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Ramos JA, Morita Y, Toyonaga T, Carvalho D, Pedrosa MS, Arantes VN. Management of esophageal neoplasms by endoscopic submucosal dissection: experience over 100 consecutive procedures. Clin Endosc 2023; 56:613-622. [PMID: 37524567 PMCID: PMC10565440 DOI: 10.5946/ce.2022.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic submucosal dissection (ESD) is currently considered the first-line treatment for the eradication of superficial neoplasms of the esophagus in Eastern countries. However, in the West, particularly in Latin America, the experience with esophageal ESD is still limited because of the high technical complexity required for its execution. This study aimed to present the results of the clinical application of ESD to manage superficial esophageal neoplasms in a Latin American center in over 100 consecutive cases. METHODS This retrospective study included consecutive patients who underwent endoscopic ESD for superficial esophageal neoplasms between 2009 and 2022. The following clinical outcomes were assessed: en bloc, complete, and curative resection rates, local recurrence, adverse events, and procedure-related mortality. RESULTS Esophageal ESD was performed mainly for squamous cell carcinoma (66.6%), high-grade intraepithelial neoplasia (17.1%), and adenocarcinoma (11.4%). En bloc and complete resection rates were 96.2% and 81.0%, respectively. The curative resection rate was 64.8%. Adverse events occurred in six cases (5.7%). Endoscopic follow-up was performed for an average period of 29.7 months. CONCLUSION ESD performed by trained operators is feasible, safe, and clinically effective for managing superficial neoplastic lesions of the esophagus in Latin America.
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Affiliation(s)
- Josué Aliaga Ramos
- Department of Gastroenterology, “Jose Agurto Tello-Chosica” Hospital, Lima, Perú
- Digestive Endoscopy Unit of San Pablo Clinic, Lima, Perú
- Faculty of Medicine, Cayetano Heredia Peruvian University, Lima, Perú
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Reserch Center, Kobe, Japan
| | - Takashi Toyonaga
- Department of Gastroenterology, Kobe University International Clinical Cancer Reserch Center, Kobe, Japan
| | - Danilo Carvalho
- Endoscopy Unit, Alfa Institute of Gastroenterology, Belo Horizonte, Brazil
| | - Moises Salgado Pedrosa
- Pathology Department, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Laboratório CEAP, Belo Horizonte, Brazil
| | - Vitor N. Arantes
- Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Hospital Mater Dei Contorno, Belo Horizonte, Brazil
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Chen Z, Ding J, Wu C, Wei D, Sun J, Fan H, Guo Z. A review of hydrogels used in endoscopic submucosal dissection for intraoperative submucosal cushions and postoperative management. Regen Biomater 2023; 10:rbad064. [PMID: 37501677 PMCID: PMC10368804 DOI: 10.1093/rb/rbad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/02/2023] [Accepted: 06/14/2023] [Indexed: 07/29/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) has been clinically proved to have prominent advantages in the treatment of early gastrointestinal cancers over traditional surgery, including less trauma, fewer complications, a quicker recovery and lower costs. During the procedure of ESD, appropriate and multifunctional submucosal injected materials (SIMs) as submucosal cushions play an important role, however, even with many advances in design strategies of SIMs over the past decades, the performance of the submucosal cushions with postoperative management function seems to be still unsatisfactory. In this review, we gave a brief historical recount about the clinical development of SIMs, then some common applications of hydrogels used as SIMs in ESD were summarized, while an account of the universal challenges during ESD procedure was also outlined. Going one step further, some cutting-edge functional strategies of hydrogels for novel applications in ESD were exhibited. Finally, we concluded the advantages of hydrogels as SIMs for ESD as well as the treatment dilemma clinicians faced when it comes to deeply infiltrated lesions, some technical perspectives about linking the clinical demand with commercial supply were also proposed. Encompassing the basic elements of SIMs used in ESD surgery and the corresponding postoperative management requirements, this review could be a good reference for relevant practitioners in expanding the research horizon and improving the well-being index of patients.
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Affiliation(s)
| | | | - Chengheng Wu
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan 610064, China
- Institute of Regulatory Science for Medical Devices, Sichuan University, Chengdu, Sichuan 610064, China
| | - Dan Wei
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan 610064, China
| | - Jing Sun
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu, Sichuan 610064, China
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Varela-Rey I, de la Iglesia D, San Bruno-Ruz A, Mejuto-Fernández R, Monteserín-Ron L, López-Diaz J, García-Salom P, González-Cantalapiedra A, Manuel Brea J, Piña-Márquez R, Díaz-Tomé V, González-Barcia M, Zarra-Ferro I, Mondelo-García C, Dominguez-Muñoz JE, Otero-Espinar FJ, Fernández-Ferreiro A. Design and biopharmaceutical preclinical characterisation of a new thermosensitive hydrogel for the removal of gastric polyps. Int J Pharm 2023; 635:122706. [PMID: 36803925 DOI: 10.1016/j.ijpharm.2023.122706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND AIMS Submucosal injection agents are widely used solutions in gastric polyp resection techniques. Currently, many different solutions are used in clinical practice, but most are not authorised for this use or are not biopharmaceutical characterised. The objective of this multidisciplinary work is to test the efficacy of a novel thermosensitive hydrogel designed specifically for this indication. METHODS A mixture design of various components (Pluronic®, hyaluronic acid and sodium alginate) was carried out to select the combination with optimal properties for this use. Three final thermosensitive hydrogels were selected on which biopharmaceutical characterisation was performed and stability and biocompatibility were analysed. Efficacy in maintaining elevation was tested ex vivo on pig mucosa and in vivo in pigs RESULTS: The mixture design allowed selection of the ideal combinations of agents for the characteristics sought. The thermosensitive hydrogels studied showed high values of hardness and viscosity at 37 °C, maintaining good syringeability. One of them demonstrated superiority in maintaining polyp elevation in the ex vivo assay and non-inferiority in the in vivo assay. CONCLUSION The thermosensitive hydrogel specifically designed for this use is promising both for its biopharmaceutical characteristics and for its demonstrated efficacy. This study lays the foundation for evaluating the hydrogel in humans.
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Affiliation(s)
- Iria Varela-Rey
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Daniel de la Iglesia
- Digestive Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Alba San Bruno-Ruz
- Digestive Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Rafael Mejuto-Fernández
- Digestive Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Luzdivina Monteserín-Ron
- Digestive Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Javier López-Diaz
- Digestive Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Pedro García-Salom
- Pharmacy Department, University Clinical Hospital Dr. Balmis, 03010 Alicante, Spain
| | | | | | | | - Victoria Díaz-Tomé
- Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain; Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Irene Zarra-Ferro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - J Enrique Dominguez-Muñoz
- Digestive Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain.
| | - Francisco J Otero-Espinar
- Pharmacology, Pharmacy and Pharmaceutical Technology Department, Faculty of Pharmacy, University of Santiago de Compostela (USC), 15782 Santiago de Compostela, Spain.
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain; Clinical Pharmacology Group, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain.
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Aliaga Ramos J. Off-label use of 0.4% sodium hyaluronate teardrops for endoscopic resection of a rectal carcinoid. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 114:119-120. [PMID: 34517714 DOI: 10.17235/reed.2021.8318/2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Different substances are used for submucosal injection in order to perform a safe endoscopic mucosal resection. Viscous solutions such as sodium hyaluronate are currently considered the first line substances for submucosal injection. This product produces a durable lifting of the mucosa. However, this solution is expensive and only available in Japan. We report on the use off-label of 0.4% sodium hyaluronate teardrops as a substance for submucosal injection.
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