Endoscopic Submucosal Dissection for Early-Stage Neuroendocrine Carcinoma of The Esophagus ：A Case Report

2021 ◽  
Author(s):  
Nan Tang ◽  
Zhonghua Cheng ◽  
Zhen Fen
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Neuroendocrine Carcinoma ◽  
Histopathological Examination ◽  
Early Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Muscularis Mucosa ◽  
En Bloc ◽  
Carcinoma Of The Esophagus ◽  
Submucosal Dissection

Abstract Background: Neuroendocrine carcinoma (NEC) of the esophagus is rare, highly aggressive and lacks biological features. Case presentation: In this report, we describe a patient with Esophageal NEC who was successfully treated using endoscopic submucosal dissection (ESD). A 55-year-old woman presented with intermittent mild dysphagia for 2 months. Gastroscopy revealed a disc-shaped protruding lesion about 18mm×18mm in size on the upper esophagus, 25cm from the incisors. Endoscopic ultrasonography (EUS) demonstrated the bulged lesion was highly echoic and homogeneous, originating from the muscularis mucosa. We assessed en bloc resection by ESD for therapeutic diagnosis to be a safe and appropriate treatment. The tumor was removed using ESD. Histopathological examination revealed a poorly differentiated neoplasm comprising large cells with marked nuclear atypia and multifocal necrosis Immunohistochemistry staining revealed tumor tissue that was positive for Ki67, CgA, Syn, CD56, but negative for P40, P63, S-100 protein. These histopathological results were consistent with a diagnosis of esophageal NEC, large cell type, derived from the muscularis mucosae. After comprehensive consideration, we adopted the combination treatments (ESD plus an adjuvant chemotherapy). The patient has been followed up till now with no recurrence. Conclusions: En bloc resection approach by ESD play a vital role in the early therapeutic diagnosis of esophageal NEC.

scholarly journals Current Challenge: Endoscopic Submucosal Dissection of Superficial Non-ampullary Duodenal Epithelial Tumors

2020 ◽  
Vol 21 (12) ◽  
Author(s):  
Kazuya Akahoshi ◽  
Masaru Kubokawa ◽  
Kazuki Inamura ◽  
Kazuaki Akahoshi ◽  
Yuki Shiratsuchi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Submucosal Dissection ◽  
Endoscopic Resection ◽  
Early Stage ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Epithelial Tumors

Opinion statement With the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.

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 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 Endoscopic submucosal dissection of 301 large colorectal neoplasias: outcome and learning curve from a specialized center in Europe

2018 ◽  
Vol 06 (11) ◽  
pp. E1340-E1348 ◽  
Author(s):  
Carl-Fredrik Rönnow ◽  
Noriya Uedo ◽  
Ervin Toth ◽  
Henrik Thorlacius
Keyword(s):  
Learning Curve ◽  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasia ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
High Rate ◽  
R0 Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Immediate Bleeding

Abstract Background and study aims Endoscopic submucosal dissection (ESD) allows en bloc resection of large colorectal lesions but ESD experience is limited outside Asia. This study evaluated implementation of ESD in the treatment of colorectal neoplasia in a Western center. Patients and methods Three hundred and one cases of colorectal ESD (173 rectal and 128 colonic lesions) were retrospectively evaluated in terms of outcome, learning curve and complications. Results Median size was 4 cm (range 1 – 12.5). En bloc resection was achieved in 241 cases amounting to an en bloc resection rate of 80 %. R0 resection was accomplished in 207 cases (69 %), RX and R1 were attained in 83 (27 %) and 11 (4 %) cases, respectively. Median time was 98 min (range 10 – 588) and median proficiency was 7.2 cm2/h. Complications occurred in 24 patients (8 %) divided into 12 immediate perforations, five delayed perforations, one immediate bleeding and six delayed bleedings. Six patients (2 %), all with proximal lesions, had emergency surgery. Two hundred and four patients were followed up endoscopically and median follow-up time was 13 months (range 3 – 53) revealing seven recurrences (3 %). En bloc rate improved gradually from 60 % during the first period to 98 % during the last period. ESD proficiency significantly improved between the first study period (3.6 cm2/h) and the last study period (10.8 cm2/h). Conclusions This study represents the largest material on colorectal ESD in the west and shows that colorectal ESD can be implemented in clinical routine in western countries after appropriate training and achieve a high rate of en bloc and R0 resection with a concomitant low incidence of complications. ESD of proximal colonic lesions should be attempted with caution during the learning curve because of higher risk of complications.

scholarly journals En bloc resection of carcinoid tumor by a hybrid endoscopic submucosal dissection technique

Endoscopy ◽  
2018 ◽  
Vol 50 (12) ◽  
pp. E346-E347
Author(s):  
Sergio Rubel Cohen ◽  
Fernando Fluxa ◽  
Pablo Fabre ◽  
Fernando Uribe Reyes ◽  
Mara Ferraris
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Carcinoid Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Dissection Technique

En bloc resection of cardia cancer and lipoma with endoscopic submucosal dissection

2009 ◽  
Vol 41 (3) ◽  
pp. 237 ◽  
Author(s):  
S. Ono ◽  
M. Fujishiro ◽  
O. Goto ◽  
S. Kodashima ◽  
M. Omata
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cardia Cancer ◽  
En Bloc ◽  
Submucosal Dissection

scholarly journals Outcomes of Endoscopic Submucosal Dissection for Subepithelial Lesions Localized Within the Submucosa, Including Neuroendocrine Tumors: A Multicenter Prospective Study

2020 ◽  
Vol 29 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Hideki Kobara ◽  
Yoichi Miyaoka ◽  
Yoshio Ikeda ◽  
Takayoshi Yamada ◽  
Masashi Takata ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Neuroendocrine Tumors ◽  
Curative Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Organ Specific ◽  
Multicenter Prospective Study ◽  
Subepithelial Lesions

Background and Aims: Endoscopic submucosal dissection (ESD) seems to be a reasonable option for gastrointestinal subepithelial lesions (SELs) localized within the submucosa. Indications for ESD include small neuroendocrine tumors (NETs) and indeterminate SELs. However, the prospective data regarding ESD and surveillance remain unclear. This study was performed to prospectively investigate the outcomes of ESD, including organ-specific outcomes and the mid-term prognosis. Methods: This prospective multicenter study included 57 patients who underwent ESD for SELs localized within the submucosa [definite NETs (n = 42) and indeterminate SELs (n = 15)]. The efficacy and safety of ESD were evaluated in the whole cohort and in subgroups (NETs and indeterminate SELs). All patients were followed up. Results: The rates of en bloc resection, curative resection, and complications were 98.2%, 66.7%, and 7.7% for the overall population (n=57); 100%, 61.9%, and 2.4% for NETs (n=42); and 93.3%, 80.0%, and 20.0% for indeterminate SELs (n=15), respectively. The rates of curative resection for NETs were poorer in the stomach (20%, n=5) and duodenum (33%, n=3) than in the rectum (71%, n=34). Including 11 of 16 patients with NETs who underwent a conservative approach resulting in non-curative resection, no patients developed tumor recurrence during the follow-up period (median, 24.5 months; range, 1–60 months). ESD followed by surveillance demonstrated acceptable mid-term outcomes for non-curative NETs. Conclusions: ESD can be an efficient therapy for SELs localized within the submucosa. However, gastric and duodenal ESD for NETs may be limited in terms of its curative and technical aspects. Clinicians should be aware of the potential complications of ESD for indeterminate SELs.

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