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Hirose R, Daidoji T, Naito Y, Dohi O, Yoshida N, Yasuda H, Konishi H, Nakaya T, Itoh Y. A New Ex Vivo Model for the Evaluation of Endoscopic Submucosal Injection Material Performance. J Vis Exp 2018. [PMID: 30394381 DOI: 10.3791/58029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Increasing the performance of submucosal injection materials (SIMs) is important for endoscopic therapy of early gastrointestinal cancer. It is essential to establish an ex vivo model that can evaluate SIM performance accurately, for developing high-performance SIMs. In our previous study, we developed a new ex vivo model that can be used to evaluate the performance of various SIMs in detail by applying constant tension to the specimen's ends. We also confirmed that the proposed new ex vivo model allows accurate submucosal elevation height (SEH) measurement under uniform conditions and detailed comparisons of the performances of various types of SIMs. Here, we describe the new ex vivo model and explain the detailed setup methodology of this model. Since all parts of the new model were easy to obtain, the setup of the new model could be completed quickly. SEH of various SIMs could be measured more accurately by using the new model. The critical factor that determines SIM performance can be identified using the new model. SIM development speed will drastically increase after the factor has been identified.
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Affiliation(s)
- Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine; Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine;
| | - Tomo Daidoji
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Hiroaki Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Takaaki Nakaya
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
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Hirose R, Nakaya T, Naito Y, Daidoji T, Dohi O, Yoshida N, Yasuda H, Konishi H, Itoh Y. Identification of the critical viscoelastic factor in the performance of submucosal injection materials. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2018; 94:909-919. [PMID: 30423779 DOI: 10.1016/j.msec.2018.10.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 12/17/2022]
Abstract
High-performance submucosal injection materials (SIMs) contribute to the success of endoscopic therapy for early-stage gastrointestinal neoplasms. This study aimed to identify the most important factor (viscoelastic parameter) that determines SIM performance and the ease of injection. To determine the ideal viscoelastic parameters of SIMs, submucosal elevation heights (SEHs) and the ease of submucosal injection [characterized by injection pressures (IPs)] were evaluated using a newly developed ex vivo model, in which a constant tension was applied to the studied specimen. The strongest positive correlation was observed between the loss modulus determined at an oscillation frequency of 0.1 rad/s and SEH (correlation coefficient > 0.9) and between the loss modulus at 10 rad/s and IP (correlation coefficient > 0.9). SIMs with high loss moduli (0.1 rad/s) also contributed to maintenance of the submucosal elevation. Moreover, the SEHs of pseudoplastic fluid SIMs (whose loss moduli increased slightly with increasing angular frequency) were greater than those of Newtonian fluid SIMs (whose loss modulus increased drastically with increasing angular frequency). In this study, the ideal viscoelastic SIM parameters were clarified. The loss modulus (0.1 rad/s) was the most important viscoelastic factor affecting SIM performance. Additionally, the development of pseudoplastic fluid SIMs may lead to the creation of next-generation SIMs, with a performance superior to that of sodium hyaluronate, which is currently used widely in endoscopic treatments.
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Affiliation(s)
- Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Takaaki Nakaya
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomo Daidoji
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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53
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Malik S, Sharma G, Sanaka MR, Thota PN. Role of endoscopic therapy in early esophageal cancer. World J Gastroenterol 2018; 24:3965-3973. [PMID: 30254401 PMCID: PMC6148428 DOI: 10.3748/wjg.v24.i35.3965] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Esophageal carcinoma is a highly lethal cancer associated with high morbidity and mortality. Esophageal squamous cell carcinoma and esophageal adenocarcinoma are the two distinct histological types. There has been significant progress in endoscopic diagnosis and treatment of early stages of cancer using resection and ablation techniques, as shown in several trials in the recent past. Earlier detection of esophageal cancer and advances in treatment modalities have lead to improvement in the 5-year survival from 5% to about 20% in the past decade. Endoscopic eradication therapy is the preferred modality of treatment in cancer limited to mucosal layer of the esophagus as there is very low risk of lymph node metastasis, leading to high cure rates, low risk of recurrence and with few adverse effects. The most common adverse events seen are strictures, bleeding and rarely perforation which can be endoscopically managed. In patients with recurrent advanced disease or invasive tumor, esophagectomy with lymph node dissection remains the mainstay of treatment. There is debate on post-endoscopic surveillance with some studies suggesting closer follow up with upper endoscopy every 6 mo for the first 1-2 years and then annually for the 3 years while others recommending the appropriate action only if symptoms or other abnormalities develop. Overall, the field of endoscopic therapy is still evolving and focus should be placed on careful patient selection using a multidisciplinary approach.
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Affiliation(s)
- Sonika Malik
- Department of Internal Medicine, Cleveland Clinic Akron General Medical Center, Akron, OH 44307, United States
| | - Gautam Sharma
- Department of Anesthesiology, University Hospitals, Cleveland, OH 44106, United States
| | - Madhusudhan R Sanaka
- Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, OH 44195, United States
| | - Prashanthi N Thota
- Department of Gastroenterology, Digestive Disease Surgery Institute, Cleveland Clinic, OH 44195, United States
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Ge S, Ai L, Erdman AG, Song C. Endoscopic Closure of Large Defects With a Novel Clipping Device and a 4S-Modified Roeder Slipknot. J Med Device 2018. [DOI: 10.1115/1.4039753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Endoscopic closure is an essential procedure in gastrointestinal (GI) surgery, but currently it is difficult to close large defects endoscopically because of the lack of an appropriate device. Previously, we developed an endoscopic clipping device that has multifiring function and is equipped with an independent clamp. The goal of this study is to provide a new closure method with this device and 4S-modified Roeder (4SMR) slipknot. The feasibility of the closure method is examined by deploying two clips during one insertion onto the 4SMR slipknot to close a 5 cm full-thickness linear defect of an ex vivo porcine stomach from the center. Mechanical strengths of clip-knot closure and the slipknot as regards to tensioning forces are also evaluated. Specifically, the mechanical strength of the 4SMR slipknot is verified by mean peak forces to failure, while the knot is tensioning by 2.5, 5, 7.5, and 10 N force (n = 20 for each group), respectively. Experimental results indicate the clip-slipknot closure can withstand a distracting force of 6.3 ± 5.6 N. Tensioning force has a great influence on the mechanical strength of slipknot, with the mean peak force (tensioning force) being 7.1± 6.5, 16.3 ± 9.3, 18.9 ± 10.4, and 24.2 ± 12.0 N, respectively. The proposed closure method can be used for large defects. Tensioning force higher than 5 N is suitable to ensure a stronger 4SMR slipknot.
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Affiliation(s)
- Shuchen Ge
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
- Earl. E. Bakken Medical Devices Center, University of Minnesota, Minneapolis, MN 55455
| | - Liaoyuan Ai
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
| | - Arthur G. Erdman
- Earl. E. Bakken Medical Devices Center, University of Minnesota, Minneapolis, MN 55455
| | - Chengli Song
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China e-mail:
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Cai MY, Martin Carreras-Presas F, Zhou PH. Endoscopic full-thickness resection for gastrointestinal submucosal tumors. Dig Endosc 2018; 30 Suppl 1:17-24. [PMID: 29658639 DOI: 10.1111/den.13003] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
Abstract
Endoscopic full-thickness resection (EFTR) is a "changing-concept" endoscopic resection technique, which safely allows resecting deep submucosal tumors (SMTs) in the gastrointestinal (GI) wall. It's a highly promising endoscopic procedure that allows full-thickness excision of a small piece of the complete GI wall by using only a flexible endoscope. EFTR is a meeting point between surgery and endoscopy and probably the onset of many prospective combined minimally invasive therapeutic techniques that science will explore. In this review, use of the EFTR technique for gastrointestinal SMTs is highlighted, focusing on some technical aspects, indications, contraindications and outcomes.
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Affiliation(s)
- Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, Shanghai, China
| | | | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital of Fudan University, Shanghai, China
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Soetikno R, East J, Suzuki N, Uedo N, Matsumoto T, Watanabe K, Sanduleanu S, Sanchez-Yague A, Kaltenbach T. Endoscopic submucosal dissection for nonpolypoid colorectal dysplasia in patients with inflammatory bowel disease: in medias res. Gastrointest Endosc 2018; 87:1085-1094. [PMID: 29571773 DOI: 10.1016/j.gie.2018.01.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/10/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Roy Soetikno
- Advanced Gastrointestinal Endoscopy, Mountain View, California, USA; Department of Gastroenterology, University of Indonesia, Jakarta, Indonesia
| | - James East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, Middlesex, United Kingdom
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan
| | - Kenji Watanabe
- Department of Intestinal Inflammation Research, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Silvia Sanduleanu
- Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Tonya Kaltenbach
- Veterans Administration San Francisco, San Francisco, California, USA; University of California San Francisco, San Francisco, California, USA
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Kukreja K, Chennubhotla S, Bhandari B, Arora A, Singhal S. Closing the Gaps: Endoscopic Suturing for Large Submucosal and Full-Thickness Defects. Clin Endosc 2018; 51:352-356. [PMID: 29502382 PMCID: PMC6078935 DOI: 10.5946/ce.2017.117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022] Open
Abstract
This article is a systematic review of relevant literature on endoscopic suturing as a primary closure technique for large submucosal and full-thickness defects after endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). A comprehensive literature search was conducted through 2016 by using PubMed, to find peer-reviewed original articles. The specific factors considered were the procedural indications and details, success rates, clinical outcomes including complications, and study limitations. Six original articles were included in the final review: two with non-human subjects and four with human subjects. The mean success rate of endoscopic suturing was 97.4% (100% for human subjects and 95.4% for non-human subjects). The procedural time ranged from 7 to 89 min. The average size and depth of lesions were 2.71 cm (3.74 cm [human] and 1.96 cm [non-human]) and 1.52 cm, respectively. The technique itself had no reported impact on mortality. In conclusion, endoscopic suturing is a minimally invasive technique for the primary closure of defects caused by EMR, ESD, and EFTR, with a high success and low complication rate.
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Affiliation(s)
- Keshav Kukreja
- Divisions of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Suma Chennubhotla
- Divisions of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bharat Bhandari
- Divisions of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ankit Arora
- Divisions of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shashideep Singhal
- Divisions of Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, TX, USA
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EMR is superior to rectal suction biopsy for analysis of enteric ganglia in constipation and dysmotility. Gastrointest Endosc 2018; 87:876-880. [PMID: 28893560 PMCID: PMC5817021 DOI: 10.1016/j.gie.2017.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with chronic constipation or motility disorders may be referred for rectal suction biopsy (RSB) to rule out Hirschsprung's disease (HD). RSB may not be successful beyond infancy because of the increased thickness of the rectal mucosa. EMR could improve the diagnostic yield for HD when compared with traditional RSB because larger and deeper samples are acquired for analysis. METHODS In this prospective, single-center study, patients referred for RSB were offered enrollment for concurrent EMR. Specimens were analyzed pathologically for size, submucosal ganglionic tissue, and acetylcholinesterase or calretinin staining. Biopsy results were compared with transit studies, anorectal manometry, and constipation severity through validated questionnaires. RESULTS Seventeen patients (2 male, 15 female; mean age, 35.8 years; range, 22-61 years) were enrolled in the study from 2008 to 2014. All patients underwent anorectal manometry (88% with anorectal dysfunction, 68% with outlet obstruction) and transit studies (41% with delayed transit). There were no reports of adverse events from the RSB and EMR procedures. The RSB sample volumes were significantly lower than the EMR sample volumes (0.023 cm3 vs 0.26 cm3, P = .001). There was diagnostic tissue for submucosal visualization by RSB in 53% (9/17) of cases compared with 100% (17/17) with EMR (P = .003). No cases of HD were diagnosed by RSB; one patient had rare ganglions observed by EMR. CONCLUSIONS EMR provides greater tissue volume and can improve the characterization of ganglion cells in rectal tissue compared with RSB in patients with moderate to severe constipation with suspected HD.
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Esaki M, Suzuki S, Hayashi Y, Yokoyama A, Abe S, Hosokawa T, Ogino H, Akiho H, Ihara E, Ogawa Y. Splash M-knife versus Flush Knife BT in the technical outcomes of endoscopic submucosal dissection for early gastric cancer: a propensity score matching analysis. BMC Gastroenterol 2018; 18:35. [PMID: 29486717 PMCID: PMC5832194 DOI: 10.1186/s12876-018-0763-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/23/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer. A new multi-functional ESD device was developed to achieve complete ESD with a single device. A metal plate attached to its distal sheath achieves better hemostasis during the procedure than the other needle-knife device, Flush Knife BT®, that has been conventionally used. The aim of this study was to compare the technical outcomes of ESD for early gastric cancer using the Splash M-Knife® with those using the Flush Knife BT. METHODS We conducted a retrospective review of the case records of 149 patients with early gastric cancer treated with ESD using the needle-type ESD knives between January 2012 and August 2016 at Kitakyushu Municipal Medical Center. Lesions treated with ESD using the Splash M-knife (ESD-M) and the Flush Knife BT (ESD-F) were compared. Multivariate analyses and propensity score matching were used to compensate for the differences in age, gender, underlying disease, antithrombotic drug use, lesion location, lesion position, macroscopic type, tumor size, presence of ulceration, operator level and types of electrosurgical unit used. The primary endpoint was the requirement to use hemostatic forceps in the two groups. The secondary endpoints of procedure time, en bloc and complete resection rates, and adverse events rates were evaluated for the two groups. RESULTS There were 73 patients in the ESD-M group, and 76 patients in the ESD-F group. Propensity score matching analysis created 45 matched pairs. Adjusted comparisons between the two groups showed a significantly lower usage rate of hemostatic forceps in the ESD-M group than in the ESD-F group (6.7% vs 84.4%, p < 0.001). Treatment outcomes showed an en bloc resection rate of 100% in both groups; complete resection rate of 95.6% vs 100%, p = 0.49; median procedure time of 74.0 min vs 71.0 min, p = 0.90; post-procedure bleeding of 2.2% vs 2.2%, p = 1, in the ESD-M and ESD-F groups, respectively. There were no perforations in either group. CONCLUSIONS ESD-M appeared to reduce the usage of hemostatic forceps during ESD for early gastric cancer without increasing the adverse effects. Thus, it may contribute to a reduction in the total ESD cost.
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Affiliation(s)
- Mitsuru Esaki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. .,Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan.
| | - Sho Suzuki
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan
| | - Yasuyo Hayashi
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Azusa Yokoyama
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Shuichi Abe
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Taizo Hosokawa
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Haruei Ogino
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan.,Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirotada Akiho
- Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu, Fukuoka, 802-0077, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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60
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Zhao Y, Wang C. Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer: An Updated Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3152346. [PMID: 29568748 PMCID: PMC5820679 DOI: 10.1155/2018/3152346] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND To systematically evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC). METHODS We searched the databases of PubMed, Web of Science, EMBASE, and the Cochrane Library from January 2000 to April 2017 and included studies that compared the outcomes of ESD with EMR for EGC. These eligible studies that met the inclusion criteria were screened out and were assessed by two independent investigators. RESULT In total, 18 retrospective cohort studies were eligible for analysis. Our results indicated that ESD is more beneficial than EMR in increasing the complete resection rate and en bloc resection rate and decreasing the local recurrence rate. However, ESD prolonged operative time and increased incidence of gastric perforation than EMR. No differences were found in postoperative bleeding rate between the two approaches. CONCLUSION Compared with EMR, ESD offers higher complete resection rate, higher en bloc resection rate, and lower local recurrence rate but has prolonged operative time and increased incidence of gastric perfusion. There is no statistical difference in the rate of postoperative bleeding between the two groups. However, the above conclusion needs further verification by well-designed, randomized trials with larger samples and long follow-up periods.
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Affiliation(s)
- Yajie Zhao
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chengfeng Wang
- Department of Pancreatic and Gastric Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Hirose R, Nakaya T, Naito Y, Daidoji T, Yasuda H, Konishi H, Itoh Y. Development of a new ex vivo model for evaluation of endoscopic submucosal injection materials performance. J Mech Behav Biomed Mater 2018; 79:219-225. [PMID: 29329031 DOI: 10.1016/j.jmbbm.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Development of high-performance submucosal injection materials (SIMs) contribute to the advancement of endoscopic therapy for early-stage gastrointestinal neoplasms. This study aimed to develop a new ex vivo model that mimics the human gastrointestinal tract to evaluate the performance (the height and duration of the submucosal elevation) of various SIMs in detail. METHODS A new ex vivo model that applies a constant tension to the tested specimen (the porcine gastric specimen) was developed. SIMs were injected into the submucosa at the center or edge of the tested specimen, and submucosal elevation heights (SEHs) were measured over time. RESULTS The average value and standard deviation of SEH determined using the conventional model (the tested specimen was fixed with pins) were higher than those obtained using the new model, which showed that the new model could precisely measure the SEH of a given SIM. In addition, the performance (SEH) of SIMs decreased with increasing tension applied to the specimen, suggesting that the performance of SIMs deteriorates with the over-expansion of the gastrointestinal tract. The submucosal elevation formed at the specimen edge disappeared faster than that formed at the specimen's center. CONCLUSIONS The proposed new ex vivo model allows accurate SEH measurement under uniform conditions and detailed comparison of the performances of various types of SIMs and can contribute to the development of high-performance materials.
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Affiliation(s)
- Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Takaaki Nakaya
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tomo Daidoji
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Kwon YH. Negative Histology after Endoscopic Resection: How to Avoid It. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yong Hwan Kwon
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
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Liu W, Wang M, Zhao L, Wang M, Wang X, Fan Z, Liu L. Thermo-sensitive isopentane aerification for mucosal lift during endoscopic resection in animal models (with video). Gastrointest Endosc 2017; 86:1168-1175.e3. [PMID: 28288842 DOI: 10.1016/j.gie.2017.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 02/27/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Mucosal lift is critical for successful endoscopic treatment. Normal saline (NS) solution is widely used as the submucosal filler, but its short persistency restricts clinical endoscopic submucosal dissection (ESD). In this study, thermo-sensitive isopentane was introduced for submucosal injection. With a boiling point at 27.8°C, liquid isopentane can be easily applied, and gasification inflation can provide great support for submucosal lifting at body temperature. The feasibility and efficiency of isopentane were evaluated in this study. METHODS Porcine stomachs were used for in vitro evaluation. A 37°C water bath was used to mimic body temperature. Compared with NS, isopentane was studied for its lifting performance, including injection dosage, persistence of lifting strength, and efficacy for assisting submucosal dissection. The changes in submucosal tissue were also compared. For in vivo evaluation, rats were used to further compare the differences between isopentane and NS, including lifting efficacy, pathologic effect, and safety. RESULTS Compared with NS, the maximum lifting height was achieved with less isopentane (2% NS volume). Longer persistency and faster operation for submucosal dissection were also recorded for isopentane during the in vitro study. Aerification resulted in vacuolization of submucosal connective tissue, which facilitates EMR and postoperative recovery. The same results were confirmed in the rat model. With the same dosage, isopentane produced better mucosal elevation and larger range than NS. According to the histologic examination, no tissue injury was observed with isopentane application. CONCLUSIONS As a submucosal injection agent, the feasibility, efficacy, and safety of isopentane has been demonstrated. Thermo-sensitive aerification may be a promising approach to facilitate ESD.
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Affiliation(s)
- Wenjie Liu
- Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Min Wang
- Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Lili Zhao
- Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Min Wang
- Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Xiang Wang
- Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Zhining Fan
- Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Li Liu
- Digestive Endoscopy Center, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
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64
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Cuda TJ, Westwood DA, Hamilton AER, Stevenson ARL. Methylene blue-assisted submucosal dissection in transanal surgery - a video vignette. Colorectal Dis 2017; 19:1033. [PMID: 28921871 DOI: 10.1111/codi.13891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023]
Affiliation(s)
- T J Cuda
- Colorectal Unit, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - D A Westwood
- Colorectal Unit, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - A E R Hamilton
- Colorectal Unit, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - A R L Stevenson
- Colorectal Unit, Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
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65
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Wong VWY, Goto O, Gregersen H, Chiu PWY. Endoscopic Treatment of Subepithelial Lesions of the Gastrointestinal Tract. ACTA ACUST UNITED AC 2017; 15:603-617. [DOI: 10.1007/s11938-017-0152-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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66
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Nunobe S, Hiki N. Function-preserving surgery for gastric cancer: current status and future perspectives. Transl Gastroenterol Hepatol 2017; 2:77. [PMID: 29034350 DOI: 10.21037/tgh.2017.09.07] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022] Open
Abstract
The number of early gastric cancer (EGC) cases has been increasing because of improved diagnostic procedures including endoscopy and screening systems. Therefore, function-preserving gastrectomy (FPG) for EGC with the expectation of better quality of life (QOL) after surgery may be increasingly utilized, due to its association with low rate of lymph node metastasis and excellent survival and the possibility of employing less invasive procedures such as laparoscopic gastrectomy in combination. Pylorus-preserving gastrectomy (PPG) with curative intent lymph node dissection is a representative FPG that has been used in EGC, and its superiorities, indications, limitations, and survival benefits have already been reported in several retrospective studies. Laparoscopic proximal gastrectomy (LAPG) has also been employed in EGC of the upper third of the stomach; however, LAPG was found to be associated with major issues in achieving a balance between swallowing and reflux prevention. In patients with EGC in the upper third of the stomach, laparoscopy-assisted subtotal gastrectomy with a preserved, albeit very small, stomach may provide a better QOL and fewer postoperative complications. FPG is recommended as a surgical treatment for EGC if the indication is accurately diagnosed and strictly confirmed; however, these techniques in laparoscopic surgery present technical difficulties to surgeons without a certain degree of skills. Although many retrospective studies revealed the functional benefits or oncological safety with FPG, further prospective studies using large case series are necessary to reveal the value of FPG compared with the conventional procedures.
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Affiliation(s)
- Souya Nunobe
- Department of Gastroenterological surgery, Cancer Institute Ariake Hospital, Tokyo, Japan
| | - Naoki Hiki
- Department of Gastroenterological surgery, Cancer Institute Ariake Hospital, Tokyo, Japan
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67
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Sugihara Y, Harada K, Kawahara Y, Takei D, Takashima S, Inokuchi T, Nakarai A, Takahara M, Kuwaki K, Hiraoka S, Okada H. Two electrosurgical endo-knives for endoscopic submucosal dissection of colorectal superficial neoplasms: a prospective randomized study. Endosc Int Open 2017; 5:E729-E735. [PMID: 28791321 PMCID: PMC5546903 DOI: 10.1055/s-0043-111792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 05/02/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Few studies have directly compared endo-knives for endoscopic submucosal dissection (ESD) in humans. We compared the performances of the Mucosectom2 and SB knife Jr. PATIENTS AND METHODS Two trainee endoscopists performed ESD of 36 lesions in this prospective, randomized controlled trial. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection using the Mucosectom2 were performed in 1 group. Mucosal incision with a 1.5-mm Dual knife and submucosal dissection with a SB knife Jr. were performed in the other group. The primary outcome was the ESD procedure time. Secondary outcomes were total procedure time, self-completion rates, and adverse events. RESULTS ESD time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (57 ± 32 min vs. 61 ± 44 min, respectively; P = 0.94). Total procedure time in Mucosectom2 patients was not significantly shorter than in SB knife Jr. patients (81 ± 42 min vs. 82 ± 51 min, respectively; P = 0.85). The trainee self-completion rate was slightly higher in SB knife Jr. patients than in Mucosectom2 patients, although the difference was not significant (94 % vs. 100 %, respectively; P = 0.959). Fewer hemostatic procedures using the Coagrasper were performed in Mucosectom2 patients than in SB knife Jr. patients, although the difference was not significant (0.62 vs. 0.7, respectively; P = 0.432). CONCLUSIONS Mucosectom2 and SB knife Jr. did not significantly differ in performance for colorectal ESD to safely and reliably enhance ESD. Knife selection is not as important for learning colorectal ESD as patient- and lesion-related factors.
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Affiliation(s)
- Yuusaku Sugihara
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan,Corresponding author Yuusaku Sugihara, MD, PhD Department of Gastroenterology and HepatologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2-5-1 Shikata-cho, Kita-kuOkayama, Japan 700-8558+81-86-225-5991
| | - Keita Harada
- Division of Endoscopy, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Yoshiro Kawahara
- Division of Endoscopy, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Daisuke Takei
- Division of Endoscopy, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Shiho Takashima
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Toshihiro Inokuchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Asuka Nakarai
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Masahiro Takahara
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Kenji Kuwaki
- Center for Innovative Clinical Medicine, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Okayama, Japan
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Topete-Gonzalez LA, Franklin ME, Balli-Martinez JE, Lammel-Lindemann J, Perez-Banuet-Farell S, Valles-Guerra O, Flores-Villalba E. Endoscopic gastric polypectomy assisted by laparoscopy for giant gastric and duodenal lesion treatment: Case series from two centres. J Minim Access Surg 2017; 13:269-272. [PMID: 28695877 PMCID: PMC5607793 DOI: 10.4103/jmas.jmas_15_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Endoscopy has developed rapidly, generating new challenges. Today, there are several procedures done endoscopically with very good results. In the past, the assisted laparoscopic colon polypectomy has been described, reducing the morbidity of a bigger procedure. Nonetheless, little has been said about the use of hybrid surgery in the management of gastric or duodenal polyps. Objectives: Evaluating the safety and efficacy of the assisted laparoscopic gastric endoscopic polypectomy. Patients and Methods: A retrospective review of the database at our two centres was performed from 1996 to 2014. Thirteen patients were found in whom an assisted laparoscopic gastric or duodenal endoscopic tumour resection was performed. Results: Thirteen patients, eight males and five females, with a median age of 61 years and average body mass index of 29.3. The procedure was done effectively and no need for further procedures was required for any patient. No complications were reported in the early post-operative period. Conclusions: The study shows that assisted laparoscopic gastric endoscopic polypectomy is a feasible and safe procedure that can be used for the management of giant polyps, which cannot be resected with the classical endoscopic polypectomy reducing the morbidity and complications associated with larger procedures.
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Affiliation(s)
- Luis Alberto Topete-Gonzalez
- Escuela Nacional de Medicina (National School of Medicine), Tecnologico de Monterrey (Monterrey Tech), Monterrey, Nuevo Leon, Mexico
| | | | - Jorge Ernesto Balli-Martinez
- Escuela Nacional de Medicina (National School of Medicine), Tecnologico de Monterrey (Monterrey Tech), Monterrey, Nuevo Leon, Mexico
| | - Jan Lammel-Lindemann
- Escuela Nacional de Medicina (National School of Medicine), Tecnologico de Monterrey (Monterrey Tech), Monterrey; Escuela de Ingenieria (Engineering School), Tecnologico de Monterrey (Monterrey tech), Monterrey, Nuevo Leon, Mexico
| | - Sofia Perez-Banuet-Farell
- Hospital Universitario (UANL Uimiversity Hospital) "Dr Jose Eleuterio Gonzalez", UANL, Monterrey, Nuevo Leon, Mexico
| | - Orestes Valles-Guerra
- Escuela Nacional de Medicina (National School of Medicine), Tecnologico de Monterrey (Monterrey Tech), Monterrey, Nuevo Leon, Mexico
| | - Eduardo Flores-Villalba
- Escuela Nacional de Medicina (National School of Medicine), Tecnologico de Monterrey (Monterrey Tech), Monterrey; Escuela de Ingenieria (Engineering School), Tecnologico de Monterrey (Monterrey tech), Monterrey, Nuevo Leon, Mexico
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69
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Akimoto T, Goto O, Nishizawa T, Yahagi N. Endoscopic closure after intraluminal surgery. Dig Endosc 2017; 29:547-558. [PMID: 28181699 DOI: 10.1111/den.12839] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/06/2017] [Indexed: 02/06/2023]
Abstract
Endoscopic submucosal dissection is established as a curative endoscopic method for gastrointestinal epithelial neoplasms with a high possibility of complete en bloc resection; however, postoperative adverse events of bleeding and delayed perforation remain. To prevent or minimize them, several techniques for endoscopic mucosal closure have been introduced, such as using endoscopic clips, combined use of hemoclips and supplement devices, and specially designed endoscopic suturing devices. Furthermore, endoscopic full-thickness suturing technique for gastrointestinal wall defect has been developed based on the concept in natural orifice transluminal endoscopic surgery and endoscopic full-thickness resection. Several closure techniques, including over-the-scope clip, threaded bars inserted in a hollow needle, stitches or staplers, and a curved needle and thread are reported. Secure closure of the iatrogenic defect may further expand the range of therapeutic endoscopy. Accumulation of evidence for the efficacy of endoscopic closure and establishment of these techniques are desired.
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Affiliation(s)
- Teppei Akimoto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Osamu Goto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Toshihiro Nishizawa
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
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Tanaka S, Toyonaga T, Kawara F, Grimm IS, Hoshi N, Abe H, Ohara Y, Morita Y, Umegaki E, Azuma T. Peroral endoscopic myotomy using FlushKnife BT: a single-center series. Endosc Int Open 2017; 5:E663-E669. [PMID: 28691051 PMCID: PMC5500118 DOI: 10.1055/s-0043-111721] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/10/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Peroral endoscopic myotomy (POEM) is an evolving new treatment strategy for achalasia. Although several kinds of electrosurgical knives have been used in performing POEM, the best device has yet to be determined. The FlushKnife BT is a waterjet-emitting short needle-knife with a small ball tip (BT) that offers the potential to perform all aspects of POEM with a single device. In this study, we evaluated the safety and efficiency of the FlushKnife BT for POEM. PATIENTS AND METHODS A total of 54 consecutive patients with achalasia and other spastic esophageal motility disorders, such as jackhammer esophagus or distal esophageal spasm, who underwent POEM between January 2016 and August 2016, were included in this retrospective study. RESULTS The median operation time was 73.0 minutes (range 39 - 184 minutes). All procedures were completed using only the FlushKnife BT without changing to any other electrosurgical instrument. The median number of additional submucosal injections with an injection needle was 0 (range 0 - 1). Endoscopic vessel sealing was performed a mean of 3 times (range 0 - 7). The median number of bleeding episodes requiring treatment with hemostatic forceps was 0 (range 0 - 5). There were no significant adverse events. Seven of 52 patients (13.5 %) reported symptoms of gastroesophageal reflux disease such as heartburn or acid reflux at 3 month follow-up. CONCLUSIONS The FlushKnife BT enabled POEM to be performed with very few device exchanges, either for re-injection or to control intraoperative bleeding. In this uncontrolled case series, the ability of the FlushKnife BT to perform nearly all aspects of the POEM procedure seems to make it particularly well suited to this procedure.
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Affiliation(s)
- Shinwa Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takashi Toyonaga
- Department of Endoscopy, Kobe University Hospital, Kobe, Japan,Corresponding author Takashi Toyonaga, MD Department of EndoscopyKobe University Hospital7-5-1 Chu-o-kuKusunoki-Cho, KobeHyogo 650-0017Japan+81-78-3826309
| | - Fumiaki Kawara
- Department of Endoscopy, Kobe University Hospital, Kobe, Japan
| | - Ian S. Grimm
- Division of Gastroenterology and Hepatology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Namiko Hoshi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hirofumi Abe
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshiko Ohara
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Eiji Umegaki
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takeshi Azuma
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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Risk factors and management for gastric stenosis after endoscopic submucosal dissection for gastric epithelial neoplasm. Gastric Cancer 2017; 20:690-698. [PMID: 27905029 DOI: 10.1007/s10120-016-0673-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/20/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Only a few studies have reported treatment options for stenosis after endoscopic submucosal dissection (ESD) for gastric neoplasms. This study aimed to identify the risk factors for and evaluate the management of stenosis after ESD for gastric epithelial neoplasms in the cardia and antrum. METHODS We retrospectively reviewed 1218 patients (1447 gastric epithelial neoplasms) who underwent ESD at Tonan Hospital from June 2004 to November 2015. Post-ESD stenosis was defined when a standard endoscope could not be passed through the site. RESULTS Post-ESD stenosis occurred in 10 (21.3%) of the 47 cardia cases and 14 (3.2%) of the 432 antrum cases. A wide resection of more than three fourths of the circumferential extent was the sole significant risk factor related to post-ESD stenosis in both cardia and antrum. Prophylactic endoscopic balloon dilation (EBD) was performed in 3 of 10 patients with cardiac stenosis and 4 of 14 with antral stenosis. Post-EBD bleeding occurred in one cardia (10%) and one antrum (7.1%) case each and was endoscopically treated. Perforation during EBD occurred in two (14.3%) antrum cases, both of which required emergency open surgery. All complications were observed in patients with conventional EBD, and no complications were associated with prophylactic EBD. CONCLUSIONS A wide resection of more than three fourths of the circumferential extent was the significant risk factor for post-ESD stenosis in both cardia and antrum, and prophylactic EBD could be a promising procedure for the management of post-ESD stenosis.
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72
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Jang JY. Future Development of Endoscopic Accessories for Endoscopic Submucosal Dissection. Clin Endosc 2017; 50:242-249. [PMID: 28609819 PMCID: PMC5475511 DOI: 10.5946/ce.2017.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 05/18/2017] [Accepted: 05/23/2017] [Indexed: 12/27/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) has recently been accepted as a standard treatment for patients with early gastric cancer (EGC), without lymph node metastases. Given the rise in the number of ESDs being performed, new endoscopic accessories are being developed and existing accessories modified to facilitate the execution of ESD and reduce complication rates. This paper examines the history underlying the development of these new endoscopic accessories and indicates future directions for the development of these accessories.
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Affiliation(s)
- Jae-Young Jang
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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73
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Tanaka S, Toyonaga T, Morita Y, Ishida T, Hoshi N, Grimes KL, Ohara Y, Yoshizaki T, Kawara F, Umegaki E, Azuma T. Efficacy of a new hemostatic forceps during gastric endoscopic submucosal dissection: A prospective randomized controlled trial. J Gastroenterol Hepatol 2017; 32:846-851. [PMID: 27648821 DOI: 10.1111/jgh.13599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Currently, endoscopic submucosal dissection (ESD) is a widely accepted standard treatment for early gastric cancer, but one challenging aspect of ESD is hemostasis. We developed a new hemostatic forceps (FD-Y0007) with the aim of achieving more effective hemostasis and investigated the hemostatic ability of the FD-Y0007 during gastric ESD in humans. METHODS This study was a prospective randomized controlled trial, which was conducted at a cancer referral center. Sixty-six patients who were scheduled to undergo ESD were enrolled and randomly assigned to either the Coagrasper or the FD-Y0007, which was used for hemostasis throughout the case. The primary end point was the time required to obtain hemostasis, which was measured for the first episode of bleeding during each case. RESULTS Hemostasis time for the first bleeding episode during ESD was 73.0 s for the Coagrasper and 21.5 s for the FD-Y0007 (P < 0.001). When all episodes of bleeding were included, hemostasis time was 56.8 s in the Coagrasper group and 25.5 s in FD-Y0007group (P < 0.0001). The frequency of adverse events (perforation: 3.4% vs 7.1%; delayed bleeding: 0% vs 0%) was not significantly different between the two groups. CONCLUSIONS Compared with the Coagrasper, the FD-Y0007 efficiently reduces the hemostatic time during gastric ESD with no increase in adverse events.
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Affiliation(s)
- Shinwa Tanaka
- Department of Endoscopy, Kobe University Hospital, Kobe, Japan
| | | | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tsukasa Ishida
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Namiko Hoshi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kevin L Grimes
- Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan
| | - Yoshiko Ohara
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | | | - Fumiaki Kawara
- Department of Endoscopy, Kobe University Hospital, Kobe, Japan
| | - Eiji Umegaki
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takeshi Azuma
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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74
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Pettke E, Shah A, Whelan RL. Endoscopic submucosal dissection and endoscopic mucosal resection methods for the removal of large sessile polyps. SEMINARS IN COLON AND RECTAL SURGERY 2017. [DOI: 10.1053/j.scrs.2016.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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75
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Rizvi QUA, Balachandran A, Koay D, Sharma P, Singh R. Endoscopic Management of Early Esophagogastric Cancer. Surg Oncol Clin N Am 2017; 26:179-191. [PMID: 28279463 DOI: 10.1016/j.soc.2016.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Esophagogastric cancer accounts for the second most common cause of cancer-related mortality worldwide. Significant efforts have been made to detect these malignancies at an earlier stage through the implementation of screening programs in high-risk individuals using advanced diagnostic techniques. Endoscopic management techniques, such as endoscopic mucosal resection and endoscopic submucosal dissection, have consistently demonstrated excellent outcomes in the management of these lesions. These techniques are associated with a lower risk of morbidity and mortality when compared with traditional surgical management.
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Affiliation(s)
- Qurat-Ul-Ain Rizvi
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia 5112, Australia
| | - Arrhchanah Balachandran
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia 5112, Australia
| | - Doreen Koay
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia 5112, Australia
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, University of Kansas School of Medicine, VA Medical Center, 4801 Linwood Boulevard, Kansas City, MO 64128, USA
| | - Rajvinder Singh
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, South Australia 5112, Australia.
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Hwang JJ, Lee DH, Yoon H, Shin CM, Park YS, Kim N. Clinicopathological characteristics of patients who underwent additional gastrectomy after incomplete endoscopic resection for early gastric cancer. Medicine (Baltimore) 2017; 96:e6172. [PMID: 28207556 PMCID: PMC5319545 DOI: 10.1097/md.0000000000006172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
To evaluate the clinicopathological characteristics and factors that lead to residual tumors in patients who underwent additional gastrectomy for incomplete endoscopic resection (ER) for early gastric cancer (EGC).Between 2003 and 2013, the medical records of patients underwent additional gastrectomy after incomplete ER were retrospectively reviewed. Those diagnosed with the presence of histologic residual tumor in specimens obtained by gastrectomy were assigned to the residual tumor (RT) group (n = 47); those diagnosed with the absence of histologic residual tumor were assigned to the nonresidual tumor (NRT) group (n = 33).In the multivariate analysis, endoscopic piecemeal resection, Helicobacter pylori infection, large tumor size (>2 cm), and both (lateral and vertical) marginal involvement were independent factors of the presence of residual tumor in additional gastrectomy after incomplete resection ER for EGC and the rates of independent factors were significantly higher in the RT group than in the NRT group (P < 0.05).Before ER, preexamination to accurately determine the GC invasion depth and the presence of LN metastasis is very important. During ER, surgeons should attempt to perform en bloc resection and to resect the mucous membrane with adequate safety margins to prevent tumor invasion into the lateral and vertical margins.
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Affiliation(s)
- Jae Jin Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Soonshunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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77
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Lim SH, Levenick JM, Mathew A, Moyer MT, Dye CE, McGarrity TJ. Endoscopic Management of Large (≥2 cm) Non-pedunculated Colorectal Polyps: Impact of Polyp Morphology on Outcomes. Dig Dis Sci 2016; 61:3572-3583. [PMID: 27696095 DOI: 10.1007/s10620-016-4314-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Referrals for endoscopic management of large non-pedunculated (NP) colorectal polyps have increased as new techniques have emerged. The outcomes for referred large NP polyps based on the polyp morphology were investigated METHODS: A retrospective review of patients referred for large (≥20 mm) NP polyp management from January 2010 through June 2014 was completed. Polyp morphology was classified as either a NP polyp with depression (M1) or NP polyp with no depression (M0). Differences in treatment, histology, adverse events, outcomes at follow-up including residual disease, and need for surgical treatment were determined by morphology for all NP polyps ≥20 mm in size. RESULTS One-hundred and sixty-nine M1 and 136 M0 polyps ≥20 mm were removed endoscopically during the review period. Mean size was 31.9 ± 11.0 mm in M1, and 26.8 ± 9.5 mm in M0 group (p < 0.0001). En bloc resection was possible in 18.3 % of M1 and 30.9 % of M0 lesions (p = 0.011) with endoscopic submucosal dissection used in 13 and 2.2 % of polyps, respectively (p < 0.0001). Residual polyp was found in 26.5 % (27/102) of M1 and 13.6 % (12/88) of M0 patients at surveillance colonoscopy (p = 0.029). On multivariate analysis, piecemeal resection and M1 morphology showed significant association with residual polyp (OR 4.23, 95 % CI 1.23-14.59, p = 0.022, and OR 2.15, 95 % CI 1.004-4.62, p = 0.049, respectively). CONCLUSION Effective endoscopic management of large NP colorectal polyps, especially polyps without depression (M0), can be accomplished in the great majority of patients. Polyp morphology, particularly the presence or absence of depression, is a useful tool which influenced treatment, histology, and outcomes.
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Affiliation(s)
- Seon Hee Lim
- Division of Gastroenterology, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 138-984, Korea
| | - John M Levenick
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Abraham Mathew
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Matthew T Moyer
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Charles E Dye
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Thomas J McGarrity
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
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78
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Sekiguchi M, Matsuda T, Saito Y. Surveillance after endoscopic and surgical resection of colorectal cancer. Best Pract Res Clin Gastroenterol 2016; 30:959-970. [PMID: 27938790 DOI: 10.1016/j.bpg.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 01/31/2023]
Abstract
With the increase in colorectal cancer burden, surveillance following endoscopic and surgical resection is an essential issue. The aim of surveillance programs is improvement of patient survival by early detection of residual tumor tissue or local recurrence, metachronous colorectal tumors, and metastases. Appropriate surveillance should be determined according to this risk of factors. In current guidelines, only surveillance colonoscopy is recommended after endoscopic resection of polyps with high-grade dysplasia, whereas intensive, multimodality surveillance using colonoscopy, radiological imaging and tumor marker measurements is recommended following surgical resection of invasive colorectal cancer. Detailed recommendations, including the timing of surveillance, are described based on high-quality evidence. However, there are still many unresolved issues for which more high-quality evidence is required.
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Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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79
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Kadota T, Yano T, Kato T, Imajoh M, Noguchi M, Morimoto H, Osera S, Yoda Y, Oono Y, Ikematsu H, Ohtsu A, Kaneko K. Prophylactic steroid administration for strictures after endoscopic resection of large superficial esophageal squamous cell carcinoma. Endosc Int Open 2016; 4:E1267-E1274. [PMID: 28028531 PMCID: PMC5179327 DOI: 10.1055/s-0042-118291] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/09/2016] [Indexed: 02/08/2023] Open
Abstract
Background and study aims: One of the major complications after endoscopic resection (ER) for large superficial esophageal squamous cell carcinoma (ESCC) is benign esophageal stricture, which can reduce quality of life even if ESCC achieves a cure without organ resection. Recently, steroid administration has been reported as a prophylactic treatment to prevent esophageal strictures. This retrospective study evaluated the stricture rate according to the different width of mucosal defects due to ER and compared it to that seen with prophylactic steroid administration. Patients and methods: Between June 2007 and December 2013, we enrolled patients with ESCC who had 3/4 or larger circumferential mucosal defects due to ER. In December 2009, steroid injections (triamcinolone acetonide 50 mg) into the ulcer bed due to ER were introduced. Beginning in November 2012, we commenced oral steroid administration (prednisolone 30 mg/day, tapered gradually for 8 weeks) in addition to steroid injection. Patients were classified into 3 groups according to the width of mucosal defect after ER (Group A, ≥ 3/4 and < 7/8; Group B, ≥ 7/8 and less than the entire circumference; and Group C, the entire circumference). We retrospectively evaluated the stricture rate by comparing no treatment, steroid injection, or steroid injection followed by oral steroid according to the width of mucosal defect. Results: A total of 115 patients met the selection criteria. In Group B, no treatment had a significantly higher stricture rate (100 %, vs. steroid injection: 56 % P = 0.015; vs steroid injection followed by oral steroid: 20 % P < 0.001). Conversely, in Group C, the stricture rate was high, regardless of treatment (no treatment: 100 %; steroid injection: 100 %; steroid injection followed by oral steroid: 71 %). Conclusions: Although prophylactic steroid administration is effective to prevent strictures for 7/8 circumference or larger mucosal defects, it is ineffective for whole-circumference defects. Further investigation is required.
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Affiliation(s)
- Tomohiro Kadota
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan,Course of Advanced Clinical Research of
Cancer, Juntendo University Graduate School of Medicine, Tokyo,
Japan
| | - Tomonori Yano
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan,Corresponding author Tomonori
Yano Department of
GastroenterologyEndoscopy
DivisionNational Cancer Center Hospital
East6-5-1,
KashiwanohaKashiwa, Chiba
277-8577Japan+81-4-7133-111104-7134-6865
| | - Tomoji Kato
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Maomi Imajoh
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Masaaki Noguchi
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Hiroyuki Morimoto
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Shozo Osera
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Yusuke Yoda
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Yasuhiro Oono
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
| | - Atsushi Ohtsu
- Course of Advanced Clinical Research of
Cancer, Juntendo University Graduate School of Medicine, Tokyo,
Japan,Exploratory Oncology Research & Clinical
Trial Center, National Cancer Center, Kashiwa, Chiba, Japan
| | - Kazuhiro Kaneko
- Department of Gastroenterology, Endoscopy
Division, National Cancer Center Hospital East, Kashiwa, Chiba,
Japan
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80
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Xie HQ, Zhong WZ. Outcomes of Colonic Endoscopic Mucosal Resection for Large Polyps in Elderly Patients. J Laparoendosc Adv Surg Tech A 2016; 26:707-9. [PMID: 27389049 DOI: 10.1089/lap.2015.0475] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Huan-Qin Xie
- The Geriatric Ward, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China
| | - Wu-Zhuang Zhong
- The Geriatric Ward, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, P.R. China
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81
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Wang H, Zhang H, Wang C, Fang Y, Wang X, Chen W, Liu F, Shen K, Qin X, Shen Z, Sun Y. Expanded endoscopic therapy criteria should be cautiously used in intramucosal gastric cancer. Chin J Cancer Res 2016; 28:348-54. [PMID: 27478320 PMCID: PMC4949280 DOI: 10.21147/j.issn.1000-9604.2016.03.09] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Accurate estimation of lymph node metastasis (LNM) in intramucosal gastric cancer is essential to select less invasive treatment options and even avoid surgery. The aim of this study was to evaluate combined clinicopathological features to predict the presence of LNM. METHODS A retrospective review of data from 386 intramucosal gastric cancer patients who underwent gastrectomy with extended lymphadenectomy from 2003 to 2010 was conducted. The mutual relation between clinicopathological characteristics and LNM was analyzed. RESULTS LNM was detected in 40 (10.4%) of the 386 patients. Histological type and vascular or lymphatic invasion presence showed a positive correlation with LNM occurrence by univariate analysis. Multivariate analysis revealed that histological type was the only factor associated with LNM. Combined clinicopathologic characteristics would be more predictable for LNM. We found no LNM when we used combined clinicopathological characteristics conforming to Japanese absolute indications for endoscopic therapy. The LNM rate was as high as 8.7% when Japanese expanded criteria were used. Univariate analysis in cancer conformity to expand endoscopic submucosal dissection (ESD) indication also revealed that the undifferential type was the only significant factor for LNM. CONCLUSIONS It was possible to predict intramucosal gastric cancer cases without LNM using combined clinicopathological characteristic analysis. Extended indication for ESD should be cautiously used for intramucosal gastric cancer patients.
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Affiliation(s)
- Hongshan Wang
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Heng Zhang
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Cong Wang
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Yong Fang
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Xuefei Wang
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Weidong Chen
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Fenglin Liu
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Kuntang Shen
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Xinyu Qin
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Zhenbin Shen
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
| | - Yihong Sun
- Department of General Surgery, Zhongshan Hospital, General Surgery Research Institute, Fudan University, Shanghai 200032, China
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82
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Thota PN, Sada A, Sanaka MR, Jang S, Lopez R, Goldblum JR, Liu X, Dumot JA, Vargo J, Zuccarro G. Correlation between endoscopic forceps biopsies and endoscopic mucosal resection with endoscopic ultrasound in patients with Barrett's esophagus with high-grade dysplasia and early cancer. Surg Endosc 2016; 31:1336-1341. [PMID: 27444824 DOI: 10.1007/s00464-016-5117-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 07/12/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients with Barrett's esophagus (BE) and high-grade dysplasia (HGD) or intramucosal cancer (IMC) on endoscopic forceps biopsies are referred to endoscopic therapy even though forceps biopsies do not reflect the disease extent accurately. Endoscopic mucosal resection (EMR) and endoscopic ultrasound (EUS) are frequently used for staging prior to endoscopic therapy. Our aims were to evaluate: (1) if endoscopic forceps biopsies correlated with EMR histology in these patients; (2) the utility of EUS compared to EMR; and (3) if accuracy of EUS varied based on grade of differentiation of tumor. METHODS This is a retrospective review of patients referred to endoscopic therapy of BE with HGD or early esophageal adenocarcinoma (EAC) who underwent EMR from 2006 to 2011. Age, race, sex, length of Barrett's segment, hiatal hernia size, number of endoscopies and biopsy results and EUS findings were abstracted. RESULTS A total of 151 patients underwent EMR. In 50 % (75/151) of patients, EMR histology was consistent with endoscopic forceps biopsy findings. EMR resulted in change in diagnosis with upstaging in 21 % (32/151) and downstaging in 29 % (44/151). In patients with HGD on EMR, EUS staging was T0 in 74.1 % (23/31) but upstaged in 25.8 % (8/31). In patients with IMC on EMR, EUS findings were T1a in 23.6 % (9/38), upstaged in 18.4 % (7/38) and downstaged in 57.8 % (22/38). EUS accurately identified EMR histology in all submucosal cancers. Grade of differentiation was reported in 24 cancers on EMR histology. There was no correlation between grade and EUS staging. CONCLUSIONS EUS is of limited utility in accurate staging of BE patients with HGD or early EAC. Endoscopic forceps biopsy correlated with EMR findings in only 50 % of patients. Irrespective of the endoscopic forceps biopsy results, all BE patients with visible lesions should be referred to EMR.
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Affiliation(s)
- Prashanthi N Thota
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Alaa Sada
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Madhusudhan R Sanaka
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Rocio Lopez
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - John R Goldblum
- Department of Biostatistics, Cleveland Clinic, Cleveland, OH, USA
| | - Xiuli Liu
- Department of Biostatistics, Cleveland Clinic, Cleveland, OH, USA
| | - John A Dumot
- Digestive Health Institute, University Hospitals, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Gregory Zuccarro
- Department of Gastroenterology and Hepatology, Center of Excellence for Barrett's Esophagus, Cleveland Clinic, Cleveland, OH, 44195, USA
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83
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Feasibility of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors (with video). Gastrointest Endosc 2016; 84:47-52. [PMID: 26684599 DOI: 10.1016/j.gie.2015.11.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Laparoscopic gastric resection is widely used for gastric submucosal tumors (SMTs). However, determining an appropriate resection line using only the laparoscopic approach is difficult. We developed a laparoscopic and endoscopic cooperative surgery (LECS) technique by combining laparoscopic gastric resection with endoscopic submucosal dissection, and we have used this procedure to resect gastric SMTs. In this study, the procedure is presented and its safety and feasibility for resecting gastric SMTs are evaluated. METHODS This retrospective study included 100 patients who underwent LECS for SMTs at the Department of Gastroenterological Surgery, Cancer Institute, between June 2006 and November 2014. The demographics, tumor histopathologic characteristics, and operative and follow-up data were reviewed. RESULTS Complete resection with negative surgical margins was achieved in all patients, and LECS was performed regardless of tumor location. The mean operation time was 174.3 minutes, with an estimated blood loss of 16.3 mL. In addition, the mean time until the initiation of oral intake was 1.4 days, and the mean postoperative hospital stay was 8.4 days. Moreover, no local or distant tumor recurrence was observed. The only severe adverse event was leakage, which was observed in 1 patient. CONCLUSIONS LECS was performed with a reasonable operation time, low blood loss, and minimal adverse events. Therefore LECS is safe and feasible for resecting gastric SMTs.
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84
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Backes Y, Moons LMG, van Bergeijk JD, Berk L, Ter Borg F, Ter Borg PCJ, Elias SG, Geesing JMJ, Groen JN, Hadithi M, Hardwick JCH, Kerkhof M, Mangen MJJ, Straathof JWA, Schröder R, Schwartz MP, Spanier BWM, de Vos Tot Nederveen Cappel WH, Wolfhagen FHJ, Koch AD. Endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) for resection of large distal non-pedunculated colorectal adenomas (MATILDA-trial): rationale and design of a multicenter randomized clinical trial. BMC Gastroenterol 2016; 16:56. [PMID: 27229709 PMCID: PMC4882830 DOI: 10.1186/s12876-016-0468-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 05/14/2016] [Indexed: 02/08/2023] Open
Abstract
Background Endoscopic mucosal resection (EMR) is currently the most used technique for resection of large distal colorectal polyps. However, in large lesions EMR can often only be performed in a piecemeal fashion resulting in relatively low radical (R0)-resection rates and high recurrence rates. Endoscopic submucosal dissection (ESD) is a newer procedure that is more difficult resulting in a longer procedural time, but is promising due to the high en-bloc resection rates and the very low recurrence rates. We aim to evaluate the (cost-)effectiveness of ESD against EMR on both short (i.e. 6 months) and long-term (i.e. 36 months). We hypothesize that in the short-run ESD is more time consuming resulting in higher healthcare costs, but is (cost-) effective on the long-term due to lower patients burden, a higher number of R0-resections and lower recurrence rates with less need for repeated procedures. Methods This is a multicenter randomized clinical trial in patients with a non-pedunculated polyp larger than 20 mm in the rectum, sigmoid, or descending colon suspected to be an adenoma by means of endoscopic assessment. Primary endpoint is recurrence rate at follow-up colonoscopy at 6 months. Secondary endpoints are R0-resection rate, perceived burden and quality of life, healthcare resources utilization and costs, surgical referral rate, complication rate and recurrence rate at 36 months. Quality-adjusted-life-year (QALY) will be estimated taking an area under the curve approach and using EQ-5D-indexes. Healthcare costs will be calculated by multiplying used healthcare services with unit prices. The cost-effectiveness of ESD against EMR will be expressed as incremental cost-effectiveness ratios (ICER) showing additional costs per recurrence free patient and as ICER showing additional costs per QALY. Discussion If this trial confirms ESD to be favorable on the long-term, the burden of extra colonoscopies and repeated procedures can be prevented for future patients. Trial registration NCT02657044 (Clinicaltrials.gov), registered January 8, 2016.
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Affiliation(s)
- Y Backes
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3508, GA, Utrecht, Netherlands
| | - L M G Moons
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3508, GA, Utrecht, Netherlands.
| | - J D van Bergeijk
- Department of Gastroenterology & Hepatology, Gelderse Vallei, Ede, Netherlands
| | - L Berk
- Department of Gastroenterology & Hepatology, Sint Franciscus, Rotterdam, Netherlands
| | - F Ter Borg
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, Netherlands
| | - P C J Ter Borg
- Department of Gastroenterology & Hepatology, Ikazia, Rotterdam, Netherlands
| | - S G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - J M J Geesing
- Department of Gastroenterology & Hepatology, Diakonessenhuis, Utrecht, Netherlands
| | - J N Groen
- Department of Gastroenterology & Hepatology, Sint Jansdal, Harderwijk, Netherlands
| | - M Hadithi
- Department of Gastroenterology & Hepatology, Maasstad hospital, Rotterdam, Netherlands
| | - J C H Hardwick
- Department of Gastroenterology & Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - M Kerkhof
- Department of Gastroenterology & Hepatology, Groene Hart Hospital, Gouda, Netherlands
| | - M J J Mangen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - J W A Straathof
- Department of Gastroenterology & Hepatology, Máxima Medical Center, Eindhoven, Netherlands
| | - R Schröder
- Department of Gastroenterology & Hepatology, Gelre Hospital, Apeldoorn, Netherlands
| | - M P Schwartz
- Department of Gastroenterology & Hepatology, Meander Medical Center, Amersfoort, Netherlands
| | - B W M Spanier
- Department of Gastroenterology & Hepatology, Rijnstate hospital, Arnhem, Netherlands
| | | | - F H J Wolfhagen
- Department of Gastroenterology & Hepatology, Albert Schweitzer, Dordrecht, Netherlands
| | - A D Koch
- Department of Gastroenterology & Hepatology, Erasmus Medical Center, Rotterdam, Netherlands
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85
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Abstract
CONTEXT Esophageal cancer continues to be one of the most lethal of all gastrointestinal malignancies. Its prognostic parameters are based on the gross and histopathologic examination of resected specimens by pathologists. OBJECTIVE To describe the implications of appropriate handling and examination of endomucosal resection and esophagectomy specimens from patients with esophageal carcinoma while considering the implications of the surgical techniques used to obtain such specimens. Parameters include histopathologic findings necessary for accurate staging, differences in the assessment of margins, residual malignancy, and criteria to evaluate for tumor regression after chemoradiation therapy as well as the role of immunohistochemistry and the judicious use of frozen sections. DATA SOURCES Sources were a review of the literature and the authors' experience handling these types of specimens. CONCLUSIONS Examining surgical specimens of the esophagus is critical in the management of patients with esophageal carcinoma, and it requires careful consideration of the diagnostic pitfalls, staging-related parameters, and results of molecular tests.
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Affiliation(s)
| | - Mariana Berho
- From the Department of Pathology, Cleveland Clinic Florida, Weston
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86
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Outcome of salvage surgery for colorectal cancer initially treated by upfront endoscopic therapy. Surgery 2016; 159:713-20. [DOI: 10.1016/j.surg.2015.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/12/2015] [Accepted: 09/14/2015] [Indexed: 12/28/2022]
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87
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Yamazaki K, Maluf-Filho F, da Costa VAP, Pessorrusso FCS, Hondo FY, Sakai P, de Figueiredo LFP. IMPROVED EXPERIMENTAL MODEL TO EVALUATE SUBMUCOSAL INJECTION SOLUTIONS FOR ENDOSCOPIC SUBMUCOSAL DISSECTION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:262-5. [PMID: 26734797 PMCID: PMC4755179 DOI: 10.1590/s0102-6720201500040011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/30/2015] [Indexed: 11/24/2022]
Abstract
Background : Endoscopic submucosal dissection carries an increased risk of bleeding and
perforation. The creation of a long lasting submucosal cushion is essential for
the safe and complete removal of the lesion. There is not a suitable experimental
model for evaluation of the durability of the cushioning effect of different
solutions. Aim : To describe an improved experimental model to evaluate submucosal injection
solutions. Methods : A total of four domestic pigs were employed to evaluate two different submucosal
fluid solutions in the gastric submucosa. After midline laparotomy, the anterior
gastric wall was incised from the gastric body to the antrum and its mucosal
surface was exposed by flipping inside out the incised gastric wall. Two different
solutions (10% mannitol and normal saline) were injected in the submucosa of the
anterior wall of the distal gastric body. All submucosal cushions were injected
until they reach the same size, standardized as 1.0 cm in height and 2.0 cm in
diameter. A caliper and a ruler were employed to guarantee accuracy of the
measurements. Results : All four animal experiments were completed. All submucosal cushions had the exact
same size measured with caliper and a ruler. By using the mannitol solution, the
mean duration of the submucosal cushion was longer than the saline solution: 20
and 22 min (mean, 21 min) vs 5 and 6 min (mean, 5.5 min) Conclusions : This experimental model is simple and evaluate the duration, size, and effect of
the submucosal cushion, making it more reliable than other models that employ
resected porcine stomachs or endoscopic images in live porcine models.
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Thread-Traction with a Sheath of Polypectomy Snare Facilitates Endoscopic Submucosal Dissection of Early Gastric Cancers. Gastroenterol Res Pract 2015; 2016:9415497. [PMID: 26843860 PMCID: PMC4710898 DOI: 10.1155/2016/9415497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/13/2015] [Indexed: 02/07/2023] Open
Abstract
Although the thread-traction (TT) method has been found useful during endoscopic submucosal dissection (ESD) for early gastric cancers, the movement of the thread interferes with the movement of the endoscope, and the lesion can only be pulled to the mouth side. We have developed the novel TT method using a sheath of polypectomy snare (TTSPS). The TTSPS method enables free and independent movement of the thread and the endoscope and allows pulling the lesion towards the anal as well as oral side. The median dissection times, numbers of instances of arterial bleeding, and numbers of local injections into the submucosal layer were significantly lower for ESD with TTSPS than for conventional ESD. Countertraction ESD using the TTSPS method is straightforward, safe, easy, noninvasive, and cost effective, and it uses instruments readily available in most hospitals to enhance visualization of cutting lines. Therefore, the TTSPS method can be universally applied in conventional ESD.
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89
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Liu W, Zhao M, Liu W, Zheng Z, Zhang X. A feasibility study of a thermally sensitive elastin-like polypeptide for submucosal injection application in endoscopic resection in 3 animal models. Gastrointest Endosc 2015; 82:944-52. [PMID: 26092617 DOI: 10.1016/j.gie.2015.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/01/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) can successfully resect large lesions en bloc by using a submucosal injection solution, but the cost of currently available submucosal injection solutions is not satisfactory. The authors' aim was to evaluate the feasibility and effectiveness of a thermally sensitive elastin-like polypeptide (ELP) used as submucosal injection solution in ESD. METHODS We conducted an ex vivo study to determine the optimal concentration of ELPs in rabbits, an in vivo study to evaluate the effectiveness of mucosal elevation in rats, and a large animal study to confirm the feasibility of preclinical application by using conventional clinical procedure in pigs. RESULTS ELP (500 μM) was proved to be the optimal injectable submucosal injection solution and elevated mucosa more efficiently than any control. The same concentration of ELP exhibited an equivalent effectiveness of mucosal elevation, the retention of the elevation, and minimal bleeding with sodium hyaluronate. The ESD procedure time with 500 μM ELP in a preclinical study with pigs was significantly shorter than with any other concentration of ELP and normal saline solution. CONCLUSIONS Use of ELP as submucosal injection solution was feasible, with higher and longer-lasting elevation and fewer adverse events.
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Affiliation(s)
- Wentian Liu
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Mingxing Zhao
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wenge Liu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Zhongqing Zheng
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xuqian Zhang
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin 300052, China
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90
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Gong S, Xue HB, Ge ZZ, Dai J, Li XB, Zhao YJ, Zhang Y, Gao YJ, Song Y. Value of Magnifying Endoscopy With Narrow-Band Imaging and Confocal Laser Endomicroscopy in Detecting Gastric Cancerous Lesions. Medicine (Baltimore) 2015; 94:e1930. [PMID: 26554797 PMCID: PMC4915898 DOI: 10.1097/md.0000000000001930] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although the respective potentials of magnifying endoscopy with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE) in predicting gastric cancer has been well documented, there is a lack of studies in comparing the value and diagnostic strategy of these 2 modalities. Our primary aim is to investigate whether CLE is superior to ME-NBI for differentiation between gastric cancerous and noncancerous lesions. A secondary aim is to propose an applicable clinical strategy.We conducted a diagnostic accuracy study involving patients with suspected gastric superficial cancerous lesions. White light endoscopy, ME-NBI, and CLE were performed diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value between ME-NBI and CLE were assessed, as well as agreements between ME-NBI/CLE and histopathology.This study involved 86 gastric lesions in 82 consecutive patients who underwent white light endoscopy, ME-NBI, and CLE before biopsy. The accuracy, sensitivity, and specificity for ME-NBI were 93.75%, 91.67%, and 95.45%, compared with 91.86%, 90%, and 93.48%, respectively, for CLE, for discrimination cancerous/noncancerous lesion (all P > 0.05). For undifferentiated/differentiated adenocarcinoma, CLE had a numerically but not statistically significantly higher accuracy than ME-NBI (81.25% vs 73.33%, P = 0.46). Agreements between ME-NBI/CLE and histopathology were near perfect (ME-NBI, κ = 0.87; CLE, κ = 0.84).CLE is not superior to ME-NBI for discriminating gastric cancerous from noncancerous lesions. Endoscopist could make an optimal choice according to the specific indication and advantages of ME-NBI and CLE in daily practices.
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Affiliation(s)
- Shuai Gong
- From the Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease, Shanghai, China
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91
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Hirasawa K, Sato C, Makazu M, Kaneko H, Kobayashi R, Kokawa A, Maeda S. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 2015; 7:1055-1061. [PMID: 26380051 PMCID: PMC4564832 DOI: 10.4253/wjge.v7.i12.1055] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/18/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Abstract
Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients.
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92
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Inokuchi Y, Kobayashi M, Kudo K, Yamada H, Inoue S, Nishimura K, Nakayama N, Motohashi O. Outcomes and precautions of endoscopic submucosal dissection for undifferentiated-type early gastric cancer. Therap Adv Gastroenterol 2015; 8:255-62. [PMID: 26327915 PMCID: PMC4530429 DOI: 10.1177/1756283x15582139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Since the development of techniques for endoscopic submucosal dissection (ESD), the indication range of endoscopic resection (ER) has been extended in early gastric cancer (EGC) treatment. For undifferentiated-type EGC, tumors with an intramucosal depth of invasion, no ulceration and a diameter of 20 mm or less were included in the expanded indications for ER in the Japanese Gastric Cancer Treatment Guidelines 2010. Nonetheless, because of difficulty in detecting lesions that meet the criteria for ER, the number of endoscopically resected cases of undifferentiated-type EGC is less than that of differentiated-type EGC. METHODS We retrospectively investigated the outcomes of ESD in 38 patients with 40 lesions of EGC in which the dominant pathological type was confirmed to be undifferentiated (signet ring cell carcinoma, poorly differentiated adenocarcinoma, mucinous adenocarcinoma) on histological examination of resected specimens. RESULTS Margin involvement and submucosal infiltration were common noncurative factors. Precise evaluation of the area and depth of lesions is a problem to be solved. Among a total of five patients with involved or uncertain horizontal margins, one of two patients who underwent additional surgery had residual cancer, and one of three patients who were observed had recurrence. CONCLUSIONS Undifferentiated-type EGC with a positive horizontal margin may relapse after ESD. It is therefore essential to precisely evaluate the area of the lesion and to perform resection with an adequate safety margin to decrease the risk of recurrence.
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Affiliation(s)
- Yasuhiro Inokuchi
- Kanagawa Cancer Center, Department of Gastroenterology, Nakao 2-3-2, Asahi-ku, Yokohama City, Yokohama 241-8515, Japan
| | | | - Kana Kudo
- Kanagawa Cancer Center, Yokohama, Japan
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Risk factors for bleeding evaluated using the Forrest classification in Japanese patients after endoscopic submucosal dissection for early gastric neoplasm. Eur J Gastroenterol Hepatol 2015; 27:1022-9. [PMID: 26075810 DOI: 10.1097/meg.0000000000000419] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND/AIMS Bleeding remains a serious complication after endoscopic submucosal dissection (ESD). Second-look endoscopy for hemostasis helps prevent post-ESD bleeding. We investigated the relationships between patient characteristics, tumor characteristics, and the Forrest classification for exposed vessels on artificial ulcers after ESD and evaluated whether hemostasis during second-look endoscopy was useful for preventing post-ESD bleeding. PATIENTS AND METHODS We analyzed 250 patients (265 lesions) who underwent ESD for gastric neoplasms. Vessels classified by Forrest classifications during scheduled second-look endoscopy were analyzed for associations with patient characteristics, tumor characteristics, and recurrent bleeding. RESULTS Two of 250 patients (0.8%) underwent emergency hemostatic endoscopy before scheduled second-look endoscopy. The remaining 248 patients (99.2%) underwent scheduled second-look endoscopy on the day after ESD. Patients with Forrest classification Ia, Ib, or IIa vessels had a significantly higher risk for recurrent bleeding after scheduled second-look endoscopy compared with patients with IIb or III vessels according to univariate analysis (P<0.05) and multivariate logistic regression analysis (odds ratio: 3.45; 95% confidence interval: 1.04-11.41; P=0.042). Univariate analysis indicated that hemodialysis correlated significantly with the presence of Ia, Ib, or IIa vessels compared with that of IIb or III vessels found during second-look endoscopy (P<0.05). Multivariate analysis indicated a significant relationship between hemodialysis and recurrent bleeding after second-look endoscopy (odds ratio: 10.05; 95% confidence interval: 1.97-51.26; P=0.006). CONCLUSION Hemodialysis is a risk factor for post-ESD bleeding. Proper classification of exposed vessels within post-ESD ulcers according to the Forrest classification using second-look endoscopy might help predict or prevent recurrent bleeding.
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94
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Park SE, Kim DH, Jung HY, Lim H, Ahn JY, Choi KS, Lee JH, Choi KD, Song HJ, Lee GH, Kim JH, Han S. Risk factors and correlations of immediate, early delayed, and late delayed bleeding associated with endoscopic resection for gastric neoplasms. Surg Endosc 2015; 30:625-632. [PMID: 26091990 DOI: 10.1007/s00464-015-4250-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 05/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bleeding is a major complication following endoscopic resection (ER) of gastric mucosal lesions. We aimed to determine the risk factors for post-ER bleeding and their correlations according to the time elapsed since the procedure. METHODS We retrospectively enrolled 670 lesions in 610 patients who underwent ER between March 2009 and December 2010. We classified these lesions into three types in accordance with the bleeding time, i.e., immediate bleeding (IB), early delayed bleeding (EDB), and late delayed bleeding (LDB). We analyzed the risk factors for each bleeding type according to baseline patient characteristics, procedure-related factors, and correlations between the occurrence of each bleeding type. RESULTS There were 408 post-ER bleeding events in our study cohort: 302 IB events, 88 EDB events, and 18 LDB events. In multivariate analysis, a histologic finding of carcinoma and the resection time were significant predictors of IB (p < 0.001). Of the 302 IB events, 13.9% showed EDB. Additionally, LDB occurred in 2.4% of lesions with EDB and 4.6% of lesions without EDB. Similar to the IB group, of 368 lesions without IB, 12.5% showed EDB. In addition, LDB occurred in 2.2% of lesions with EDB and 1.2% of lesions without EDB. IB was associated with a higher risk of EDB (p < 0.001) and LDB (p < 0.001), whereas EDB was not related to an increased risk of LDB (p = 0.997). CONCLUSION IB significantly increases the risk of EDB and LDB, but EDB does not increase the risk of LDB. Histologically confirmed carcinoma or a prolonged time for resection increases the risk of post-ER IB. We recommend careful follow-up approaches following ER of a gastric mucosal lesion in high-risk patients to prevent a potentially critical occurrence of delayed bleeding.
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Affiliation(s)
- So-Eun Park
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Hyun Lim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Kwi-Sook Choi
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Jin-Ho Kim
- Department of Gastroenterology, Asan Digestive Disease Research Institute, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
| | - Seungbong Han
- Department of Applied Statistics, Gachon Univertisy, 1342 Seongnamdaero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 461-701, Korea
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95
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Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection for Endoscopic Therapy of Barrett's Esophagus-related Neoplasia. Gastroenterol Clin North Am 2015; 44:317-35. [PMID: 26021197 DOI: 10.1016/j.gtc.2015.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A major paradigm shift has occurred in the management of dysplastic Barrett's esophagus (BE) and early esophageal carcinoma. Endoscopic therapy has now emerged as the standard of care for this disease entity. Endoscopic resection techniques like endoscopic mucosal resection and endoscopic submucosal dissection combined with ablation techniques help achieve long-term curative success comparable with surgical outcomes, in this subgroup of patients. This article is an in-depth review of these endoscopic resection techniques, highlighting their role and value in the overall management of BE-related dysplasia and neoplasia.
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96
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Abstract
Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-related deaths in the world. The prognosis of GC is clearly associated with the tumor stage, with a 5-year overall survival rate for early gastric cancer (EGC) exceeding 90%, which is significantly higher than that of advanced gastric cancer. Endoscopic resection, including endoscopic mucosal resection and endoscopic submucosal dissection, has been adopted in recent decades as the first treatment option of EGC in many countries for its minimal invasion and high curative rate. However, the horizontal and vertical margins are related to the curative resection of EGC and the prognosis of patients. Thus the accurate prediction of the tumor boundary and its invasive depth before treatment counts for much in planning the most appropriate treatment strategy and promising curative resection. To date, various endoscopic techniques have been identified to play a role in pretreatment evaluation, such as white light endoscopy, chromoendoscopy, narrow band imaging and endoscopic ultrasonography. This article aimed to summarize the diagnostic methods, applications and limitations of these different endoscopic techniques for identifying tumor horizontal and vertical margins in EGC, helping to increase preoperative evaluation of capabilities and to improve the curative resection rate of EGC.
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Affiliation(s)
- Ying Zhou
- Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
| | - Xiao Bo Li
- Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China
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97
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Kajiura S, Hosokawa A, Ueda A, Mihara H, Ando T, Fujinami H, Nishikawa J, Ogawa K, Minemura M, Sugiyama T. Effective healing of endoscopic submucosal dissection-induced ulcers by a single week of proton pump inhibitor treatment: a retrospective study. BMC Res Notes 2015; 8:150. [PMID: 25889379 PMCID: PMC4404649 DOI: 10.1186/s13104-015-1111-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/31/2015] [Indexed: 12/27/2022] Open
Abstract
Background Although artificial ulcers generally heal faster than Helicobacter pylori-related or nonsteroidal anti-inflammatory drug-related peptic ulcers, endoscopic submucosal dissection (ESD)-induced gastric ulcers are usually treated with a proton pump inhibitor (PPI) for 4–8 weeks. The effect of oral administration of a PPI for 1 week on ESD-induced gastric ulcers has not yet been evaluated. In the present study, we evaluated the efficacy of oral PPI for 1 week in patients with ESD-induced ulcers. Methods We selected 45 patients who underwent ESD for gastric mucosal tumors between June 2005 and July 2006 at Toyama University Hospital, and who met our inclusion criteria. All patients received omeprazole intravenously for 2 days after ESD and then orally for 1 week to prevent bleeding. Twenty two patients received no further omeprazole therapy (1-week group) and the rest received omeprazole orally for 7 more weeks (8-week group). Follow-up endoscopy was performed at 1 day, 4 weeks, and 8 weeks after ESD. We compared the ulcer healing rates between both groups. Results There were no significant differences between the groups in the ulcer-healing rate, because ulcers healed in 22 (96%) and 20 (91%) patients from the 8-week and 1-week groups, respectively. Conclusions In our study, oral administration of omeprazole for 1 week was sufficient to achieve healing of ESD-induced artificial gastric ulcers. A larger prospective trial will be required to confirm these findings.
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Affiliation(s)
- Shinya Kajiura
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan. .,Department of Medical Oncology, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Ayumu Hosokawa
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Akira Ueda
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Hiroshi Mihara
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Takayuki Ando
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Haruka Fujinami
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Jun Nishikawa
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Kohei Ogawa
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Masami Minemura
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
| | - Toshiro Sugiyama
- Department of Gastroenterology and Hematology, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama-shi, Toyama-ken, 930-0194, Japan.
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98
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Sekiguchi M, Kushima R, Oda I, Suzuki H, Taniguchi H, Sekine S, Fukagawa T, Katai H. Clinical significance of a papillary adenocarcinoma component in early gastric cancer: a single-center retrospective analysis of 628 surgically resected early gastric cancers. J Gastroenterol 2015; 50:424-34. [PMID: 25142800 DOI: 10.1007/s00535-014-0991-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 08/07/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND We recently reported that the presence of a papillary adenocarcinoma (pap) component was an independent risk factor for lymphatic involvement in endoscopically resected early gastric cancer (EGC). This study aimed to investigate the potential association between the presence of a pap component in EGC and lymph node metastasis (LNM). METHODS In order to evaluate the association between LNM and clinicopathological features, including a pap component, we reviewed 628 surgically resected EGCs at our institution between 2009 and 2012. Clinicopathological features included age, gender, tumor location, macroscopic type, tumor size, histological type, depth, ulcerative findings, and lymphatic and venous involvement. In addition, the association between clinicopathological features and lymphatic involvement was also evaluated. RESULTS LNM was observed in 52 cases (8.3%). Univariate analyses revealed a significant correlation between a pap component and LNM as well as tumor size, depth, macroscopic type, a poorly differentiated adenocarcinoma component, and lymphatic and venous involvement. The percentage of positive LNM among the EGC cases with a pap component was significantly higher than in those without the component (18.2 vs. 7.3%, P = 0.010). Via multivariate analyses lymphatic involvement was identified as the strongest risk factor for LNM [odds ratio (OR) 14.1] and a pap component was revealed as an independent risk factor for lymphatic involvement (OR 3.1). CONCLUSION Our study revealed that EGC cases with a pap component were at higher risk of lymphatic involvement and showed a higher percentage of positive LNM. More attention should be paid to a pap component in EGC.
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Affiliation(s)
- Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan,
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99
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Lim L, Streutker CJ, Marcon N, Cirocco M, Iakovlev VV, DaCosta R, Foster FS, Wilson BC. Clinical study ofex vivophotoacoustic imaging in endoscopic mucosal resection tissues. ACTA ACUST UNITED AC 2015. [DOI: 10.1117/12.2075451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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100
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Laine L, Kaltenbach T, Barkun A, McQuaid KR, Subramanian V, Soetikno R, Farraye FA, Feagan B, Ioannidis J, Kiesslich R, Krier M, Matsumoto T, McCabe RP, Mönkemüller K, Odze R, Picco M, Rubin DT, Rubin M, Rubio CA, Rutter MD, Sanchez-Yague A, Sanduleanu S, Shergill A, Ullman T, Velayos F, Yakich D, Yang YX. SCENIC international consensus statement on surveillance and management of dysplasia in inflammatory bowel disease. Gastroenterology 2015; 148:639-651.e28. [PMID: 25702852 DOI: 10.1053/j.gastro.2015.01.031] [Citation(s) in RCA: 336] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/09/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Loren Laine
- Section of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut; Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Tonya Kaltenbach
- Veterans Affairs Palo Alto Healthcare System and Stanford University School of Medicine (affiliate), Palo Alto, California
| | - Alan Barkun
- Division of Gastroenterology, McGill University, Montreal, Quebec, Canada
| | - Kenneth R McQuaid
- University of California at San Francisco, Veterans Affairs Medical Center, San Francisco, California
| | | | - Roy Soetikno
- Veterans Affairs Palo Alto Healthcare System and Stanford University School of Medicine (affiliate), Palo Alto, California
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