  
...  
Keyword(s):  
Propensity Score ◽  
Endoscopic Submucosal Dissection ◽  
Propensity Score Matching ◽  
Colorectal Neoplasms ◽  
Rubber Band ◽  
Lateral Spreading ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection ◽  
Matched Study

Abstract Background Colorectal endoscopic submucosal dissection (ESD) is a technically demanding but effective treatment for superficial neoplasms. We conducted a study to compare the effectiveness and safety of inner traction facilitated ESD using rubber band and clip (RAC-ESD) with conventional ESD.Methods We retrospectively evaluated 622 consecutive patients underwent colorectal ESD between January 2016 and December 2019. To overcome selection bias, we used propensity score matching (1:4) between RAC-ESD and conventional ESD. The frequency of en bloc resections, R0 resections, curative resections, procedure speed and complications were evaluated.Results After propensity score matching, 35 patients were included in RAC-ESD group and 140 were included in conventional ESD group. RAC-ESD resulted in a significant increase in resection speed (0.14 vs. 0.09 cm2/min; P=0.003). There were no significant differences in en bloc, R0 and curative resection rates between two groups. In subgroup analysis, the resection speed of RAC-ESD was significantly higher than conventional ESD when the lesions were equal to or larger than 2cm, macroscopically presenting as lateral spreading tumor, and located in transverse colon to ascending colon.Conclusions RAC-ESD is safe and effective in treating colorectal neoplasms, especially in lesions presenting particular difficulty.

scholarly journals Novel three-dimensional imaging system may facilitate gastric endoscopic submucosal dissection procedure: an ex vivo animal study

2018 ◽  
Vol 06 (12) ◽  
pp. E1431-E1435 ◽  
Author(s):  
Naoki Akizue ◽  
Tomoaki Matsumura ◽  
Daisuke Maruoka ◽  
Kentaro Ishikawa ◽  
Dao Hang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Depth Perception ◽  
Imaging System ◽  
Ex Vivo ◽  
Three Dimensional ◽  
3D Image ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Significant Difference ◽  
Better Than

Abstract Background and study aims Endoscopic submucosal dissection (ESD) requires advanced skills to perform safely without complications. The current study evaluated the usefulness of a novel three-dimensional (3D) imaging system in ESD using porcine stomachs. Methods Four endoscopists (two trainees and two experts) performed eight ESD procedures using both 3D and 2D images. The usefulness of 3D image versus 2D image was evaluated by visibility and procedure time. In addition, occurrence of eyestrain and dizziness in 3D image was assessed. Results En bloc resection was successfully achieved, without perforation, in all cases. The evaluation score in the 3D image group was better than that in the 2D image group, particularly depth perception was statistically significantly good. No significant difference was found in the working speed between the 2D and 3D image groups. Two examiners experienced eyestrain and dizziness while using the 3D image. Conclusions All the ESD procedures were performed safely. Depth perception using the 3D image was better than with the 2D image. A novel 3D image system may facilitate ESD.

scholarly journals Evaluating the effect of injecting triamcinolone acetonide in two sessions for preventing esophageal stricture after endoscopic submucosal dissection

2019 ◽  
Vol 07 (06) ◽  
pp. E764-E770 ◽  
Author(s):  
Satoru Hashimoto ◽  
Ken-ichi Mizuno ◽  
Kazuya Takahashi ◽  
Hiroki Sato ◽  
Junji Yokoyama ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Triamcinolone Acetonide ◽  
Esophageal Stricture ◽  
Control Group ◽  
Study Group ◽  
Stricture Formation ◽  
Endoscopic Injection ◽  
Submucosal Dissection ◽  
Stricture Rate ◽  
Significant Difference

Abstract Background and study aims Several previous reports indicate that endoscopic injection of triamcinolone acetonide (TA) after widespread endoscopic submucosal dissection (ESD) is effective for preventing esophageal stricture. We investigated the efficacy of injecting TA in two sessions for preventing stricture formation post-ESD. Patients and methods Sixty-six consecutive patients with widespread mucosal defects that affected more than three-fourths of the circumference of the esophagus were included. The study group (n = 40) received TA injections over two sessions: immediately after and 14 days after ESD. The control group (n = 26) did not receive a TA injection. This study was performed retrospectively against historical controls. The primary endpoint of this study was frequency of stricture after TA injection. The secondary endpoint was number of required endoscopic balloon dilations (EBDs) after TA injection. Results The post-ESD stricture rate among patients who had subcircumferential mucosal defects was 45.7 % in the study group (16/35 patients), which was significantly lower than the rate of 73.9 % in the control group (17/23 patients; P = 0.031). The number of EBD procedures required was significantly lower in the study group (median 0, range 0 – 7) than in the control group (median 4, range 0 – 20; P < 0.001). There was no significant difference between the study and control groups among the patients who had full circumferential mucosal defects. Conclusion This study showed that performing two sessions of TA injection is an effective and safe treatment for prevention of esophageal stricture following subcircumferential ESD.

Risk factors for conversion to snare resection during colorectal endoscopic submucosal dissection in an expert Western center

Endoscopy ◽  
2018 ◽  
Vol 51 (02) ◽  
pp. 152-160 ◽  
Author(s):  
Enrique Pérez-Cuadrado-Robles ◽  
Christophe Snauwaert ◽  
Tom Moreels ◽  
Anne Jouret-Mourin ◽  
Pierre Deprez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Submucosal Dissection ◽  
Tumor Size ◽  
Multivariable Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Factors Associated ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background There are limited data regarding the risk factors and consequences of conversion to endoscopic mucosal resection (rescue EMR) during colorectal endoscopic submucosal dissection (ESD) in Western centers. Methods This was a retrospective analysis of a prospectively collected database, from which 225 consecutive ESDs performed between 2013 and 2017 were selected. Of the included patients, 39 (18.6 %) required rescue EMR. Pre- and per-procedure characteristics were evaluated to determine the features associated with the need for rescue EMR. Outcomes and complications were also assessed. Results 210 patients were included, with median tumor size of 40 mm (range 20 – 110) and most tumors being in a non-rectal location (66.2 %). When compared with full ESD, rescue EMR was significantly associated with lower rates of en bloc resection (43.6 % vs. 100 %) and complete resection (R0 status; 28.2 % vs. 88.9 %), and with a higher rate of recurrence (5.1 % vs. 0 %) and more need for surgery (15.4 % vs. 3.5 %). In multivariable analysis, non-lifting (adjusted odds ratio [ORa] 3.06, 95 % confidence interval [CI] 1.23 – 7.66; P = 0.02), nongranular-type laterally spreading tumor (LST-NG; ORa 2.56, 95 %CI 1.10 – 5.99; P = 0.03), and difficult retroflexion (OR 3.22, 95 %CI 1.01 – 10.28; P = 0.049) were independent risk factors associated with conversion to rescue EMR, while tumor size and location were not. Conclusions During ESD, the presence of poor lifting, LST-NG morphology, and a difficult retroflexed approach were factors associated with the need to convert to rescue EMR. Conversion to rescue EMR remains a valuable strategy.

scholarly journals Usefulness of “Nelaton Attachment” for endoscopic submucosal dissection of colorectal neoplasms

2019 ◽  
Vol 07 (09) ◽  
pp. E1187-E1191 ◽  
Author(s):  
Taiji Yoshimoto ◽  
Hiroshi Takihara ◽  
Tomoatsu Yoshihara ◽  
Taro Inoue ◽  
Kohei Ishibashi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Ex Vivo ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Efficacy And Safety ◽  
En Bloc ◽  
Left Hand ◽  
Novel Device ◽  
Submucosal Dissection ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims Although colorectal endoscopic submucosal dissection (ESD) has enabled high en bloc resection rates regardless of tumor size, colorectal ESD is still a challenging procedure. We developed a novel device called the Nelaton Attachment, which allows endoscopists to manipulate the ESD knives using two fingers of their left hand while holding the endoscope with their right hand. We retrospectively investigated the efficacy and safety of the Nelaton Attachment for colorectal ESD. We compared efficacy and safety between Nelaton Attachment and non-Nelaton Attachment groups, and also conducted an ex vivo experiment to evaluate the effect of the Nelaton Attachment. Patients and methods We retrospectively reviewed 36 consecutive patients with 37 colorectal tumors who had undergone ESD at Kishiwada Tokushukai Hospital and Naritatomisato Tokushukai Hospital between April 2016 and September 2018. The Nelaton Attachment was used for 22 of the 37 colorectal ESDs. In the ex vivo experiment, endoscopists inserted and withdrew an ESD knife 2 cm using two fingers of their left hand with and without the Nelaton Attachment. Results Median procedure time was significantly shorter in the Nelaton Attachment group (38 min [range 6 – 195 min]) compared to the non-Nelaton Attachment group (75 min [range 17 – 198 min]; P = 0.030). Median time to complete the ex vivo experiment five times was significantly faster with the Nelaton Attachment than without the Nelaton Attachment (P = 0.001). Conclusions Use of the Nelaton Attachment for colorectal ESD is feasible and safe, and may facilitate colorectal ESD procedures.

scholarly journals Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection

2020 ◽  
Vol 08 (08) ◽  
pp. E1044-E1051
Author(s):  
Shuntaro Inoue ◽  
Noriya Uedo ◽  
Takahiro Tabuchi ◽  
Kentaro Nakagawa ◽  
Masayasu Ohmori ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Type ◽  
Procedure Time ◽  
Injection Solution ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Epinephrine-added submucosal injection solution is used to facilitate hemostasis of non-variceal upper gastrointestinal bleeding and to prevent delayed bleeding of large pedunculated colorectal lesions. However, its benefit in gastric endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is unclear. The effectiveness of epinephrine-added injection solution for outcomes of gastric ESD was examined using propensity score matching analysis. Patients and methods A total of 1,599 patients with solitary EGC (83 with non-epinephrine-added solution and 1,516 with epinephrine-added solution) between 2011 and 2018 were enrolled. Propensity scores were calculated to balance the distribution of baseline characteristics: age, sex, tumor location, specimen size, presence of ulcer scar, tumor depth, histological tumor type, and operators’ experience, and 1:3 matching was performed. En bloc resection rate, mean procedure time, delayed bleeding rate, and perforation rate were compared between the non-epinephrine (n = 79) and epinephrine (n = 237) groups. Results Mean procedure time was significantly shorter in the epinephrine group than in the non-epinephrine group (60 vs. 78 min, P < 0.001). No significant difference was found in the rate of en bloc resection (both 99 %), incidence of delayed bleeding (both 6 %), or perforation (0 vs. 0.8 %) between the two groups. In multiple linear regression analysis, use of epinephrine-added solution was independently associated with short procedure time (P < 0.001) after adjustment for other covariates. Conclusion The results suggest that epinephrine-added injection solution is useful for reduction of gastric ESD procedure time, warranting validation in a randomized controlled trial.

scholarly journals The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection

2018 ◽  
Vol 06 (08) ◽  
pp. E975-E983 ◽  
Author(s):  
Naohisa Yoshida ◽  
Yuji Naito ◽  
Ritsu Yasuda ◽  
Takaaki Murakami ◽  
Ryohei Hirose ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Procedure Time ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Intramucosal Cancer ◽  
Colorectal Endoscopic Submucosal Dissection ◽  
Severe Fibrosis

Abstract Background and study aims Severe fibrosis poses a challenge in colorectal endoscopic submucosal dissection (ESD). Recently, the pocket-creation method (PCM) has been developed for overcoming various difficulties of ESD. A specific tapered hood is used for adequate traction in the PCM, and endoscopic operability becomes stable in the pocket. In this study, we investigated the efficacy of the PCM in ESD for cases with severe fibrosis. Patients and methods We retrospectively reviewed 1000 consecutive colorectal ESD cases (April 2006 to January 2017). Since 2016, the PCM was performed in 58 cases. The indications for ESD included (1) tumors ≥ 20 mm in size diagnosed as intramucosal cancer or high-grade dysplasia and part of T1a cancer using magnifying endoscopic examinations and (2) tumors that appeared impossible to resect with endoscopic mucosal resection because of suspected fibrosis. We identified 120 cases with severe fibrosis and compared them to cases without severe fibrosis. Additionally, the 120 severe fibrosis cases were divided into the PCM and non-PCM groups. En bloc resection, procedure time, discontinuation, and complications were analyzed between these 2 groups. Results Among all 1000 ESDs, severe fibrosis and discontinuation rates were 12.0 % (120 cases) and 1.8 % (18 cases), respectively. Regarding the comparison between cases with severe fibrosis and with no severe fibrosis, there were significant differences about en bloc resection rate (78.3 % vs. 95.7 %, P < 0.001), discontinuance rate (12.5 % vs. 0.3 %, P < 0.001), and perforation rate (8.3 % vs. 2.6 %, P = 0.001). Among the 120 cases with severe fibrosis, 21 and 99 cases were in the PCM and non-PCM groups, respectively. The PCM group had a higher en bloc resection rate (95.2 vs. 74.7, P =  0.03), a shorter mean procedure time (min) (79.6 ± 26.5 vs. 118.8 ± 71.0, P = 0.001), and no cases of discontinuation. An analysis of the interobserver agreement for the diagnosis of severe fibrosis among the 3 endoscopists showed kappa values of > 0.6. Conclusions In cases with severe fibrosis, the PCM with ESD improved en bloc resection rates and shortened the procedure time compared to the conventional non-PCM method. Additionally, the PCM reduced the discontinuation rate.

Sign in / Sign up

Export Citation Format

Share Document