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Tanaka H, Takehara Y, Morimoto S, Tanino F, Yamamoto N, Kamigaichi Y, Tsuboi A, Yamashita K, Kotachi T, Arihiro K, Oka S. Diagnostic and therapeutic strategies for colorectal tumor with positive muscle-retracting sign. DEN OPEN 2024; 4:e278. [PMID: 37529381 PMCID: PMC10387743 DOI: 10.1002/deo2.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/19/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) for colorectal tumors with positive muscle-retracting (MR) sign often results in incomplete resection or discontinuation owing to the difficulty of submucosal dissection. The present study aimed to evaluate the usefulness of endoscopic ultrasonography (EUS) in diagnosing the MR sign and performing ESD using the pocket-creation method (PCM). Methods Thirty-six cases of colorectal tumors with positive MR sign during ESD between January 2015 and December 2021 were retrospectively reviewed. Cases were divided into two groups: 1) the conventional method (CM) group, comprising 29 cases, and 2) the PCM group with seven cases, in which preoperative EUS and ESD using PCM were performed. Treatment outcomes were compared between the groups. The diagnostic yield of EUS for the MR sign was evaluated among large sessile tumors >20 mm in which preoperative EUS was performed. Results Histologic diagnosis was adenoma or Tis carcinoma in 12 cases (33%), T1 carcinoma in 18 cases (50%), T2 carcinoma in four cases (11%), and unevaluable in two cases (6%). The sensitivity and specificity of the EUS-MR sign for large sessile tumors were 87.5% and 83.3%, respectively. ESD was achieved in all cases in the PCM group, although it was discontinued in eight cases (28%) in the CM group. There were significant differences between the PCM and CM groups in en bloc resection (100% vs. 48%, p = 0.013) and R0 resection rates (71% vs. 31%, p = 0.049). Conclusion The MR sign can be predicted by preoperative EUS, and ESD using PCM allows en bloc resection.
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Affiliation(s)
- Hidenori Tanaka
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Yudai Takehara
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Shin Morimoto
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Fumiaki Tanino
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Noriko Yamamoto
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Yuki Kamigaichi
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Akiyoshi Tsuboi
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Ken Yamashita
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Takahiro Kotachi
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
| | - Koji Arihiro
- Department of Anatomical PathologyHiroshima University HospitalHiroshimaJapan
| | - Shiro Oka
- Department of GastroenterologyHiroshima University HospitalHiroshimaJapan
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Tanaka H, Oka S, Kunihiro M, Nagata S, Kitamura S, Kuwai T, Hiraga Y, Furudoi A, Tanaka S. Endoscopic submucosal dissection for tumors involving the ileocecal valve with extension into the terminal ileum: a multicenter study from the Hiroshima GI Endoscopy Research Group. Surg Endosc 2023; 37:958-966. [PMID: 36070146 DOI: 10.1007/s00464-022-09542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 08/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The efficacy and safety of endoscopic submucosal dissection (ESD) for tumors extending into the terminal ileum remain obscure. We aimed to evaluate the outcomes of ESD for tumors involving the ileocecal valve (ICV) with extension into the terminal ileum. METHODS Sixty-eight patients (40 men; mean age, 67 years) with 68 tumors involving the ICV that were resected by ESD between December 2013 and December 2018 were included and classified into Group A (21 tumors with extension into the terminal ileum) and Group B (47 tumors without extension). ESD outcomes were compared between groups. RESULTS The clinical features of the patients and tumors were not significantly different between the groups. There were no significant differences in en bloc resection rate (95% and 94%, respectively; p = 0.79), R0 resection rate (90% and 89%, respectively; p = 0.89), procedure time (95 ± 54 min and 94 ± 69 min, respectively; p = 0.64), postoperative bleeding rate (5% and 3%, respectively; p = 0.79), intraoperative perforation rate (0% and 4%, respectively; p = 0.34), delayed perforation rate (0% and 0%, respectively), or postoperative symptomatic stenosis rate (0% and 0%, respectively) between Groups A and B. No specific factors related to the outcomes of ESD were found by subgroup analysis according to the dominance and degree of circumference of the ICV. Local recurrence was observed in 1 patient in Group A who was retreated using ESD. CONCLUSIONS ESD for tumors involving the ICV with extension into the terminal ileum is safe and effective.
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Affiliation(s)
- Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Shosuke Kitamura
- Department of Gastroenterology, JA Onomichi General Hospital, Onomichi, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center, Chugoku Cancer Center, Kure, Japan
| | - Yuko Hiraga
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Akira Furudoi
- Department of Gastroenterology, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
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Miyazaki K, Kato M, Sasaki M, Masunaga T, Nakayama A, Kanai T, Yahagi N. Successful hemostasis of a parapapillary diverticular hemorrhage by the retroflexion technique in the descending part of duodenum. Endoscopy 2022; 55:E66-E67. [PMID: 36179715 PMCID: PMC9829758 DOI: 10.1055/a-1931-4161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Kurato Miyazaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan,Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Teppei Masunaga
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Nakayama
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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Tanaka H, Oka S, Tsuboi A, Kamigaichi Y, Tamari H, Sumioka A, Shimohara Y, Nishimura T, Inagaki K, Okamoto Y, Iio S, Yamashita K, Sumimoto K, Tanaka S. Efficacy of single-balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score-matched analysis. DEN OPEN 2022; 2:e58. [PMID: 35310737 PMCID: PMC8828212 DOI: 10.1002/deo2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 04/14/2023]
Abstract
OBJECTIVES A single-balloon overtube (SBO) can improve poor scope operability during colonic endoscopic submucosal dissection (ESD). We aimed to evaluate the clinical usefulness of SBO for ESD in the proximal colon and the predictive factors for cases in which SBO is useful. METHODS A total of 88 tumors located in the proximal colon resected by balloon-assisted ESD (BA-ESD) using SBO and 461 tumors resected by conventional ESD (C-ESD) between June 2015 and November 2020 were considered. Seventy-eight tumors each in the BA-ESD and C-ESD groups were matched by propensity score matching. ESD outcomes were compared between the groups, and a decision tree analysis was performed to explore the predictive factors for cases in which SBO is useful. RESULTS There were no significant differences between the groups in the major outcomes such as en bloc resection rate (95% vs. 99%, p = 0.17), R0 resection rate (92% vs. 96%, p = 0.30), mean dissection speed (16 mm2/min vs. 16 mm2/min, p = 0.53), and intraoperative perforation rate (5% vs. 6%, p = 0.73). Even when considering cases with poor preoperative scope operability, there were no significant differences between the groups. Comparison of tumors ≥40 mm in diameter between the groups confirmed that the intraoperative perforation rate was significantly lower in the BA-ESD group than in the C-ESD group (0% vs. 24%, p = 0.0188). CONCLUSION SBO is useful for ESD of tumors ≥40 mm in diameter in the proximal colon to prevent intraoperative perforation, which usually has a long procedure time.
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Affiliation(s)
- Hidenori Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Shiro Oka
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Akiyoshi Tsuboi
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Yuki Kamigaichi
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Hirosato Tamari
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Akihiko Sumioka
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Yasutsugu Shimohara
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Tomoyuki Nishimura
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Katsuaki Inagaki
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Yuki Okamoto
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Sumio Iio
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Ken Yamashita
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Kyoku Sumimoto
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Shinji Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
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5
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Tanaka H, Oka S, Tanaka S, Nagata S, Kunihiro M, Kuwai T, Hiraga Y, Mizumoto T, Okanobu H, Chayama K. Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: Large multicenter 10-year study. Dig Endosc 2021; 33:608-615. [PMID: 33448492 DOI: 10.1111/den.13797] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES For local residual/recurrent and endoscopic resection (ER) interrupted colorectal tumors, endoscopic retreatment is often difficult due to severe submucosal fibrosis. Endoscopic submucosal dissection (ESD) can achieve en bloc resection, even for tumors with severe submucosal fibrosis, although it is a risk factor for incomplete resection and perforation. We aimed to determine the safety and efficacy of colorectal ESD for local residual/recurrent tumors including ER interrupted tumors from a large multicenter study. METHODS From January 2008 until December 2018, 3,937 colorectal tumors were resected by ESD at the Hiroshima GI Endoscopy Research Group. From this group, 81 local residual/recurrent tumors and 21 ER interrupted tumors were included. We analyzed ESD outcomes, particularly the difference between the early and late phases and re-recurrence after ESD for local residual/recurrent tumors. RESULTS For local residual/recurrent tumors, en bloc and R0 resection rates were 95% (77/81) and 90% (73/81), respectively. The intraoperative perforation rate was 6% (5/81), and one patient required surgery. The delayed perforation rate was 2% (2/81), and one patient required surgery. For ER interrupted tumors, both the en bloc and R0 resection rates were 86% (18/21), with no major adverse events. For local residual/recurrent and ER interrupted tumors, the intraoperative perforation rate was significantly lower in the late phase compared with the early phase. Following curative resection for local residual/recurrent tumors, no local re-recurrences occurred. CONCLUSIONS Colorectal ESD is an effective treatment for local residual/recurrent and ER interrupted tumors.
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Affiliation(s)
- Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuko Hiraga
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takeshi Mizumoto
- Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan
| | - Hideharu Okanobu
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Masunaga T, Kato M. Retroflexion technique in the descending part of the duodenum for endoscopic mucosal resection. Dig Endosc 2021; 33:e45-e46. [PMID: 33506590 DOI: 10.1111/den.13920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Teppei Masunaga
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Motohiko Kato
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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7
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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: 7] [Impact Index Per Article: 1.4] [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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