scholarly journals Clinicopathologic correlations of superficial esophageal adenocarcinoma in endoscopic submucosal dissection specimens

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Sadhna Dhingra ◽  
Firas Bahdi ◽  
Sarah B. May ◽  
Mohamed O. Othman
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Esophageal Adenocarcinoma ◽  
Tumor Invasion ◽  
Invasive Adenocarcinoma ◽  
Submucosal Dissection ◽  
Deep Margin ◽  
Poor Outcomes ◽  
Histopathologic Features

Abstract Background Endoscopic submucosal dissection (ESD) is a novel endoscopic treatment for early esophageal adenocarcinoma (EAC). The western pathologists’ experience with ESD specimens remains limited. This study aimed to correlate histopathologic features of Barrett’s esophagus (BE)-associated adenocarcinoma in ESD resections with clinical outcomes to determine whether they aid future management decisions. Methods We retrospectively evaluated 49 consecutive ESD resection specimens from 42 patients with BE-associated adenocarcinoma (24 intramucosal and 18 submucosal EAC) at a single tertiary referral center. Pathologic evaluation included presence of dysplasia, invasive adenocarcinoma, peritumoral inflammation, desmoplasia, lymphovascular and perineural invasion; tumor differentiation, depth of invasion, morphology, and budding; and margin status for dysplasia or carcinoma. Follow up data included endoscopic biopsies in 35 patients and pathology reports of esophagectomies in 11 patients. Poor outcomes were defined as recurrence or residual invasive adenocarcinoma at esophagectomy, metastasis on imaging, or R1 resection in patients undergoing ESD for tumor debulking. Results Two patients (8%) with intramucosal adenocarcinoma and 9 patients (50%) with submucosal adenocarcinoma had poor outcomes. Histopathologic features associated with poor outcomes included poor differentiation, lymphovascular invasion, submucosal invasion > 500 μm, tumor budding, and tubuloinfiltrative histologic pattern. Four patients had positive deep margin away from the deepest tumor invasion and did not show residual tumor on follow up. Conclusions Our results validated European Society of Gastroenterology (ESGE) guidelines of high-risk pathologic features for additional therapy in esophageal adenocarcinoma and identified tumor budding frequently in association with other high-risk features. Positive deep margin distant from deepest tumor invasion could be procedural and warrants endoscopic correlation for management.

OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) DURING LIVE ENDOSCOPY EVENTS – A 12- YEAR FOLLOW-UP

2019 ◽  
Author(s):  
A Ebigbo ◽  
S Freund ◽  
A Probst ◽  
C Römmele ◽  
S Gölder ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Submucosal Dissection

scholarly journals Feasibility of a modified search, coagulation, and clipping method with and without the use of polyglycolic acid sheets and fibrin glue for preventing delayed bleeding after gastric endoscopic submucosal dissection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Satoshi Abiko ◽  
Soichiro Oda ◽  
Akimitsu Meno ◽  
Akane Shido ◽  
Sonoe Yoshida ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Median Time ◽  
Fibrin Glue ◽  
Polyglycolic Acid ◽  
Low Risk ◽  
R0 Resection ◽  
Antithrombotic Agents ◽  
Delayed Bleeding ◽  
Submucosal Dissection

Abstract Background Methods have been developed for preventing delayed bleeding (DB) after gastric endoscopic submucosal dissection (GESD). However, none of the methods can completely prevent DB. We hypothesized that DB could be prevented by a modified search, coagulation, and clipping (MSCC) method for patients at low risk for DB and by combining the use of polyglycolic acid sheets and fibrin glue with the MSCC method (PMSCC method) for patients at high risk for DB (antibleeding [ABI] strategy). This study assessed the technical feasibility of this novel strategy. Method We investigated 123 lesions in 121 consecutive patients who underwent GESD in Kushiro Rosai Hospital between April 2018 and January 2020. The decision for continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment. Results Oral antithrombotic agents were administered to 28 patients (22.8%). The en bloc R0 resection rate was 98.4%. The MSCC method and the PMSCC method for preventing DB were performed in 114 and 9 lesions, respectively. The median time of the MSCC method was 16 min, and the median speed (the resection area divided by the time of method used) was 3.6 cm2/10 min. The median time of the PMSCC method was 59 min, and the median speed was 1.3 cm2/10 min. The only delayed procedural adverse event was DB in 1 (0.8%) of the 123 lesions. Conclusions The ABI strategy is feasible for preventing DB both in patients at low risk and in those at high risk for DB after GESD, whereas the PMSCC method may be necessary for reduction of time.

PS02.146: LARYNX-PRESERVING SURGERY FOR CERVICAL ESOPHAGEAL CANCER USING INTRAOPERATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION: A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 162-162
Author(s):  
Yoshiki Taniguchi ◽  
Koji Tanaka ◽  
Yasuhiro Miyazaki ◽  
Tomoki Makino ◽  
Tsuyoshi Takahashi ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Endoscopic Submucosal Dissection ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Tumor Invasion ◽  
Pathological Examination ◽  
Submucosal Layer ◽  
Cervical Esophageal Cancer ◽  
Submucosal Dissection

Abstract Background We sometimes experience cases of cervical esophageal cancer which requires laryngectomy due to spread of cancer to larynx. We report a case of esophageal cancer resection with preservation of larynx using intraoperative endoscopic submucosal dissection. Methods The patient was a 59-year-old woman who had dysphagia. She had received total gastrectomy with Roux-en-Y reconstruction for gastric cancer in 2001, chemoradiation (61.2Gy) for esophageal cancer in 2008. Argon plasma coagulation (APC) was performed for the carcinoma in situ of cervical esophagus in 2016. This time superficial 0-IIc tumor was observed at the same site of the scar of APC, and a biopsy revealed squamous cell carcinoma. An endoscopic findings revealed two 0-IIc lesions at distance of 18–22 cm, and 32–34 cm from the incisors, and biopsy resulted in a diagnosis of squamous cell carcinoma. Since tumor was close to the esophageal orifice, the tumor invasion to the larynx was suspected. On the other hand, there were no obvious findings of the submucosal layer invasion, and the both tumor were thought to be limited to the epithelium or lamina propria mucosae (EP/LPM). We performed mediastinoscopic and thoracoscopic transhiatal esophagectomy, subcutaneous ileocolic reconstruction. Results After confirming the tumor invasion to the esophageal orifice by chromoendoscopy with 1% Lugol's iodine solution, we dissected the whole circumference of esophagus in submucosal layer just above the tumor by ESD, put an incision outside of esophageal wall, and resected the esophagus. We preserved short length of muscle layer and performed reconstruction with hypopharynx-ileum anastomosis. Pathological examination revealed squamous cell carcinoma, pT1a-EP, ly0, v0, pPM0, pDM0, pIM0, and curative resection was performed. The postoperative course was uneventful. Conclusion There were no reports of successful larynx-preserving surgery for cervical esophageal cancer using intraoperative ESD. When the tumor was limited in the mucosa, esophagectomy with intraoperative ESD may enable larynx preservation even if the tumor invaded to the esophageal orifice. Disclosure All authors have declared no conflicts of interest.

scholarly journals Cervical esophageal adenocarcinoma arising from heterotopic gastric mucosa, treated with endoscopic submucosal dissection

Endoscopy ◽  
2018 ◽  
Vol 51 (02) ◽  
pp. E28-E29 ◽  
Author(s):  
Yasuhiro Oono ◽  
Shinmura Kensuke ◽  
Yusuke Yoda ◽  
Keisuke Hori ◽  
Hiroaki Ikematsu ◽  
...  
Keyword(s):  
Gastric Mucosa ◽  
Endoscopic Submucosal Dissection ◽  
Esophageal Adenocarcinoma ◽  
Heterotopic Gastric Mucosa ◽  
Submucosal Dissection

scholarly journals Polysaccharide hemostatic powder to prevent bleeding after endoscopic submucosal dissection in high risk patients: A randomized controlled trial

Endoscopy ◽  
2020 ◽  
Author(s):  
Da Hyun Jung ◽  
Chan Hyuk Park ◽  
Hee Seok Moon ◽  
Jun Chul Park
Keyword(s):  
High Risk ◽  
Endoscopic Submucosal Dissection ◽  
Controlled Trial ◽  
Gastric Neoplasms ◽  
Control Group ◽  
High Risk Patients ◽  
Randomized Controlled ◽  
Submucosal Dissection ◽  
Risk Patients ◽  
Hemostatic Powder

Background and aims: Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Several methods to prevent post-ESD bleeding (PEB) have been introduced; however, they have not been widely used because of technical difficulties. We aimed to investigate whether polysaccharide hemostatic powder (PHP), which is very easy to apply, can prevent early PEB, especially in patients with high risk of PEB. Methods: This was a prospective, multicenter, randomized, open-label, controlled trial. Patients with a high risk for PEB were enrolled. Patients with gastric neoplasms in whom the resected specimen size was expected to be >40 mm and those who were regularly taking antithrombotic agents were defined as high-risk patients. Patients were randomly assigned to the PHP or control group. Results: Between May 2017 and September 2018, 143 patients were enrolled (PHP group: 73, control group: 70). The total PEB rate was 6.3% (PHP group: 5% vs. control group: 7.1%, P=0.742). There was no bleeding within 7 days after ESD in the PHP group. Continued antithrombotic use was an independent risk factor of PEB. In subgroup analysis excluding patients who continued to take antithrombotics (n=129) during ESD, the rate of PEB was tended to be lower in the PHP group than in the control group (0% vs. 6.3%, P=0.058). Conclusion: PHP did not demonstrate a significant effect on the prevention of PEB in this study. Further larger-scale, randomized controlled trials are needed to confirm this.(ClinicalTrials.gov 03169569)

PS02.035: CIRCUMFERENTIAL ENDOSCOPIC SUBMUCOSAL DISSECTION OF A LARGE SUPERFICIAL OESOPHAGUS SQUAMOUS CELL CANCER WITHOUT STRICTURES ON FOLLOW-UP

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 129-130
Author(s):  
Francisco Baldaque-Silva ◽  
Magnus Konradsson ◽  
Naning Wang ◽  
Masami Omae
Keyword(s):  
Hyaluronic Acid ◽  
Endoscopic Submucosal Dissection ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
High Volume ◽  
Stricture Formation ◽  
Submucosal Dissection ◽  
Oral Steroids

Abstract Description The optimal treatment for oesophageal superficial squamous cell cancer (SCC) is end bloc resection, that in large lesions is only possible with endoscopic submucosal dissection (ESD). Resections larger than 3cm, in the upper esophagus and encompassing more than 3/4 of the luminal circumference, are associated with high stricture rate. That risk is virtually 100% in cases of circumferential ESD. High focus had been given to preventive measurements such as steroids injection, oral steroids or cell sheet transplantation. Usually highly osmotic substances such as Glicerol ® are used for subepitelial lifting. Hyaluronic acid has high viscosity and anti-inflammatory proprieties, that due to its high cost is not widely used in ESD or is used in low concentration formulas and low volume. We report a case of a 7.5 cm long circumferential oesophageal ESD performed with injection of a high volume and concentration of hyaluronic acid that was not associated with stricture in the follow-up. A 73 years-old male patient was referred to our clinic due to the presence of a long superficial lesion and biopsies positive for SCC. We performed chromoendoscopy with lugol that revealed the presence of a ca 6cm long Paris IIa-b, circumferential SCC in the middle esophagus with ‘Tatami-no-me ‘and ‘pink-color’ signs, without ulcers or other endoscopic signs of deep invasion. The PET-CT was negative for metastasis. After multidisciplinary conference and patient's consent an ESD was performed under full narcosis using Dualknife ® and hyaluronic acid for subepitelial injection. A 7.5 cm circumferential ESD specimen was resected and the patient was discharged at day 3 without complications under proton pump Inhibitors and a step-down dose of 30mg/d of oral prednisolone. The pathological result revealed R0 resection of a SCC with invasion of the superficial muscularis mucosae (T1a) and no lymphovascular engagement. The follow-up at 2, 5, 8 weeks and 6, 9 and 12 months revealed the absence of stricture. There was no cancer recurrence in the last follow-up (1 year). Long circumferential ESD of oesophageal SCC is possible with curative intent. The combination of PPI, oral steroids and high volume/concentration of hyaluronic acid, avoided stricture formation in this case. Disclosure All authors have declared no conflicts of interest.

Histopathologic Change of a Case of Gastric Oxyntic Neoplasm (Gastric Adenocarcinoma of Fundic Gland Mucosa Type) Through 5 Years With Concurrent Other Oxyntic Gland Lesions

2020 ◽  
pp. 106689692096257
Author(s):  
Yoko Sato ◽  
Taiki Sato ◽  
Jun Matsushima ◽  
Akiko Fujii ◽  
Yuko Ono ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Gastric Adenocarcinoma ◽  
Chief Cell ◽  
Fundic Gland ◽  
Submucosal Dissection ◽  
Epithelial Neoplasms ◽  
Oxyntic Gland ◽  
Gland Type ◽  
Histological Progression

Some gastric epithelial neoplasms show predominant chief cell differentiation (oxyntic gland neoplasms), in which the entity of “gastric adenocarcinoma of fundic gland type” was firstly designated, whereas a possible more aggressive subgroup “gastric adenocarcinoma of fundic gland mucosa type” (GA-FGM) was subsequently proposed. However, the histopathologic progression mode of these neoplasms has not been sufficiently reported. In this article, we describe a case of GA-FGM in which we could observe its progression during 5 years. The tumor was removed by endoscopic submucosal dissection 5 years after the first biopsy, which had already shown a feature of oxyntic gland neoplasm. During the follow-up period, the endoscopy revealed little change in the tumor appearance. However, the histology of endoscopic submucosal dissection showed submucosal extension with its histological progression. Besides, other oxyntic gland neoplasms of the stomach were observed metachronously or synchronously, giving an implication about a common pathogenetic basis of these lesions.

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