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Deng R, Wu J, Li D, Wu B, Shi R, Tian Y, Yao J, Wang LS. Clip-and-snare method with a pre-looping technique versus conventional method in the treatment of precancerous lesion and early gastric cancer: a retrospective study. BMC Gastroenterol 2024; 24:170. [PMID: 38760726 PMCID: PMC11100069 DOI: 10.1186/s12876-024-03231-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Low grade intraepithelial neoplasia (LGIN) and high grade intraepithelial neoplasia (HGIN) are potential precancerous lesion of gastric neoplasms. Endoscopic submucosal dissection (ESD) is the first option for the treatment of precancerous lesion and early gastric cancer (EGC). Traction is an effective method to improve efficiency, and reduce complications during ESD. In this study, we shared a useful traction method using the clip-and-snare method with a pre-looping technique (CSM-PLT) for precancerous lesion and EGC. METHODS We retrospectively analyzed patients received ESD combined with CSM-PLT or conventional ESD from June 2018 to December 2021 in Shenzhen People's hospital. The primary outcome was resection speed. RESULTS Forty-two patients were enrolled in ESD combined with CSM-PLT group and sixty-five patients in conventional ESD group respectively. Baseline characteristics were comparable among two groups (P>0.05). There were no significant differences in terms of R0 resection rate, en bloc resection rate (97.6% vs. 98.5%, P = 1.000 and 97.6% vs. 96.9%, P = 1.000, respectively), operation costs (933.7 (644.1-1102.4) dollars vs. 814.7 (614.6-988.3) dollars, P = 0.107), and hospital stays (8.0 ± 3.1 days vs. 7.3 ± 3.2 days, P = 0.236). In addition, no significant difference was observed with respect to complications (P>0.05). However, the resection speed of ESD combined with CSM-PLT was faster than that of conventional ESD (11.3 (9.4-14.9) mm2/min vs. 8.0 (5.8-10.9) mm2/min, P < 0.001), particularly lesions located in anterior wall and lesser curvature. In addition, the association between ESD combined with CSM-PLT and resection speed was still supported after propensity matching scores (PMS). CONCLUSIONS CSM-PLT can help to improve ESD efficiency without reducing the en bloc resection rate or increasing the incidence of complications.
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Affiliation(s)
- Ruichong Deng
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China
| | - Jiatong Wu
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China
| | - Defeng Li
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China
| | - Benhua Wu
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China
| | - Ruiyue Shi
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China
| | - Yanhui Tian
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China
| | - Jun Yao
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China
| | - Li-Sheng Wang
- Department of Gastroenterology, The Second Clinical Medical College, The First Affiliated Hospital, Shenzhen People's Hospital, Jinan University, Southern University of Science and Technology, No.1017, Dongmen North Road, Luohu District, Shenzhen, 518020, China.
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2
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Li J, Lu G, Yin Y, Lu X, Ma F, Lv Y, He S, Ren M. Efficacy, safety, and advantages of magnetic anchor-guided endoscopic submucosal dissection vs conventional endoscopic submucosal dissection: A retrospective paired cohort study. J Gastrointest Surg 2024; 28:394-401. [PMID: 38583889 DOI: 10.1016/j.gassur.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/05/2024] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has been recommended as the first-line treatment for early gastric cancer (EGC). However, poor visualization of the operative field increases both the procedure time and the risk of complications, especially for large and difficult lesions. We introduced a novel technique, magnetic anchor-guided ESD (MAG-ESD) and compared it with conventional ESD (C-ESD) for the treatment of large EGCs in terms of efficacy, safety, and advantages. METHODS Patients with large EGCs who underwent MAG-ESD or C-ESD at the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to March 2022 were retrospectively enrolled in this study. The patients in the MAG-ESD cohort were matched to those in the C-ESD cohort using propensity score-based matching. The operation time, submucosal dissection time, complete resection status, magnetic anchor, adverse event rate, and tumor recurrence rate were evaluated. RESULTS Twenty-two patients who underwent MAG-ESD were ultimately matched to those who underwent C-ESD. The median operation time of MAG-ESD and C-ESD was 43 minutes (IQR, 35.2-49.5) and 50.5 minutes (IQR, 42.0-76.0), respectively, among which the submucosal dissection time was 7.6 minutes (IQR, 5.2-10.4) and 14.8 minutes (IQR, 10.8-19.6), respectively. The operation time of MAG-ESD was shorter than that of C-ESD, especially the submucosal dissection time (P < .05). There was a lower incidence of adverse events associated with MAG-ESD (P < .05) when magnetic anchors were successfully placed and retrieved. CONCLUSION MAG-ESD is feasible, effective, safe, and simple for the treatment of large EGCs at different sites and has a high anchor success rate, which could shorten the operation time and reduce the adverse event rate.
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Affiliation(s)
- Jing Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Shaanxi Clinical Research Center of Digestive Disease (Cancer Division), Xi'an, Shaanxi, China
| | - Guifang Lu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Shaanxi Clinical Research Center of Digestive Disease (Cancer Division), Xi'an, Shaanxi, China
| | - Yan Yin
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Shaanxi Clinical Research Center of Digestive Disease (Cancer Division), Xi'an, Shaanxi, China
| | - Xinlan Lu
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Shaanxi Clinical Research Center of Digestive Disease (Cancer Division), Xi'an, Shaanxi, China
| | - Feng Ma
- National and Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Lv
- National and Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shuixiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Shaanxi Clinical Research Center of Digestive Disease (Cancer Division), Xi'an, Shaanxi, China; National and Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Mudan Ren
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China; Shaanxi Clinical Research Center of Digestive Disease (Cancer Division), Xi'an, Shaanxi, China; National and Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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3
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Gao Y, Liu W, Ye L, Du J, Xie J, Zhang Q, Hu B. Magnet-assisted traction method helps to reduce the difficulty of esophageal endoscopic submucosal dissection. Endoscopy 2023; 55:E1186-E1188. [PMID: 38029796 PMCID: PMC10686747 DOI: 10.1055/a-2186-5029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Yuan Gao
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, China
| | - Wei Liu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, China
| | - Liansong Ye
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, China
| | - Jiang Du
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, China
| | - Jia Xie
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, China
| | - Qiongying Zhang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, China
| | - Bing Hu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, China
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Yinhe S, Yang J, Aijun Z, Ruyuan L. ESD with elastic ring traction is more effective and safer than conventional ESD in large proximal colon neoplastic lesions: a retrospective cohort study (with video). Surg Endosc 2023; 37:9658-9664. [PMID: 37907659 PMCID: PMC10709475 DOI: 10.1007/s00464-023-10445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/02/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND AND AIMS Colorectal endoscopic submucosal resection (ESD), especially ESD in proximal colon, has always been challenging. We invented a novel elastic ring as a traction method to facilitate ESD. Our study aims to compare the safety and effectiveness of ESD with in vivo traction and conventional ESD without traction in the treatment of large proximal colon neoplastic lesions. METHODS This retrospective cohort study included consecutive patients with large (≥ 20 mm in their maximal diameter) proximal colon neoplastic lesions who underwent ESD with in vivo elastic ring traction or conventional ESD without traction in our endoscopy center between June 2018 and April 2022 by one experienced endoscopist. RESULTS The ESD with traction group has lower overall complication rate and lower perforation rate than those in the conventional ESD group (0% vs 14.71%, P = 0.021; 0% vs 11.76%, P = 0.048, respectively), and the differences are statistically significant. Although there are no significant differences in the rates of en bloc resection and R0 resection and bleeding rate, ESD with traction group still had higher en bloc resection and R0 resection rates and lower bleeding rate than conventional ESD group without traction (100% vs 94.12%, P = 0.226; 94.59% vs 85.29%, P = 0.189, 8.82% vs 2.70%, P = 0.276, respectively). CONCLUSION ESD with elastic ring traction is potentially more effective and safer than conventional ESD in the treatment of large proximal colon neoplastic lesions. Further large, prospective controlled studies are needed to fully evaluate this novel method.
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Affiliation(s)
- Sikong Yinhe
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Jiao Yang
- Department of General Surgery, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China
| | - Zhang Aijun
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China.
| | - Li Ruyuan
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shangdong University, 758 Hefei Road, Qingdao, Shangdong, China.
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5
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Libânio D, Pimentel-Nunes P, Bastiaansen B, Bisschops R, Bourke MJ, Deprez PH, Esposito G, Lemmers A, Leclercq P, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, Fuccio L, Bhandari P, Dinis-Ribeiro M. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55:361-389. [PMID: 36882090 DOI: 10.1055/a-2031-0874] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.
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Affiliation(s)
- Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal.,Gastroenterology, Unilabs, Portugal
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianluca Esposito
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy. Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.,University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
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6
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A Look into the Future of Endoscopic Submucosal Dissection and Third Space Endoscopy: The Role for Robotics and Other Innovation. Gastrointest Endosc Clin N Am 2023; 33:197-212. [PMID: 36375883 DOI: 10.1016/j.giec.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Endoscopic resection has been widely applied especially in endoscopic submucosal dissection and third space endoscopy (TSE). Flexible endoluminal robotics allow performance of endoscopic submucosal dissection with exposure of the submucosal plane for precise dissection using two robotic arms. The introduction of TSE revolutionized the horizon of therapeutic endoscopy to the submucosal space beneath and beyond the mucosa. Advantages of TSE include avoidance of full thickness incision in gastrointestinal tract through the submucosal tunneling for performance of peroral endoscopic myotomy and submucosal tunneling endoscopic resection. In future, robotic-driven devices should be developed to enhance performance of complex endoluminal procedures and TSE.
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7
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Li D, Zheng L, Zhang Z, Chen L, Jiang C, Wang R, Lin J, Lu Y, Bai Y, Wang W. Usefulness of the combined orthodontic rubber band and clip method for gastric endoscopic submucosal dissection. BMC Gastroenterol 2022; 22:527. [PMID: 36528595 PMCID: PMC9759892 DOI: 10.1186/s12876-022-02606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIMS Effective traction is an important prerequisite for successful endoscopic submucosal dissection (ESD). The combined orthodontic rubber band (ORB) and clip method was effective in colorectal cancer ESD. To date, the method was not reported in gastric ESD. This study aimed to investigate its efficacy and safety for gastric neoplasms ESD. METHODS We retrospectively analyzed data of 118 patients with gastric neoplasms treated by ESD from November 2020 to April 2022, 43 by ORB-ESD and 75 by the conventional ESD. The primary outcome measure was the ESD procedure time. Clinical data on efficacy and safety were also collected and analyzed. Propensity score matching (PSM) matched the patients in both groups. RESULTS PSM successfully matched 31 pairs of patients. The ORB-ESD operation time was shorter (median [interquartile range], 35 [30-48] vs. 49 [40-70] min, P < 0.001) and dissection speed was higher (median [interquartile range], 22.6 [14.4-29.3] vs. 13.5 [9.6-17.9] mm2/min, P < 0.001) than in the conventional ESD. The groups were similar in muscular injury rate, frequency and time of use of thermal hemostatic forceps, postoperative adverse events, en bloc resection, and R0 resection rate (P > 0.05). CONCLUSIONS Compared to the conventional ESD, ORB-ESD significantly reduced the procedure time and increased the dissection speed, proving beneficial to gastric ESD.
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Affiliation(s)
- Dazhou Li
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China ,Department of Gastroenterology, 900th Hospital of People’s Liberation Army, Fuzhou, 350025 China ,grid.12955.3a0000 0001 2264 7233Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, 350025 China
| | - Linfu Zheng
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China ,grid.284723.80000 0000 8877 7471Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 China
| | - Zewen Zhang
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China
| | - Longping Chen
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China ,Department of Gastroenterology, 900th Hospital of People’s Liberation Army, Fuzhou, 350025 China
| | - Chuanshen Jiang
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China ,Department of Gastroenterology, 900th Hospital of People’s Liberation Army, Fuzhou, 350025 China
| | - Rong Wang
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China ,Department of Gastroenterology, 900th Hospital of People’s Liberation Army, Fuzhou, 350025 China ,grid.12955.3a0000 0001 2264 7233Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, 350025 China
| | - Jiahong Lin
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China
| | - Yiwen Lu
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China
| | - Yang Bai
- grid.284723.80000 0000 8877 7471Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 China
| | - Wen Wang
- grid.256112.30000 0004 1797 9307Department of Gastroenterology, The 900th Hospital of PLA, Fuzhou General Clinical Medical College, Fujian Medical University, Fuzhou, 350025 China ,Department of Gastroenterology, 900th Hospital of People’s Liberation Army, Fuzhou, 350025 China ,grid.12955.3a0000 0001 2264 7233Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, 350025 China
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Khan S, Ali FS, Ullah S, Huang X, Li H. Advancing endoscopic traction techniques in endoscopic submucosal dissection. Front Oncol 2022; 12:1059636. [PMID: 36387236 PMCID: PMC9663992 DOI: 10.3389/fonc.2022.1059636] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/10/2022] [Indexed: 02/26/2024] Open
Abstract
Traction techniques have emerged as a desirable "second-hand" while performing endoscopic submucosal dissection (ESD), enabling adequate visualization of submucosal tissue and vasculature, which allows for safe and efficient dissection. Multiple traction techniques have been developed over the years, and these can be broadly divided into internal and external traction techniques. This arsenal of techniques allows for traction that is personalized to the location of the lesion undergoing ESD. Mastering traction techniques requires structured training, and understanding of the benefits and pitfalls of each technique. Future research and development efforts need to focus on pathways and curriculums for trainees to master the currently available endoscopic traction techniques and provide avenues for the development of newer traction modalities.
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Affiliation(s)
- Suliman Khan
- The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Faisal S. Ali
- Gastroenterology, Hepatology, and Nutrition Department, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Saif Ullah
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Changxing, Zhengzhou, China
| | - Xue- Huang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Changxing, Zhengzhou, China
| | - Hongyu Li
- Department of Gastroenterology, The People’s Hospital of Changxing Country, Zhejiang Province, China
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9
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Hayat M, Azeem N, Bilal M. Colon Polypectomy with Endoscopic Submucosal Dissection and Endoscopic Full-Thickness Resection. Gastrointest Endosc Clin N Am 2022; 32:277-298. [PMID: 35361336 DOI: 10.1016/j.giec.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic resection has become the gold standard for the management of most of the large colorectal polyps. Various endoscopic resection techniques include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). ESD is a minimally invasive method for the resection of advanced lesions in the gastrointestinal (GI) tract to achieve en-bloc resection. While, EFTR is more commonly used in lesions with suspected deeper submucosal invasion, lesions originating from muscularis propria, or those with advanced fibrosis. This article reviews the indications, technique, and adverse events for use of ESD and EFTR in the colon.
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Affiliation(s)
- Maham Hayat
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA
| | - Nabeel Azeem
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mohammad Bilal
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; Advanced Endoscopy, Division of Gastroenterology & Hepatology, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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10
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Orthodontic Rubber Band-Assisted Endoscopic Submucosal Dissection: An Efficient Method for Treating Superficial Colorectal Tumors. Gastroenterol Res Pract 2022; 2022:2835258. [PMID: 35136406 PMCID: PMC8818396 DOI: 10.1155/2022/2835258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Colorectal endoscopic submucosal dissection (ESD) is a complex operation. Effective traction is crucial. We have successfully used an orthodontic rubber band (ORB) combined with the clip traction method to assist ESD (ORB-ESD). The aim of this retrospective study is to describe the method and to compare the efficacy and safety of ORB-ESD versus conventional ESD in the treatment of superficial colorectal tumors. Methods We retrospectively analyzed the data of patients with superficial colorectal tumor (with diameter ≥ 20 mm) who received either ORB-ESD (n = 34) or conventional ESD (n = 90) between January 2019 and September 2020. Propensity score matching (PSM) was used to match the clinical data of 31 pairs of patients in each group. Results Operation time was significantly shorter for ORB-ESD than for conventional ESD (34.5 minutes vs. 56 minutes, P ≤ 0.001). In the propensity-matched cohorts, the operation time remained significantly shorter in the ORB-ESD patients (35 minutes vs. 50 minutes, P = 0.001). Postoperative adverse events, en bloc resection rate, and R0 resection rate were comparable between the two groups (P > 0.05), both before and after propensity score matching. In the ORB subgroup analysis, the trainee and expert ESD operation times were similar (37 (26–53) vs. 33.5 (26–37) minutes, respectively; P = 0.274). Conclusion ORB-ESD appears to be an effective technique for ESD of colorectal cancer. Our findings need to be confirmed in large prospective multicenter studies.
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Wu X, Ye C, Cao Z, Hu X, Pan W, Jing J. Comparison of the Effectiveness and Safety of Different Methods of Colorectal Endoscopic Submucosal Dissection: A Systematic Review and Network Meta-Analysis. Dig Dis 2021; 40:796-809. [PMID: 34937035 DOI: 10.1159/000521377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method (P-ESD), traction-assisted method (T-ESD), and hybrid method (H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. STUDY DESIGN Studies comparing different methods of colorectal ESD were searched by using PubMed, EMBASE, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. RESULTS Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3,002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than that of C-ESD, P-ESD, and T-ESD (RR = 0.28, 95% CI [0.12, 0.65]; RR = 0.11, 95% CI [0.03, 0.44]; RR = 8.28, 95% CI [2.50, 27.42]). Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter (MD = -21.83, 95% CI [-34.76, -8.90]; MD = -23.8, 95% CI [-32.55, -15.06]). Meanwhile, the operation time of T-ESD was also significantly shorter than that of P-ESD (MD = -18.74, 95% CI [-31.93, -5.54]). The dissection speed of T-ESD was significantly faster than that of C-ESD (MD = 6.26, 95% CI [2.29, 10.23]). CONCLUSION P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time.
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Affiliation(s)
- Xueping Wu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenglong Ye
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhongsheng Cao
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangcheng Hu
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wensheng Pan
- Zhejiang Chinese Medical University, Hangzhou, China.,Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiyong Jing
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Abe S, Wu SYS, Ego M, Takamaru H, Sekiguchi M, Yamada M, Nonaka S, Sakamoto T, Suzuki H, Yoshinaga S, Matsuda T, Oda I, Saito Y. Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection. Gut Liver 2021; 14:673-684. [PMID: 31887810 PMCID: PMC7667936 DOI: 10.5009/gnl19266] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/08/2019] [Accepted: 10/12/2019] [Indexed: 12/20/2022] Open
Abstract
This systematic review aimed to assess the efficacy of the current approach to tissue traction during the endoscopic submucosal dissection (ESD) of superficial esophageal cancer, early gastric cancer, and colorectal neoplasms. We performed a systematic electronic literature search of articles published in PubMed and selected comparative studies to investigate the treatment outcomes of tractionassisted versus conventional ESD. Using the keywords, we retrieved 381 articles, including five eligible articles on the esophagus, 13 on the stomach, and 12 on the colorectum. A total of seven randomized controlled trials and 23 retrospective studies were identified. Clip line traction and submucosal tunneling were effective in reducing the procedural time during esophageal ESD. The efficacy of traction methods in gastric ESD varied in terms of the devices and strategies used depending on the lesion location and degree of submucosal fibrosis. Several prospective and retrospective studies utilized traction devices without the need to reinsert the colonoscope. When pocket creation is included, the traction devices and methods effectively shorten the procedural time during colorectal ESD. Although the efficacy is dependent on the organ and tumor locations, several traction techniques have been demonstrated to be efficacious in facilitating ESD by maintaining satisfactory traction during dissection.
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Affiliation(s)
- Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Mai Ego
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Keihanian T, Othman MO. Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice. Clin Exp Gastroenterol 2021; 14:317-330. [PMID: 34377006 PMCID: PMC8349195 DOI: 10.2147/ceg.s249869] [Citation(s) in RCA: 8] [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: 03/15/2021] [Accepted: 07/17/2021] [Indexed: 12/13/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is a method of en-bloc resection of neoplastic colorectal lesions which is less invasive compared to surgical resection. Lesion stratification, architecture recognition and estimation of depth of invasion are crucial for patient selection. Expert endoscopists have integrated a variety of classification systems including Paris, lateral spreading tumor (LST), narrow band imaging (NBI), international colorectal endoscopic (NICE) and Japanese NBI expert team (JNET) in their day-to-day practice to enhance lesion detection accuracy. Major societies recommend ESD for LST-non granular (NG), Kudo-VI type, large depressed and protruded colonic lesions with shallow submucosal invasion. Chance of submucosal invasion enhances with increased depth as well as tumor location and size. In comparison to endoscopic mucosal resection (EMR), ESD has a lowerl recurrence rate and higher curative resection rate, making it superior for larger colonic lesions management. Major complications such as bleeding and perforation could be seen in up to 11% and 16% of patients, respectively. In major Western countries, performing ESD is challenging due to limited number of expert providers, lack of insurance coverage, and unique patient characteristics such as higher BMI and higher percentage of previously manipulated lesions.
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Affiliation(s)
- Tara Keihanian
- Division of Gastroenterology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mohamed O Othman
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
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Endoscopic Traction Techniques. Am J Gastroenterol 2021; 116:862-866. [PMID: 33929371 DOI: 10.14309/ajg.0000000000001100] [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: 03/11/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
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15
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Review on colorectal endoscopic submucosal dissection focusing on the technical aspect. Surg Endosc 2020; 34:3766-3787. [PMID: 32342217 DOI: 10.1007/s00464-020-07599-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) enables removal of broad-based colorectal polyps or lateral spreading tumors with a higher rate of en bloc resection and a lower risk of local recurrence. However, it is technically demanding. Over the past 20 years, various equipment and innovative techniques have been developed to reduce the difficulty of ESD. The information in the literature is scattered. Our aim is to provide a comprehensive review on the setup and technical aspects of colorectal ESD. METHODS We searched the PubMed database and systemically reviewed all original and review articles related to colorectal ESD. Further manual search according to reference lists of identified articles were done. The selected articles were categorized and reviewed. Original figures were created to help readers understand some of the ESD techniques. RESULTS A total of 216 articles were identified, in which 25 of them were review articles and 191 of them were original articles. They were categorized and reviewed. An in-depth appraisal of the setting, equipment, and technical aspects of colorectal ESD was performed. CONCLUSIONS Although ESD is a technically demanding procedure that requires expert endoscopic skills, it can be mastered. With good peri-procedural preparation, sufficient knowledge of the equipment, and thorough understanding of the useful endoscopic tricks and maneuvers, colorectal ESD can be performed smoothly and safely.
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16
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Tziatzios G, Ebigbo A, Gölder SK, Probst A, Messmann H. Methods that Assist Traction during Endoscopic Submucosal Dissection of Superficial Gastrointestinal Cancers: A Systematic Literature Review. Clin Endosc 2020; 53:286-301. [PMID: 31914722 PMCID: PMC7280854 DOI: 10.5946/ce.2019.147] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is a well-established method for the treatment of early-stage gastrointestinal neoplasms. Adequate submucosal exposure is one of the most significant factors related to an effective and safe dissection. The aim of this systematic review was to evaluate the effcacy and safety of various methods that assist traction during ESD of precancerous and earlystage neoplastic lesions of the gastrointestinal tract. We performed an electronic search of the MEDLINE and the Cochrane Controlled Trials Register databases for relevant studies published up to May 2019. Trials exclusively recruiting patients undergoing ESD for superficial gastrointestinal cancer were considered eligible for inclusion. Thirty-three articles including 3,134 patients met the inclusion criteria. The studies evaluated different approaches for widening the endoscopic view, including magnetic anchor-guided ESD (3 studies), use of a second endoscope (5 studies), clip-involving technique (21 studies), and miscellaneous methods (4 studies). Among them, only 6 were randomized controlled trials evaluating different approaches. Overall, the implementation of methods that assist traction during ESD significantly improved the operating time and R0 resection rate and decreased the rate of complications (bleeding and perforation). Interventions that assist traction seem effcacious in improving tissue traction, thus facilitating ESD performance.
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Affiliation(s)
- Georgios Tziatzios
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Karl Gölder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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Hu B, Ye LS. Endoscopic applications of magnets for the treatment of gastrointestinal diseases. World J Gastrointest Endosc 2019; 11:548-560. [PMID: 31839874 PMCID: PMC6885730 DOI: 10.4253/wjge.v11.i12.548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
Endoscopic treatment of gastrointestinal diseases has developed rapidly in recent years, due to its minimally invasive nature. One of the main contributing factors for this progress is the improvement of endoscopic instruments, which are essential for facilitating safe and effective endoscopic interventions. However, the slow learning curve required in the implementation of many advanced endoscopic procedures using standard devices is associated with a high risk of complications. Other routine procedures may also be complicated by unexpected difficulties. Based on the ferromagnetic properties of many objects, both internal and external magnetic devices have been developed and applied for multiple endoscopic interventions. The applications of magnets, mainly including compression, anchoring and traction, facilitate many difficult procedures and make it feasible to operate procedures that were previously impossible. Other novel endoscopic applications, such as magnetic nanoparticles, are also under development. In this article, we reviewed published studies of endoscopic applications of magnets for the treatment of gastrointestinal diseases such as precancerous lesions and cancer, obstruction, stricture, congenital and acquired malformations, motility disorders, and ingestion of foreign bodies. Since several endoscopic applications of magnets may also be relevant to surgery, we included them in this review.
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Affiliation(s)
- Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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