scholarly journals Endoscopic Submucosal Dissection for Neoplasia of the Greater Curvature of the Upper and Middle Stomach: J-shaped Superficial Cutting and Splashed Dissection

2019 ◽  
Vol 28 (4) ◽  
pp. 397-404
Author(s):  
Noriko Nishiyama ◽  
Hideki Kobara ◽  
Shintaro Fujihara ◽  
Kazuhiro Koduka ◽  
Taiga Chiyo ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Bleeding Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
Perforation Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Gastric Neoplasia ◽  
Greater Curvature

Background and Aims: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric neoplasia. However, as the upper and middle body of the greater curvature has a rich vasculature and submucosal fibrosis, ESD of neoplasia in these locations requires a specific strategy. We aimed to investigate the efficacy and safety of the J-shaped superficial cutting and splashed submucosal dissection (JSCS) technique for neoplasia of the greater curvature by comparing ESD using JSCS with conventional ESD. Methods: Twenty-two patients who underwent ESD for gastric neoplasia affecting the upper and middle body of the greater curvature were divided into two groups for retrospective analysis. Nine patients underwent conventional ESD (c-Group), while 13 underwent ESD with JSCS (j-Group). Primary outcome was the en bloc resection rate. Secondary outcomes included complete resection (R0) rate, procedure time, perforation rate, total bleeding time, and the total number of massive bleeding events and of hemostatic forceps times applied during ESD. Results: There were no significant differences between both groups (c-Group vs j-Group) in en bloc resection rate, or R0 resection rate. Compared with the c-Group, the j-Group tended to have a decreased mean procedure time (mean 133 minutes vs 74 minutes, p=0.11) and perforation rate (11% vs 0%, p=0.41). Compared with the c-Group, the j-Group had significantly fewer bleeding incidents (13.4 times vs 6.6 times, p=0.0095), shorter total bleeding time (17.6 min vs 7.4 min, p=0.036), and fewer usages of hemostatic forceps (6.3 times vs 2.4 times, p=0.026) during ESD. Conclusion: Endoscopic submucosal dissection with JSCS is superior to conventional ESD, as it reduces intraprocedural bleeding. This technique has the potential to become the standard strategy for neoplasia affecting the upper and middle body of the greater curvature.

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.

scholarly journals Preoperative endoscopic predictors of severe submucosal fibrosis in colorectal tumors undergoing endoscopic submucosal dissection

2019 ◽  
Vol 07 (04) ◽  
pp. E421-E430 ◽  
Author(s):  
Uayporn Kaosombatwattana ◽  
Takeshi Yamamura ◽  
Julajak Limsrivilai ◽  
Masanao Nakamura ◽  
Somchai Leelakusolvong ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
Significant Risk ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Submucosal Fibrosis ◽  
Severe Fibrosis

Abstract Background and study aims Endoscopic submucosal dissection (ESD) enables en bloc removal of colorectal neoplasms regardless of size. Submucosal fibrosis is a significant factor for technical difficulty and poor outcomes. We assessed the predictive factors for severe submucosal fibrosis and the ESD outcomes. Patients and methods Patients undergoing ESD from January 2006 to September 2017 were retrospectively reviewed. The degree of submucosal fibrosis was classified into three types: no fibrosis (F0), mild fibrosis (F1), and severe fibrosis (F2). F0 and F1 cases were grouped as non-severe fibrosis for comparison with the severe fibrosis group. Predictors of severe submucosal fibrosis and ESD outcomes were evaluated. Results ESD was performed in 524 lesions (60 % male; mean age, 67.8 years). Eighty lesions with severe fibrosis (15.3 %) were observed. The overall en bloc resection rate and curative resection rate were 94.3 % and 77.7 %, respectively. Rates of en bloc resection (91.2 % vs. 94.8 %, P = 0.2) and perforation (7.5 % vs. 5.6 %, P = 0.45) were no different between severe fibrosis and non-severe fibrosis groups. However, incidences of non-curative resection and low resection speed were significantly higher in the severe fibrosis group. Among protruding lesions, tumor height and volume were significantly greater in the severe counterparts. A diameter ≥ 40 mm, endoscopic finding of the tumor beyond fold, and fold convergence were independent risk factors for severe fibrosis. Conclusions Severe submucosal fibrosis is a significant risk factor for non-curative resection and a long procedural time. Tumor size and morphology might help to predict the severity of fibrosis.

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.

Endoscopic submucosal dissection performed in livE pig models and in humans with large, laterally spreading gastric and colorectal adenomas – Assessment of the initial learning curves, success rate and complications

2012 ◽  
Vol 153 (21) ◽  
pp. 824-833
Author(s):  
Gábor Balogh jr. ◽  
Zsolt Dubravcsik ◽  
Attila Szepes ◽  
László Madácsy
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Total Duration ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Specimen Size ◽  
Colorectal Adenomas ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Hungarian Experience

Endoscopic submucosal dissection is a promising new endoscopic technique for en block resection of early, superficial, flat, and laterally spreading gastrointestinal neoplasms. The primary aims of this prospective study were to summarize the first Hungarian experience with endoscopic submucosal dissection, and to compare the experimental in vivo procedures in pigs with the human application of this technique in two academic centers. Methods: The ex vivo Erlangen pig model was used until initial competence was achieved. Thereafter 15 endoscopic submucosal dissection procedures were performed in up to 5 sessions in living pigs under general anesthesia. After submucosal injection with saline Fujinone ball tip, a Flush knife was used with a transparent hood for circumferential incision and submucosal dissection. The following variables were analyzed: specimen size, complete and en bloc resection rate, total duration of the procedure, and complications. Furthermore, between 2009 and 2012, 14 endoscopic submucosal dissections were carried out in humans; 1 duodenal, 3 gastric and 10 colorectal interventions were performed due to large laterally spreading intramucosal neoplasms. The specimen size, en bloc resection rate, total duration of the procedure and complications were next analyzed. Results: 87% complete resection rate, 29.4±19.5 cm2 specimen size and 136.2±26.8 min of procedure duration were achieved in the live pig models. Nontransmural damages of the muscular layer occurred in 3/15 (20%) cases which were successfully closed with hemoclips, except in one pig that died due to fatal esophageal perforation. All bleedings were easily managed with hot biopsy forceps coagulation and hemoclips without hemodynamic instability. In humans, endoscopic submucosal dissection was accomplished with an 11/14 (79%) en block resection rate, with average resected specimen size of 11.56±4.9 cm2 and with 157±55 min of operating time. Two cases of bleeding and 2 cases of perforation occurred (14%), all of which were managed endoscopically. After 1.5 year of average follow up, local recurrence occurred in one case only. In addition, due to the 3 incomplete resections and unsuccessful endoscopic submucosal dissection, surgical intervention was required in 4 cases altogether. Conclusions: This study demonstrates the first Hungarian experience with endoscopic submucosal dissection. Training in live pig models could help endoscopists to overcome the learning curve and minimize the risk of complications before starting the procedure in humans. Reduction in the resection time and low risk of complications, especially bleeding, could be achieved by the application of a flush knife. Orv. Hetil., 2012, 153, 824–833.

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.

scholarly journals Implementation of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms in Sweden

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Henrik Thorlacius ◽  
Noryia Uedo ◽  
Ervin Toth
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Adenomas ◽  
Unexpected Finding ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection

Objectives. Endoscopic submucosal dissection (ESD) is an effective method for en bloc removal of large colorectal tumors in Japan, but this technique is not yet widely established in western countries. The purpose here was to report the experience of implementing colorectal ESD in Sweden.Methods. Twenty-nine patients with primarily nonmalignant and early colorectal neoplasms considered to be too difficult to remove en bloc with EMR underwent ESD. Five cases of invasive cancer underwent ESD due to high comorbidity excluding surgical intervention or as an unexpected finding.Results. The median age of the patients was 74 years. The median tumor size was 26 mm (range 11–89 mm). The median procedure time was 142 min (range 57–291 min). En bloc resection rate was 72% and the R0 resection rate was 69%. Two perforations occurred amounting to a perforation rate of 6.9%. Both patients with perforation could be managed conservatively. One bleeding occurred during ESD but no postoperative bleeding was observed.Conclusion. Our data confirms that ESD is an effective method for en bloc resection of large colorectal adenomas and early cancers. This study demonstrates that implementation of colorectal ESD is feasible in Sweden after proper training, careful patient selection, and standardization of the ESD procedure.

scholarly journals Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

2020 ◽  
Author(s):  
Ting Fan ◽  
Qi Sun ◽  
Shouli Cao ◽  
Xiangshan Fan ◽  
Qin Huang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Cardiac Cancer ◽  
Submucosal Dissection ◽  
Metastasis Rate

Abstract Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% ( P =0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively ( P <0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% ( P <0.001). The distant metastasis rate was 0.4%, 0% and 2.3% ( P =0.150). The five-year disease-specific survival rate in the BEI group was 96.6% ( P =0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

scholarly journals Current research status of endoscopic submucosal dissection for colorectal neoplasms

2012 ◽  
Vol 35 (4) ◽  
pp. 158 ◽  
Author(s):  
Chen Huang ◽  
Ren-Xiang Huang ◽  
Ping Xiang ◽  
Zheng-Jun Qiu
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
Local Recurrence Rate ◽  
Standard Treatment ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Review Article ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection

Endoscopic submucosal dissection (ESD) has been applied to, and gradually standardized for, early gastric cancers; however, it has not yet been widely used for treatment of colorectal neoplasms. Compared with gastric ESD, the thinner colorectal wall and winding nature of the colon make colorectal ESD a much more difficult operative technique. Despite greater risks of postoperative complications, particularly perforation of the colon, more and more endoscopists are making an effort to study this new technique in terms of its capability of larger neoplastic resection, higher en bloc resection rate and lower local recurrence rate of neoplasms in comparison with other endoscopic treatments. Thus, colorectal ESD may become the standard treatment for early colorectal neoplasms in the future. This review article discusses the current research on endoscopic submucosal dissection for colorectal neoplasms.

scholarly journals Wide-field endoscopic submucosal dissection for the treatment of Barrett’s esophagus neoplasia

2021 ◽  
Vol 09 (05) ◽  
pp. E727-E734
Author(s):  
Masami Omae ◽  
Hannes Hagström ◽  
Nelson Ndegwa ◽  
Michael Vieth ◽  
Naining Wang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Barrett’S Esophagus ◽  
Barrett's Esophagus ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Wide Field ◽  
Resection Rate ◽  
En Bloc ◽  
Multicenter Studies ◽  
Submucosal Dissection

Abstract Background and study aims Implementation of endoscopic submucosal dissection (ESD) for the treatment of Barrett’s esophagus neoplasia (BEN) has been hampered by high rates of positive margins and complications. Dissection with wider margins was proposed to overcome these problems, but was never tested. We aim to compare Wide-Field ESD (WF-ESD) with conventional ESD (C-ESD) for treatment of BEN. Patients and methods This was a cohort study of all ESDs performed in our center during 2011 to 2018. C-ESD was the only technique used before 2014, with WF-ESD used beginning in 2014. In WF-ESD marking was performed 10 mm from the tumor margin compared to 5 mm with C-E. Results ESD was performed in 90 cases, corresponding to 74 patients, 84 % male, median age 69. Of these, 22 were C-ESD (24 %) and 68 were WF-ESD (76 %). The en bloc resection rate was 95 vs 100 % (ns), the positive lateral margin rate was 23 % vs 3 % (P  < 0.01), the R0 rate was 73 % vs 90 %, and the curative resection rate was 59 % vs 76 % in the C-ESD and WF-ESD groups, respectively, (both P > 0.05). The procedure speed was 4.4 and 2.3 (min/mm) in the C-ESD and WF-ESD groups (P < 0.01), respectively. WF-ESD was associated with less post-operative strictures, 6 % vs 27 % (P = 0.01), with no local recurrence but no significantly reduced risk of metachronous recurrence (Hazard Ratio = 0.46, 95 %CI = 0.14–1.46), during a follow-up of 13.4 and 9.4 months in the C-ESD and WF-ESD cohorts, respectively. Conclusions WF-ESD is associated with a reduction in positive lateral margins, faster dissection, and lower stricture rates. Further prospective, multicenter studies are warranted to evaluate its role in clinical practice.

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