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Bourke MJ. Endoscopic submucosal dissection: Will it always be a hyperspecialized skill? Gastrointest Endosc 2024; 100:140-143. [PMID: 38331223 DOI: 10.1016/j.gie.2024.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/22/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney; University of Sydney, Sydney, Australia
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2
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Kouladouros K, Bourke MJ. Endoscopy First: The Best Choice to Optimize Outcomes for Early Gastrointestinal Malignancy. Visc Med 2024; 40:107-109. [PMID: 38873628 PMCID: PMC11166897 DOI: 10.1159/000539178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/01/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michael J. Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia
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Hilton CB, Lander S, Gibson MK. An Ailment with Which I Will Contend: A Narrative Review of 5000 Years of Esophagogastric Cancers and Their Treatments, with Special Emphasis on Recent Advances in Immunotherapeutics. Cancers (Basel) 2024; 16:618. [PMID: 38339368 PMCID: PMC10854527 DOI: 10.3390/cancers16030618] [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: 11/22/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Esophagogastric cancers are among the most common and deadly cancers worldwide. This review traces their chronology from 3000 BCE to the present. The first several thousand years were devoted to palliation, before advances in operative technique and technology led to the first curative surgery in 1913. Systemic therapies were introduced in 1910, and radiotherapy shortly thereafter. Operative technique improved massively over the 20th century, with operative mortality rates reducing from over 50% in 1933 to less than 5% by 1981. In addition to important roles in palliation, endoscopy became a key nonsurgical curative option for patients with limited-stage disease by the 1990s. The first nonrandomized studies on combination therapies (chemotherapy ± radiation ± surgery) were reported in the early 1980s, with survival benefit only for subsets of patients. Randomized trials over the next decades had similar overall results, with increasing nuance. Disparate conclusions led to regional variation in global practice. Starting with the first FDA approval in 2017, multiple immunotherapies now encompass more indications and earlier lines of therapy. As standards of care incorporate these effective yet expensive therapies, care must be given to disparities and methods for increasing access.
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Affiliation(s)
- C. Beau Hilton
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 37232, USA
| | - Steven Lander
- Internal Medicine Residency Program, University of Tennessee Health Sciences Center, 920 Madison Ave, Suite 531, Memphis, TN 38163, USA;
| | - Michael K. Gibson
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, 2220 Pierce Ave, Nashville, TN 37232, USA
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Yachida T, Kobara H, Kozuka K, Nakatani K, Tada N, Matsui T, Chiyo T, Kobayashi N, Fujihara S, Nishiyama N, Kondo A, Ando Y, Okano K, Nonaka W, Ishikawa K, Masugata H, Masaki T. Comparison of Needle Knife versus Scissors Forceps for Colorectal Endoscopic Submucosal Dissection: A Prospective Randomized Study. J Clin Med 2023; 12:jcm12062329. [PMID: 36983328 PMCID: PMC10056117 DOI: 10.3390/jcm12062329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Background and Aim: To evaluate the efficacy and safety of a grasping-type knife, called Clutch Cutter (CC), for colorectal endoscopic submucosal dissection (C-ESD). Methods: This was a randomized prospective study. Patients who underwent C-ESD for colorectal neoplasms >20 mm and <50 mm in size were enrolled, dividing into two groups: ESD using needle type of dual knife alone (D-group) and circumferential incision using dual knife followed by submucosal dissection using CC (CC-group). The primary outcome was the self-completion rate. The secondary outcomes were intraoperative complication rate, procedure time, and en bloc resection rate. Results: A total of 45 patients were allocated to the D-group and 43 to the CC-group were allocated. The self-completion rate was higher in the CC-group (87% [39/45] vs. 98% [42/43]). All of the six patients with an incomplete procedure in the D-group were completely resected with CC use. The intraoperative complication rate was not significant in either group (D vs. CC: 2% vs. 0%). The mean procedure time was significantly shorter in the D-group than that in the CC-group (62.0 vs. 81.1 min; p = 0.0036). The en bloc resection rate was 100% in the D-group and 98% in the CC-group. Conclusions: While dual knife use is superior to CC in terms of time efficiency, the use of CC may be a safe and efficacious option for achieving complete C-ESD.
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Affiliation(s)
- Tatsuo Yachida
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
- Department of General Internal Medicine, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
- Correspondence: ; Tel.: +81-87-891-2156; Fax: +81-87-891-2158
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Kazuhiro Kozuka
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Kaho Nakatani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Naoya Tada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Takanori Matsui
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Taiga Chiyo
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Nobuya Kobayashi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Akihiro Kondo
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Yasuhisa Ando
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Wakako Nonaka
- Department of General Internal Medicine, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Kaori Ishikawa
- Department of General Internal Medicine, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Hisashi Masugata
- Department of General Internal Medicine, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita 761-0793, Kagawa, Japan
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5
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Huang ZZ, Mao R, Li YQ, Tian HZ, Iacucci M, Shen B, Cui Y, Xiao YL, Wang JH, Chen MH, Xing XB. Cost-efficient snare-assisted peroral endoscopic myotomy in comparison of conventional endoscopic knife for treatment of achalasia: results of a randomized controlled trial. Dis Esophagus 2022; 35:6549064. [PMID: 35291006 DOI: 10.1093/dote/doab099] [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: 07/14/2021] [Revised: 10/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND To date, the ideal endoscopic knife for peroral endoscopic myotomy (POEM) with good performance and cost-effectiveness is still under investigation. The present study was aimed to evaluate the efficacy, safety, and cost-effectiveness of snare-assisted POEM, compared with the conventional endoscopic knife approach. METHODS From May 2017 to December 2018, patients with achalasia presenting for POEM without previous endoscopic or surgical therapy were prospectively recruited in this randomized controlled trial. Patients were randomly allocated to receive POEM using either the snare (snare group) or HookKnife (conventional group). The primary outcome was clinical success (Eckardt score ≤ 3) at 12-month follow-up, powered for noninferiority with a margin of -15%. The secondary outcomes included adverse events (AEs), procedure-related parameters, clinical outcomes, and cost-effectiveness. RESULTS A total of 75 patients with similar baseline characteristics between the snare (N = 37) and conventional (N = 38) groups were included. Clinical success at 12-month follow-up was achieved in 94.6% of patients in the snare group and 92.1% of patients in the conventional group (difference, 2.5% [95% CI, -8.7% to 13.7%]; P < 0.001 for noninferiority). No severe AEs occurred in both groups. The use of snare is associated with comparable procedure time (40.6 minutes vs. 42.5 minutes, P = 0.337), a lower frequency of hemostatic forceps use (27.0% vs. 68.4%, P < 0.001), and lower hospital costs ($4271.1 vs. $5327.3, P < 0.001). The cost-effectiveness plane revealed that 96.9% of snare-assisted POEM procedures offered more cost-savings and health utility benefits. CONCLUSIONS The snare-assisted POEM was noninferior to the conventional endoscopic knife approach in terms of clinical efficacy, with comparable safety outcomes and cost-effective benefits.
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Affiliation(s)
- Zhen-Zi Huang
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ren Mao
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yuan-Qi Li
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Hong-Zhan Tian
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Marietta Iacucci
- National Institute of Health Research Biomedical Research Institute, Institute of Translational Medicine, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK
| | - Bo Shen
- Center for Interventional Inflammatory Bowel Disease, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY 10032, USA
| | - Yi Cui
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Ying-Lian Xiao
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jin-Hui Wang
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Min-Hu Chen
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Xiang-Bin Xing
- Department of Gastroenterology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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Mukkada RJ, Mathew PG. Knives in Third Space. JOURNAL OF DIGESTIVE ENDOSCOPY 2022. [DOI: 10.1055/s-0042-1750128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractEndoscopic mucosal resection (EMR) has always been done with a snare. The maximum diameter of the snare is usually 2 cm and the largest lesion that can be removed in one piece is usually maximum of 2 cm. In EMR, after the elevation of the submucosa, snares are used for the resection of the mucosal lesion; however, for endoscopic submucosal dissection (ESD), special knives are required, which have various uses in different areas of the gastrointestinal tract. ESD knives have developed and evolved over the past 30 years allowing it to be performed safely. It allows very precise cutting of the mucosa as well as dissection of the submucosal tissue planes. This review discusses some of the more commonly used knives.
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Affiliation(s)
- Roy J. Mukkada
- Department of Gastroenterology, VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Pradeep G. Mathew
- Department of Gastroenterology, VPS Lakeshore Hospital, Kochi, Kerala, India
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7
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Yahagi N. Development of colorectal endoscopic submucosal dissection. Dig Endosc 2022; 34 Suppl 2:95-98. [PMID: 35132686 DOI: 10.1111/den.14229] [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: 10/05/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
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Stress Dispersion Design in Continuum Compliant Structure toward Multi-DOF Endoluminal Forceps. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052480] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gastrointestinal cancer, when detected early, is treated by accessing the lesion through the natural orifice using flexible endoscopes. However, the limited degree-of-freedom (DOF) of conventional treatment devices and the narrow surgical view through the endoscope demand advanced techniques. In contrast, multi-DOF forceps systems are an excellent alternative; however, these systems often involve high fabrication costs because they require a large number of micro-parts. To solve this problem, we designed compact multi-DOF endoluminal forceps with a monolithic structure comprising compliant hinges. To allow an efficient stress dispersion at the base end when the hinge bends, we proposed a novel design method to obtain the hinge parameters using the beam of uniform strength theory. This method does not involve a high computational cost. The results show that the improved design with a variable hinge thickness can reduce the maximum bending stress, dispersing the stress in a larger area than that of the previous design considering a constant thickness of the hinge. Moreover, the experiments conducted in a prototype confirm that the radius of the curvature was significantly improved. The proposed method could aid in designing other continuum robots relying on compliant hinges.
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Nakadate R, Iwasa T, Onogi S, Arata J, Oguri S, Okamoto Y, Akahoshi T, Eto M, Hashizume M. Surgical Robot for Intraluminal Access: An Ex Vivo Feasibility Study. CYBORG AND BIONIC SYSTEMS 2020; 2020:8378025. [PMID: 37063410 PMCID: PMC10097415 DOI: 10.34133/2020/8378025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022] Open
Abstract
Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection (ESD) using a flexible endoscope. Compared with conventional percutaneous surgery, ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision, and the organ is preserved. However, the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices, which have limited degrees of freedom. To facilitate easier manipulation of these flexible devices, we developed a surgical robot comprising a flexible endoscope and two articulating instruments. The robotic system is based on a conventional flexible endoscope, and an extrapolated motor unit moves the endoscope in all its degrees of freedom. The instruments are thin enough to allow insertion of two instruments into the endoscope channel, and each instrument has a bending section that allows for up–down, right–left, and forward–backward motion. In this study, we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach. The procedure was successfully performed by five novice operators without complications. Our findings demonstrated the feasibility of the proposed robotic system and, furthermore, suggest that even operators with limited experience can use this system to perform ESD.
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Affiliation(s)
- Ryu Nakadate
- Center for Advanced Medical Innovation, Kyushu University, Japan
| | - Tsutomu Iwasa
- Kitakyushu Municipal Medical Center, Kyushu University, Japan
| | - Shinya Onogi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Japan
| | - Jumpei Arata
- Department of Mechanical Engineering, Kyushu University, Japan
| | - Susumu Oguri
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | | | - Tomohiko Akahoshi
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Masatoshi Eto
- Center for Advanced Medical Innovation, Kyushu University, Japan
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
- Department of Urology, Kyushu University, Japan
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Taşkın OÇ, Aslan F, Kulaç İ, Yılmaz S, Adsay V, Kapran Y. Pathologic Evaluation of Large Colorectal Endoscopic Submucosal Dissections: An Analysis of 279 Cases With Emphasis on the Importance of Multidisciplinary Work and Establishing Examination Protocols. Int J Surg Pathol 2020; 28:600-608. [PMID: 32349582 DOI: 10.1177/1066896920918309] [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] [Indexed: 12/27/2022]
Abstract
Background. Endoscopic submucosal dissections (ESDs) allow removal of large gastrointestinal tumors and help patients avoid major oncologic surgery. In this study, the challenges and development of approaches toward successfully handling ESDs were analyzed in 279 colorectal specimens (114 rectal, 47 left, 118 right colonic; 90% adenoma with/without carcinoma). Methods. Each specimen was processed according to an established protocol including gross photography, mapping, and total submission for histopathologic examination. Results. Mean lesion size was 4.2 cm (range: 0.5-22 cm; 28% ≥5 cm; 6% ≥10 cm). Invasive carcinoma was present in 38 cases (14%), which had a mean overall tumor size of 3.8 cm (range: 1.1-17.5 cm), and mean largest size of the invasive component was 0.93 cm (range: 0.04-3 cm). Fifteen cases were staged as pT1a (submucosal invasion of <1000 µm) and 13 cases as pT1b (submucosal invasion of ≥1000 µm). En-bloc and R0 resection rates were 99.3% and 90.6%, respectively. Conclusion. Various histopathologic challenges were encountered, which were carefully evaluated by dedicated pathologists with familiarity to the subtleties in handling and reporting these specimens. We recommend these specimens to be prepared in the endoscopy suite, submitted to the Pathology Department oriented, pinned, and placed into copious amount of fixative. Total sampling, gross photography, mapping, and proper fixation are crucial components in the histopathologic evaluation. Micromeasurement of invasion depth and substaging per European/Japanese guidelines as well as accurate measurement of the distance from the resection margins are highly recommended. In conclusion, ESD is an adequate method that can be successfully implemented in a tertiary care center to perform en-bloc and margin-free resections of clinically selected large colorectal superficial lesions.
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Affiliation(s)
- Orhun Çığ Taşkın
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Fatih Aslan
- Department of Gastroenterology, Koç University Hospital, Istanbul, Turkey
| | - İbrahim Kulaç
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Serpil Yılmaz
- Department of Pathology, VKV American Hospital, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
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Zhang X, Ly EK, Nithyanand S, Modayil RJ, Khodorskiy DO, Neppala S, Bhumi S, DeMaria M, Widmer JL, Friedel DM, Grendell JH, Stavropoulos SN. Learning Curve for Endoscopic Submucosal Dissection With an Untutored, Prevalence-Based Approach in the United States. Clin Gastroenterol Hepatol 2020; 18:580-588.e1. [PMID: 31220645 DOI: 10.1016/j.cgh.2019.06.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Endoscopic submucosal dissection (ESD) is widely used in Asia to resect early-stage gastrointestinal neoplasms, but use of ESD in Western countries is limited. We collected data on the learning curve for ESD at a high-volume referral center in the United States to guide development of training programs in the Americas and Europe. METHODS We performed a retrospective analysis of consecutive ESDs performed by a single operator at a high-volume referral center in the United States from 2009 through 2017. ESD was performed in 540 lesions: 449 mucosal (10% esophageal, 13% gastric, 5% duodenal, 62% colonic, and 10% rectal) and 91 submucosal. We estimated case volumes required to achieve accepted proficiency benchmarks (>90% for en bloc resection and >80% for histologic margin-negative (R0) resection) and resection speeds >9cm2/hr. RESULTS Pathology analysis of mucosal lesions identified 95 carcinomas, 346 premalignant lesions, and 8 others; the rate of en bloc resection increased from 76% in block 1 (50 cases) to a plateau of 98% after block 5 (250 cases). The rate of R0 resection improved from 45% in block 1 to >80% after block 5 (250 cases) and ∼95% after block 8 (400 cases). Based on cumulative sum analysis, approximately 170, 150, and 280 ESDs are required to consistently achieve a resection speed >9cm2/hr in esophagus, stomach, and colon, respectively. CONCLUSIONS In an analysis of ESDs performed at a large referral center in the United States, we found that an untutored, prevalence-based approach allowed operators to achieve all proficiency benchmarks after ∼250 cases. Compared with Asia, ESD requires more time to learn in the West, where the untutored, prevalence-based approach requires resection of challenging lesions, such as colon lesions and previously manipulated lesions, in early stages of training.
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Affiliation(s)
- Xiaocen Zhang
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York; Department of Internal Medicine, Mount Sinai St Luke's-West Hospital Center, New York, New York
| | - Erin K Ly
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Sagarika Nithyanand
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Rani J Modayil
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Dmitriy O Khodorskiy
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Sivaram Neppala
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Sriya Bhumi
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Matthew DeMaria
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Jessica L Widmer
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - David M Friedel
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - James H Grendell
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York
| | - Stavros N Stavropoulos
- Division of Gastroenterology, Hepatology and Nutrition, New York University-Winthrop Hospital, Mineola, New York.
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Douridas GN, Fountoulakis A, Souglakos J, Gourtsoyianni S, Vini L, Levidou G, Liakakos T, Agalianos C, Dervenis C, Kalogeridi MA, Karavokyros I, Koumarianou A, Kountourakis P, Oikonomopoulos G, Economopoulou P, Sgouros J, Sgouros SN, Stamou K, Triantopoulou C, Zacharoulis D, Gouvas N, Xynos E. Consensus statement of the Hellenic and Cypriot Gastric Cancer Study Group on the diagnosis, staging and management of gastric cancer. Updates Surg 2020; 72:1-19. [PMID: 32112342 DOI: 10.1007/s13304-020-00723-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/11/2020] [Indexed: 12/15/2022]
Abstract
Gastric Cancer epidemics have changed over recent decades, declining in incidence, shifting from distal to proximal location, transforming from intestinal to diffuse histology. Novel chemotherapeutic agents combined with modern surgical operations hardly changed overall disease related survival. This may be attributed to a substantial inherent geographical variation of disease genetics, but also to a failure to standardize and implement treatment protocols in clinical practice. To overcome these drawbacks in Greece and Cyprus, a Gastric Cancer Study Group under the auspices of the Hellenic Society of Medical Oncology (HeSMO) and Gastrointestinal Cancer Study Group (GIC-SG) merged their efforts to produce a consensus considering ethnic parameters of healthcare system and the international proposals as well. Utilizing structured meetings of experts, a consensus was reached. To achieve further consensus, statements were subjected to the Delphi methodology by invited multidisciplinary national and international experts. Sentences were considered of high or low consensus if they were voted by ≥ 80%, or < 80%, respectively; those obtaining a low consensus level after both voting rounds were rejected. Forty-five statements were developed and voted by 71 experts. The median rate of abstention per statement was 9.9% (range: 0-53.5%). At the end of the process, one statement was rejected, another revised, and all the remaining achieved a high consensus. Forty-four recommendations covering all aspects of the management of gastric cancer and concise treatment algorithms are proposed by the Hellenic and Cypriot Gastric Cancer Study Group. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and individualization are emphasized.
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Affiliation(s)
| | | | - John Souglakos
- Department of Medical Oncology, University Hospital of Heraklion, Crete, Greece
| | | | - Louiza Vini
- Department of Radiotherapy, Iatriko Medical Center, Athens, Greece
| | | | - Theodoros Liakakos
- 1st Department of General Surgery, Laikon University Hospital, Athens, Greece
| | | | - Christos Dervenis
- General Surgery, Faculty of Medicine, University of Cyprus, Nicosia, Cyprus
| | | | - Ioannis Karavokyros
- 1st Department of General Surgery, Laikon University Hospital, Athens, Greece
| | - Anna Koumarianou
- Department of Medical Oncology, Attikon University Hospital, Athens, Greece
| | | | | | | | - Joseph Sgouros
- Department of Medical Oncology, Agioi Anargyroi Hospital, Athens, Greece
| | | | | | | | | | - Nikolaos Gouvas
- Department of General Surgery, Medical School, University of Nicosia, Nicosia, Cyprus
| | - Evangelos Xynos
- Department of General Surgery, Creta Interclinic Hospital, Heraklion, Crete, Greece
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Water-pocket endoscopic submucosal dissection for superficial gastric neoplasms (with video). Gastrointest Endosc 2018; 88:253-260. [PMID: 29660320 DOI: 10.1016/j.gie.2018.04.2331] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS During endoscopic submucosal dissection (ESD), a clear view is essential for precise dissection of the appropriate submucosal layer. Some advantages have been reported for underwater techniques of endoscopic resection in comparison with the gas insufflation method. We have developed a new ESD method with the creation of a local water pocket (WP) that provides a clear view in the dissection field. Therefore, we aimed to investigate the feasibility and safety of WP-ESD for superficial gastric neoplasms. METHODS We prospectively recruited 50 patients with gastric neoplasms (early gastric cancer or gastric adenomas) between April 2017 and December 2017. Among them, 48 patients were treated with the WP-ESD technique. The patients undergoing WP-ESD were compared with 48 patients treated with standard ESD (S-ESD) who were selected by propensity score matching. The primary outcome was the ESD procedure time. RESULTS Total procedure time was significantly shorter in the WP-ESD group than in the S-ESD group (median [interquartile range], 27.5 [19-45] minutes vs 41 [29.8-69] minutes; P < .001). Similarly, the dissection speed was significantly greater in the WP-ESD group than in the S-ESD group (median [interquartile range], 22.5 [16.8-35.3] mm2/min vs 17.3 [12.7-22.1] mm2/min; P < .001). The rates of complete en bloc resection in the WP-ESD group and the S-ESD group were 97.9% and 95.8%, respectively (P > .99). There were no perforations in either group. CONCLUSION WP-ESD was associated with a shorter procedure time than S-ESD. WP-ESD may provide an alternative method for resection of superficial gastric neoplasms. (Clinical trial registration number: UMIN 000030266.).
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Bourke MJ, Neuhaus H, Bergman JJ. Endoscopic Submucosal Dissection: Indications and Application in Western Endoscopy Practice. Gastroenterology 2018; 154:1887-1900.e5. [PMID: 29486200 DOI: 10.1053/j.gastro.2018.01.068] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Abstract
Endoscopic submucosal dissection was developed in Japan, early in this century, to provide a minimally invasive yet curative treatment for the large numbers of patients with early gastric cancer identified by the national screening program. Previously, the majority of these patients were treated surgically at substantial cost and with significant risk of short- and long-term morbidity. En-bloc excision of these early cancers, most with a limited risk of nodal metastasis, allowed complete staging of the tumor, stratification of the subsequent therapeutic approach, and potential cure. This transformative innovation changed the nature of endoscopic treatment for superficial mucosal neoplasia and, ultimately, for the first time allowed endoscopists to assert that the early cancer had been definitively cured. Subsequently, Western endoscopists have increasingly embraced the therapeutic possibilities offered by endoscopic submucosal dissection, but with some justifiable scientific caution. Here we provide an evidence-based critical appraisal of the role of endoscopic submucosal dissection in advanced endoscopic tissue resection.
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Affiliation(s)
- Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Horst Neuhaus
- Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Jacques J Bergman
- Academic Medical Centre, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
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Ma MX, Bourke MJ. Endoscopic submucosal dissection in the West: Current status and future directions. Dig Endosc 2018; 30:310-320. [PMID: 28884493 DOI: 10.1111/den.12960] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/31/2017] [Indexed: 02/08/2023]
Abstract
Endoscopic submucosal dissection (ESD) was first conceptually described almost 30 years ago in Japan and is now widely practiced throughout East Asia. ESD expands the boundaries of endoscopic resection (ER) by allowing en bloc resection of large early neoplastic lesions within the gastrointestinal tract (GIT). This offers advantages over other ER techniques by facilitating definitive histological staging and curative treatment of early cancer in selected cases. Indeed, the experience of ESD in Eastern countries is significant, and excellent outcomes from high-volume centers are reported. The potential benefits of ESD are recognized by Western endoscopists, but its adoption has been limited. A number of factors contribute to this, including epidemiological differences in GIT neoplasia between Western and Eastern populations and limitations in training opportunities. In this review, we discuss the role of ESD, its current status and the future in Western endoscopic practice.
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Affiliation(s)
- Michael X Ma
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
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Abstract
Two current major research topics concern the incorporation of flexible robotic endoscopy systems developed for natural-orifice translumenal endoscopic surgery (NOTES), primarily for the purpose of remote forceps operation, into endoscopic submucosal dissection (ESD) and other flexible endoscopic treatments and the use of robots for the manipulation of flexible endoscopes themselves with the aim of enabling the remote insertion of colonoscopes, etc. However, there are still many challenges that remain to be addressed; the ideal robotic endoscope has not yet been realized. This article reviews the ongoing developments and our own efforts in the area of flexible robotic endoscopy.
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Affiliation(s)
- Keiichiro Kume
- a Third Department of Internal Medicine, School of Medicine , University of Occupational and Environmental Health , Kitakyusyu , Japan
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17
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Fu YW, Lin MS, Yang B, Yu H, Jiao X, Huang JX. An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report. Oncol Lett 2017; 14:3755-3759. [PMID: 28927143 PMCID: PMC5588043 DOI: 10.3892/ol.2017.6576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/19/2017] [Indexed: 01/13/2023] Open
Abstract
Early superficial non-ampullary duodenal tumors are particularly rare, the clinical manifestations, including typical endoscopic or imaging features, and treatment methods are not well-characterized. The present case report describes a case of an asymptomatic 74-year-old male who presented to the Taizhou People's Hospital (Taizhou, China) for a regular health screening, where a primary superficial non-ampullary duodenal tumor was identified. Upper endoscopy revealed ~1.2 cm lesion in the second portion of the duodenum. Chromoscopy and magnification endoscopy indicated an early cancer characteristic. Subsequent endoscopic submucosal dissection was performed to remove the lesion. Histopathology validated that the lesion was a high-grade intro-epithelial neoplasm without lymph node or blood vessel invasion.
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Affiliation(s)
- Yi Wei Fu
- Department of Gastroenterology, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Mao Song Lin
- Department of Gastroenterology, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Bing Yang
- Department of Gastroenterology, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Hong Yu
- Department of Pathology, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Xia Jiao
- Department of Pathology, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Jun Xing Huang
- Department of Oncology, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
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18
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Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer. Gastrointest Endosc 2017; 85:1218-1224. [PMID: 27889547 DOI: 10.1016/j.gie.2016.11.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/02/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS There has been little information about the long-term outcomes of patients with early gastric cancer (EGC) treated by non-curative endoscopic submucosal dissection (ESD) with negative resected margins (R0 resection). We aimed to compare the clinical outcomes of non-curative ESD with R0 resection between patients who underwent additional gastrectomy and those who did not. METHODS Among EGC patients treated by ESD from 2002 to 2010, 66 patients were treated by non-curative ESD with R0 resection. Patients received either additional gastrectomy (group A, n = 45) or were followed up without gastrectomy (group B, n = 21). The clinicopathologic findings and the subsequent clinical course were compared between the 2 groups. RESULTS Patients in group A were younger than those in group B (68.0 vs 71.0 years, P = .006). The follow-up period was longer in group A than in group B (7.8 vs 5.9 years, P = .011). The percentage of patients who died of any cause was not statistically lower in group A than in group B (13.3% vs 33.3%, P = .06). Although the overall survival rate was higher in group A than in group B (93.3% vs 76.2%, P = .028), disease-specific survival rates did not differ between the 2 groups (97.8% vs 100%, P = .495). A Cox proportional hazards model showed that gastrectomy was not an independent factor associated with overall survival. CONCLUSIONS Careful follow-up may be an alternative strategy to gastrectomy for a subgroup of patients treated by non-curative ESD with R0 resection.
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19
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Ko BM. History and Development of Accessories for Endoscopic Submucosal Dissection. Clin Endosc 2017; 50:219-223. [PMID: 28609820 PMCID: PMC5475513 DOI: 10.5946/ce.2017.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 01/14/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) procedure is composed of circumferential mucosal incision and submucosal dissection. A variety of endoscopic accessories are required to perform mucosal incision and submucosal dissection safely. As a result of the improvements in ESD devices and peripheral equipment and development of the ESD technique, ESD procedures have been performed extensively worldwide. Here I review the history of the development of accessories used in performing ESD procedures.
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Affiliation(s)
- Bong Min Ko
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University Hospital , Bucheon, Korea
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20
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Fujita I, Toyokawa T, Matsueda K, Omote S, Fujita A, Ueda Y, Endo S, Omote R, Watanabe K, Horii J, Murakami T, Tomoda J. Association between CT-Diagnosed Pneumonia and Endoscopic Submucosal Dissection of Gastric Neoplasms. Digestion 2017; 94:37-43. [PMID: 27438698 DOI: 10.1159/000448134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/02/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS This prospective cohort study aimed to elucidate the incidence and characteristics of pneumonia associated with endoscopic submucosal dissection (ESD) of gastric neoplasms using CT. METHODS We included consecutive 188 patients with gastric neoplasms treated with ESD. All patients underwent CT before ESD and the day after ESD. Pneumonia associated with ESD was defined as lung ground glass opacity or consolidation by CT the day after ESD. RESULTS In 188 patients, 28 patients had diabetes mellitus. Pneumonia was observed by CT in 21 patients (11.2%) after ESD. Of those, 7 patients had diabetes mellitus. By univariate analysis, compared with patients with non-pneumonia complications, risk factors for pneumonia were significantly increased in patients with diabetes mellitus (p = 0.01) and in those who underwent a long procedure time (p = 0.02). By multivariate analysis, pneumonia was significantly increased in patients with diabetes mellitus (OR 4.06, 95% CI 1.35-12.19) and in those who underwent a long procedure time (OR 1.01, 95% CI 1.00-1.02). CONCLUSIONS The incidence of CT-diagnosed pneumonia associated with ESD was relatively high. Furthermore, it was revealed that diabetes mellitus and a long procedure time were risk factors of CT-diagnosed pneumonia.
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Affiliation(s)
- Isao Fujita
- Department of Gastroenterology, National Hospital Organization, Fukuyama Medical Center, Hiroshima, Japan
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21
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Russo A, Li P, Strong VE. Differences in the multimodal treatment of gastric cancer: East versus west. J Surg Oncol 2017; 115:603-614. [PMID: 28181265 DOI: 10.1002/jso.24517] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 02/06/2023]
Abstract
There has been a great deal of interest about varying treatment paradigms of gastric cancer in Eastern and Western countries. Differences in tumor biology, screening initiatives, surgical approach, extent of lymphadenectomy, and neoadjuvant versus adjuvant chemotherapy regimens have been studied and documented in the literature. The purpose of this review is to give an updated report on the current status and management differences in the treatment of gastric cancer between Eastern and Western countries.
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Affiliation(s)
- Ashley Russo
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ping Li
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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22
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Hoteya S, Furuhata T, Takahito T, Fukuma Y, Suzuki Y, Kikuchi D, Mitani T, Matsui A, Yamashita S, Nomura K, Kuribayashi Y, Iizuka T, Kaise M. Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Non-Ampullary Superficial Duodenal Tumor. Digestion 2017; 95:36-42. [PMID: 28052275 DOI: 10.1159/000452363] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic submucosal resection (ESD) and endoscopic mucosal resection (EMR) are well established as curable and safety procedures for treating superficial tumors of the stomach, esophagus and colon. However, a majority of endoscopic resection strategies for non-ampullary superficial duodenal tumors (NASDTs) remains undefined. The aim of this study was to clarify which was the right method for NASDT treatment - EMR or ESD. SUMMARY We analyzed 129 consecutive endoscopic resection (74 ESD and 55 EMR) procedures performed with NADSTs and divided the ESD group into 49 large ESD groups (more than 20 mm in diameter) and 25 small ESD groups (less than 20 mm in diameter). With respect to the technical outcomes of EMR/ESD for small size NASDTs, EMR was safer than ESD, but its nature of curability was inferior to that of ESD. The rates of complication such as perforation or delayed bleeding were significantly higher in both ESD groups than in the EMR group. However, the prophylactic endoscopic closure of large mucosal defects after ESD was useful for resolving those complications. The limitations of our study were involvement of a single-center, limited sample size, short follow-up duration and the retrospective design, which may have introduced selection bias. However, the present findings suggest that adequate endoscopic treatment strategy for NASDTs can lead to favorable outcomes and an excellent prognosis. Key Message: It is necessary to select EMR or ESD adequately for R0 resection of small NASDTs, according to their size and location. For large NASDTs, duodenal ESD with essential management is feasible and useful as a therapeutic procedure.
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Affiliation(s)
- Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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23
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Hirotsu Y, Kojima Y, Okimoto K, Amemiya K, Mochizuki H, Omata M. Comparison between two amplicon-based sequencing panels of different scales in the detection of somatic mutations associated with gastric cancer. BMC Genomics 2016; 17:833. [PMID: 27782820 PMCID: PMC5080794 DOI: 10.1186/s12864-016-3166-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/15/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Sequencing data from The Cancer Genome Atlas (TGCA), the International Cancer Genome Consortium and other research institutes have revealed the presence of genetic alterations in several tumor types, including gastric cancer. These data have been combined into a catalog of significantly mutated genes for each cancer type. However, it is unclear to what extent significantly mutated genes need to be examined for detecting genetic alterations in gastric cancer patients. Here, we constructed two custom-made sequencing panels of different scales, the Selective hotspot Panel and the Comprehensive Panel, to analyze genetic alterations in 21 resected specimens endoscopically obtained from 20 gastric cancer patients, and we assessed how many mutations were detectable using these different panels. RESULTS A total of 21 somatic mutations were identified by the Selective hotspot Panel and 70 mutations were detected by the Comprehensive Panel. All mutations identified by the Selective hotspot Panel were detected by the Comprehensive Panel, with high concordant values of the variant allelic fraction of each mutation (correlation coefficient, R = 0.92). At least one mutation was identified in 13 patients (65 %) by the Selective hotspot Panel, whereas the Comprehensive Panel detected mutations in 19 (95 %) patients. Library preparation and sequencing costs were comparable between the two panels. CONCLUSIONS Our results indicate the utility of comprehensive panel-based targeted sequencing in gastric cancer.
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Affiliation(s)
- Yosuke Hirotsu
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Yuichiro Kojima
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Kenichiro Okimoto
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8677 Japan
| | - Kenji Amemiya
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Hitoshi Mochizuki
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
| | - Masao Omata
- Genome Analysis Center, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
- Department of Gastroenterology, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-8506 Japan
- The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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Hikichi T, Yamasaki M, Watanabe K, Nakamura J, Sato M, Takagi T, Suzuki R, Sugimoto M, Kikuchi H, Konno N, Waragai Y, Asama H, Takasumi M, Ejiri Y, Watanabe H, Ohira H, Obara K. Gastric endoscopic submucosal dissection using sodium carboxymethylcellulose as a new injection substance. Fukushima J Med Sci 2016; 62:43-50. [PMID: 27020144 PMCID: PMC5131580 DOI: 10.5387/fms.2015-27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/23/2016] [Indexed: 12/12/2022] Open
Abstract
AIM To investigate the feasibility of endoscopic submucosal dissection (ESD) using sodium carboxymethylcellulose (SCMC) for gastric cancer. METHODS During October 2011 through April 2013, 98 lesions from 98 patients who underwent ESD using SCMC (ESD-SCMC) for early gastric cancer were enrolled in this study. Two endoscopists, who had each performed fewer than 30 ESD procedures (less-experienced ESD physicians), performed ESD-SCMC under the supervision of two experts. The primary outcome was the en bloc resection rate. Secondary outcomes included the complete resection rate, the procedural time, the bleeding rate after SCMC injection, and complications. Patient characteristics, time necessary for hemostasis after SCMC injection, rate of treatment completion by less-experienced ESD physicians alone, and the effects of SCMC during ESD and on resected specimens were also evaluated. RESULTS The en bloc resection rate was 100%. Among these resections, 87.8% of the cases were completed by a less-experienced ESD physician alone. The complete resection rate was 98.0%. The mean total procedural time was 75.4 min. The mean incidence of intraoperative bleeding following SCMC local injection was 1.7 times. No bleeding was observed after SCMC injection in 29.6% of cases (29/98). Five complications occurred: one case of microperforation (1.0%) and four cases of postoperative bleeding (4.0%). SCMC remained in the submucosa. The submucosa was readily manipulated when the deep submucosa was dissected, even after placing the specimen on a slide. CONCLUSION ESD-SCMC is feasible for the resection of early gastric cancer.
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Affiliation(s)
- Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital
| | - Masahiro Yamasaki
- Third Department of Internal Medicine, University of Occupational and Environmental Health
- Division of Gastroenterology, Fukushima Rosai Hospital
| | - Ko Watanabe
- Department of Endoscopy, Fukushima Medical University Hospital
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Jun Nakamura
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Masaki Sato
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Tadayuki Takagi
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Rei Suzuki
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Mitsuru Sugimoto
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Hitomi Kikuchi
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Naoki Konno
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Yuichi Waragai
- Department of Endoscopy, Fukushima Medical University Hospital
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Hiroyuki Asama
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Mika Takasumi
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Yutaka Ejiri
- Division of Gastroenterology, Fukushima Rosai Hospital
| | - Hiroshi Watanabe
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Hiromasa Ohira
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
| | - Katsutoshi Obara
- Department of Advanced Gastroenterological Endoscopy, Fukushima Medical University
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Patel N, Alexander J, Ashrafian H, Athanasiou T, Darzi A, Teare J. Meta-analysis comparing differing methods of endoscopic therapy for colorectal lesions. World J Meta-Anal 2016; 4:44-54. [DOI: 10.13105/wjma.v4.i2.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/18/2015] [Accepted: 11/09/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) of colorectal lesions.
METHODS: An electronic systematic literature search of four computerized databases was performed in July 2014 identifying studies reporting the outcomes of colorectal ESD and EMR. The primary outcome measures were en-bloc resection rate, endoscopic clearance rate and lesion recurrence rate of the patients followed up. The secondary outcome was the complication rate (including bleeding, perforation and surgery post EMR or ESD rate). Statistical pooling and random effects modelling of the studies calculating risk difference, heterogeneity and assessment of bias and quality were performed.
RESULTS: Six observational studies reporting the outcomes of 1324 procedures were included. The en-bloc resection rate was 50% higher in the ESD group than in the EMR group (95%CI: 0.17-0.83, P < 0.0001, I2 = 99.7%). Endoscopic clearance rates were also significantly higher in the ESD group (95%CI: -0.06-0.02, P < 0.0001, I2 = 92.5%). The perforation rate was 7% higher in the ESD group than the EMR group (95%CI: 0.05-0.09, P > 0.05, I2 = 41.1%) and the rate of recurrence was 50% higher in the EMR group than in the ESD group (95%CI: 0.20-0.79, P < 0.001, I2 = 99.5%). Heterogeneity remained consistent when subgroup analysis of high quality studies was performed (with the exception of piecemeal resection rate), and overall effect sizes remained unchanged for all outcomes.
CONCLUSION: ESD demonstrates higher en-bloc resection rates and lower recurrence rates compared to colorectal EMR. Differences in outcomes may benefit from increased assessment through well-designed comparative studies.
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Yamamoto K, Michida T, Nishida T, Hayashi S, Naito M, Ito T. Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful procedures. World J Gastrointest Endosc 2015; 7:1114-1128. [PMID: 26468335 PMCID: PMC4600177 DOI: 10.4253/wjge.v7.i14.1114] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is very useful in en bloc resection of large superficial colorectal tumors but is a technically difficult procedure because the colonic wall is thin and endoscopic maneuverability is poor because of colonic flexure and extensibility. A high risk of perforation has been reported in colorectal ESD. To prevent complications such as perforation and unexpected bleeding, it is crucial to ensure good visualization of the submucosal layer by creating a mucosal flap, which is an exfoliated mucosa for inserting the tip of the endoscope under it. The creation of a mucosal flap is often technically difficult; however, various types of equipment, appropriate strategy, and novel procedures including our clip-flap method, appear to facilitate mucosal flap creation, improving the safety and success rate of ESD. Favorable treatment outcomes with colorectal ESD have already been reported in many advanced institutions, and appropriate understanding of techniques and development of training systems are required for world-wide standardization of colorectal ESD. Here, we describe recent technical advances for safe and successful colorectal ESD.
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27
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Well-trained and planned: Preparation for endoscopic submucosal dissection for early gastric cancer. ADVANCES IN DIGESTIVE MEDICINE 2015. [DOI: 10.1016/j.aidm.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sold M, Kähler G. Improved Techniques for Endoscopic Mucosal Resection (EMR) in Colorectal Adenoma. VISZERALMEDIZIN 2015; 30:33-8. [PMID: 26286120 PMCID: PMC4513797 DOI: 10.1159/000358243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Endoscopic therapy of colorectal adenomas and early cancers is a standard method. Besides oncological criteria, the method is limited by polyp location, size, and texture. Method Based on the current literature, technical modifications and developments in endoscopic mucosal resection are described. Results Numerous approaches exist to improve the conditions of resection, including optimisation of mucosal elevation and modification of techniques, tools, and devices. Conclusion Endoscopic therapy of sessile and flat colorectal polyps remains a challenge. Some of the presented modifications can help to address this challenge.
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Affiliation(s)
- Moritz Sold
- Zentrale Interdisziplinäre Endoskopie ZIE, Universitätsmedizin Mannheim, Germany
| | - Georg Kähler
- Zentrale Interdisziplinäre Endoskopie ZIE, Universitätsmedizin Mannheim, Germany
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Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y. Indications and Techniques for Endoscopic Submucosal Dissection. Am J Gastroenterol 2015; 110:784-91. [PMID: 25623656 DOI: 10.1038/ajg.2014.425] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic submucosal dissection (ESD) allows for curative resection of superficial neoplasms of the gastrointestinal tract. Although ESD is the standard of care in Japan, its adoption in the West has been slow. Recent studies have shown the advantages of ESD over endoscopic mucosal resection, and as many of the barriers to ESD have been overcome, we are seeing an increasing interest in this technique. ESD can be used to treat superficial gastric, esophageal, and colorectal lesions. The most important pre-procedure step is estimating the depth of invasion of a lesion and by proxy the risk of lymph node metastasis. After a lesion has been resected, the histopathological analysis will determine whether the resection was curative or whether further surgery is needed. In conclusion, ESD is being more widely used in the West, and it is important to understand the indications, limitations, and techniques of ESD.
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Affiliation(s)
- Amit Bhatt
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center, Hospital, Tokyo, Japan
| | - Arthi Kumaravel
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center, Hospital, Tokyo, Japan
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Kwon CI, Kim G, Chung IK, Kim WH, Ko KH, Hong SP, Jeong S, Lee DH. Endoscopic Submucosal Dissection Using a Novel Versatile Knife: An Animal Feasibility Study (with Video). Clin Endosc 2014; 47:544-54. [PMID: 25505721 PMCID: PMC4260103 DOI: 10.5946/ce.2014.47.6.544] [Citation(s) in RCA: 3] [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: 02/09/2014] [Revised: 05/01/2014] [Accepted: 06/12/2014] [Indexed: 12/29/2022] Open
Abstract
Background/Aims In order to reduce the procedure time and the number of accessory changes during endoscopic submucosal dissection (ESD), we developed a novel versatile knife, which has the combined advantages of several conventional knives. The aim of this study was to compare the efficacy, safety, and histological quality of ESD performed using this novel versatile knife and a combination of several conventional knives. Methods This was an in vivo animal study comparing two different modalities of ESD in mini-pigs. Completion time of each resection was documented, and the resected specimens were retrieved and evaluated for completeness. To assess the quality control of the procedures and adverse events, detailed histopathological examinations were performed. Results A total of 18 specimens were dissected by ESD safely and easily (nine specimens using the new versatile knife; nine specimens by mixing conventional knives). All resections were completed as en bloc resections. There was no significant difference in procedure time between the 2 modalities (456 seconds vs. 355 seconds, p=0.258) and cutting speed (1.983 mm2/sec vs. 1.57 mm2/sec, p=1.000). The rate of adverse events and histological quality did not statistically differ between the modalities. Conclusions ESD with a versatile knife appeared to be an easy, safe, and technically efficient method.
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Affiliation(s)
- Chang-Il Kwon
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Gwangil Kim
- Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Il-Kwun Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Kwang Hyun Ko
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sung Pyo Hong
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seok Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Don Haeng Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
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Hoteya S, Iizuka T, Kikuchi D, Mitani T, Matsui A, Ogawa O, Furuhata T, Yamashta S, Yamada A, Kaise M, Yahagi N. Secondary endoscopic submucosal dissection for residual or recurrent tumors after gastric endoscopic submucosal dissection. Gastric Cancer 2014; 17:697-702. [PMID: 24310295 DOI: 10.1007/s10120-013-0325-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/24/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a widely accepted technique for the management of gastric tumors. However, residual or recurrent tumors can occur after ESD; currently, there is no adequate management strategy for these tumors. Thus, the aim of the present study was to establish a strategy of secondary ESD (sESD) for cases with positive lateral margins (LM+), which cause post-ESD residual or recurrent tumors. METHODS Fifty-three lesions that were subjected to ESD were diagnosed as LM+ with suspected local residual tumor. The short- and long-term outcomes of early sESD (performed shortly after the initial ESD in LM+ cases to prevent local recurrence) were retrospectively compared with those of late sESD (performed after the detection of recurrent tumors). RESULTS Of the 53 LM+ cases, the local residual positive rate was 38.5 % (10/26) in those undergoing early sESD or additional surgery and the local recurrence rate was 29.6 % (8/27) in those that were not treated. Thus, the overall incidence of residual or recurrent tumors in LM+ cases was 34.0 % (18/53). Both early and late sESD had favorable outcomes with no severe complications: 100 % of early sESD resections were curative, compared with 86.7 % of late sESD resections, over the course of a mean (±SD) observation period of 50.8 ± 16.7 months. The performance of early sESD was significantly greater than that of late sESD (in terms of dissection speed). CONCLUSIONS Early sESD is more reliable than late sESD as a therapeutic strategy for salvaging residual tumors and for preventing recurrence. However, if a tumor has already recurred, late sESD remains useful.
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Affiliation(s)
- Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan,
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Kusano T, Etoh T, Akagi T, Ueda Y, Shiroshita H, Yasuda K, Satoh M, Inomata M, Shiraishi N, Kitano S. Evaluation of 0.6% sodium alginate as a submucosal injection material in endoscopic submucosal dissection for early gastric cancer. Dig Endosc 2014; 26:638-45. [PMID: 24655031 DOI: 10.1111/den.12268] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/03/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM We have focused on sodium alginate (SA) solution as a potential submucosal injection material for endoscopic submucosal dissection (ESD). A previous SA solution had high viscosity and problems such as difficult handling. After its properties were adjusted, SA solution was examined in vitro and its clinical safety was evaluated. METHODS With 0.4% sodium hyaluronate (SH) solution as a control, catheter injectability and mucosa-elevating capacity of 0.3-0.8% SA solutions were evaluated. Next, 0.6% SA solution was used for ESD in 10 patients with early gastric cancer in a prospective clinical study. RESULTS Compared with 0.4% SH solution, 0.6% SA solution exhibited no significant difference in catheter injectability but significant superiority in mucosa-elevating capacity. In the clinical study, no adverse events were observed in any patient. CONCLUSION The safety of 0.6% SA solution as a submucosal injection material was confirmed and it is suggested that its efficacy should be investigated in a larger number of cases.
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Affiliation(s)
- Toru Kusano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
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Hoteya S, Haruta S, Shinohara H, Yamada A, Furuhata T, Yamashita S, Kikuchi D, Mitani T, Ogawa O, Matsui A, Iizuka T, Udagawa H, Kaise M. Feasibility and safety of laparoscopic and endoscopic cooperative surgery for gastric submucosal tumors, including esophagogastric junction tumors. Dig Endosc 2014; 26:538-44. [PMID: 24355070 DOI: 10.1111/den.12215] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 11/11/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Recently, the use of endoscopic submucosal dissection (ESD) for gastric submucosal tumor (gSMT) and the development of laparoscopic and endoscopic cooperative surgery (LECS) have enabled either preservation of the stomach or minimization of the extent of partial resection. In the present study, the outcomes following the recent introduction of LECS for gSMT are presented. The aim of this retrospective study was to evaluate the feasibility and safety of LECS for gSMT, including esophagogastric junction (EGJ) SMT. METHODS LECS is indicated for lesions that have an intragastric growth pattern, or for which fundusectomy can be avoided despite an extragastric growth pattern. We retrospectively evaluated the outcome of LECS carried out in 25 patients including five EGJ SMT. RESULTS Surgery was completed achieving an R0 resection rate of 100% with no postoperative complications. Mean tumor size was 32.3 ± 13.5 mm and mean resected specimen size was 37.6 ± 13.5 mm. Resection margins were tumor-free in all cases, with adequate minimum surgical margins, and precise conclusive diagnosis was achieved with perfect operative specimens. Endoscopic confirmation of the EGJ enabled the extent of resection to be minimized and the stomach to be preserved, avoiding fundusectomy. Although there were significant differences in tumor size and resected specimen size between EGJ SMT and non-EGJ SMT, there were no significant differences in outcomes of the LECS procedure. CONCLUSION LECS is feasible and safe for cases with gSMT including lesions adjacent to the EGJ.
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Affiliation(s)
- Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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Kosaka T, Endo M, Toya Y, Abiko Y, Kudara N, Inomata M, Chiba T, Takikawa Y, Suzuki K, Sugai T. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc 2014; 26:183-91. [PMID: 23560494 DOI: 10.1111/den.12099] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 02/19/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND The aim of the present study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) based on the long-term outcomes. PATIENTS AND METHODS From June 2002 to March 2007, ESD was carried out in 472 cases and 570 lesions of EGC. Post-surgical cases and status-unknown cases were excluded. The following long-term outcomes were examined in 438 patients who were reliably followed up for at least 5 years after treatment (range: 5 years [60 months] to 9 years, 9 months [117 months]): local recurrence, metachronous recurrences, and the survival rate. RESULTS The overall en bloc resection rate was 97.7% for all lesions treated by ESD. The median procedure time was 47.0 min (range 8-345 min). The incidence of positive horizontal andvertical margins was 3.7% and 3.4%, respectively. The incidence of perforation and postoperative bleeding was 5.3% and 4.3%, respectively. There were no deaths related to ESD. Local recurrence was observed in five patients (1.1%), and metachronous recurrences in 7.8% of the patients. The post-treatment 5-year survival was 83.1%. There were no deaths as a result of gastric cancer associated with sites treated by ESD. CONCLUSION ESD can be considered a standard treatment for EGC based on its expanded indications and low incidences of local recurrence and lymph node metastasis.
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Affiliation(s)
- Takashi Kosaka
- Department of Gastroenterology and Hepatology, Iwate Medical University School of Medicine, Morioka, Japan
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Oda I, Oyama T, Abe S, Ohnita K, Kosaka T, Hirasawa K, Ishido K, Nakagawa M, Takahashi S. Preliminary results of multicenter questionnaire study on long-term outcomes of curative endoscopic submucosal dissection for early gastric cancer. Dig Endosc 2014; 26:214-9. [PMID: 23826719 DOI: 10.1111/den.12141] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/27/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM There are a number of published reports on long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC), but most reports are from single centers with median follow-up periods shorter than 5 years. This questionnaire study investigated long-term outcomes of curative ESD for EGC at six Japanese institutions with follow-up rates of at least 90% over a minimum 5-year period. METHODS All consecutive patients with initial-onset EGC who underwent ESD through December 2006 at the six institutions were included in our study. The questionnaire covered pathological curability and long-term outcomes of patients with curative resections or curative resections for expanded indications over follow-up periods of at least 5 years. RESULTS There were 3788 patients with initial-onset EGC including 1710 (45.1%) patients with curative resections and 1289 (34.0%) patients with curative resections for expanded indications. The remaining 789 (20.8%) patients had non-curativeresections. Altogether, 1601 (93.6%) patients with curative resections and 1205 (93.5%) patients with curative resections for expanded indications were successfully followed up for at least 5 years. No recurrences were reported in any of the 1601 patients with curative resections whereas three recurrences (0.2%) were reported in the 1205 patients with curative resections for expanded indications. Gastric cancer-related deaths occurred in seven (0.2%) of the 2806 patients with curative resections or curative resections for expanded indications including six patients with metachronous gastric cancer-related deaths. CONCLUSION This questionnaire study's results indicated favorable long-term outcomes for patients with curative resections or curative resections for expanded indications.
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Affiliation(s)
- Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Chiu PWY. Novel endoscopic therapeutics for early gastric cancer. Clin Gastroenterol Hepatol 2014; 12:120-5. [PMID: 23954641 DOI: 10.1016/j.cgh.2013.07.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/24/2013] [Accepted: 07/30/2013] [Indexed: 02/07/2023]
Abstract
Gastrointestinal cancers are among the commonest cancers worldwide. Treatment of these cancers at an early stage will result in a significantly better prognosis. Endoscopic submucosal dissection (ESD) is a new method of endoscopic resection that can achieve higher rates of en bloc resection for early gastrointestinal neoplasia. Three retrospective case-control studies showed that ESD achieved significantly higher en bloc resection with lower recurrence rates than endoscopic mucosal resection for treatment of early gastric cancers. Most of the reports on clinical outcomes of ESD were from countries with a high incidence of gastric cancers, including Japan and Korea. The development of ESD has been slow for countries outside Japan and Korea because ESD requires a high level of endoscopic skills, and the dissection was performed single-handedly without assistance. A newly developed robotic endoscopic platform will enhance the performance of ESD through the use of 2 robotic arms: one arm for retraction of the mucosa and the other arm for dissection.
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Affiliation(s)
- Philip Wai Yan Chiu
- Department of Surgery, Hong Kong Jockey Club Minimally Invasive Surgical Skills Center, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
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Numata N, Oka S, Tanaka S, Higashiyama M, Sanomura Y, Yoshida S, Arihiro K, Chayama K. Clinical outcomes of endoscopic submucosal dissection for early gastric cancer in patients with chronic kidney disease. J Gastroenterol Hepatol 2013; 28:1632-7. [PMID: 23808356 DOI: 10.1111/jgh.12320] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastric cancer (EGC), and the number of ESD performed for EGC in patients with chronic kidney disease (CKD) is increasing. Although patients undergoing hemodialysis tend to bleed and are at high risk for cardiovascular disease, the effectiveness and safety of ESD for EGC in patients with CKD in particular have not been established. The aim of this study was to evaluate the effectiveness and potential adverse effects of ESD for EGC in patients with CKD undergoing hemodialysis. METHODS Sixty-three consecutive CKD patients in whom 79 EGCs were treated by ESD between October 2004 and January 2012; 15 of the 63 patients were hemodialysis patients. Complete en bloc resection rate and ESD-related complications in hemodialysis patients versus non-hemodialysis patients were evaluated. RESULTS The complete en bloc resection rate was 100% (15/15) in the hemodialysis patients and 87.5% (56/64) in the non-hemodialysis patients, respectively. The post-ESD bleeding rate was 33% (5/15) and 9% (6/64), respectively (P < 0.05). Perforation occurred only in non-hemodialysis patients; the incidence was 5% (3/64). Two ESD-related deaths occurred among hemodialysis patients (13%, 2/15); femoral artery infarction triggered post-ESD bleeding in one of these two patients, and alveolar hemorrhage occurred in the other. CONCLUSION Hemodialysis poses a risk of post-ESD bleeding. We must understand this risk and provide countermeasures for post-ESD bleeding in hemodialysis patients.
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Affiliation(s)
- Norifumi Numata
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Li L, Wang F, Wu B, Wang Q, Wang C, Liu J. Endoscopic submucosal dissection of gastric fundus subepithelial tumors originating from the muscularis propria. Exp Ther Med 2013; 6:391-395. [PMID: 24137195 PMCID: PMC3786878 DOI: 10.3892/etm.2013.1181] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 06/14/2013] [Indexed: 12/18/2022] Open
Abstract
Endoscopic resection of gastric subepithelial tumors (SETs) carries a high risk of perforation, particularly for tumors located at the gastric fundus and originating from the muscularis propria. Based on our experience with endoscopic submucosal dissection (ESD) and a novel endoscopic device, namely the ‘Resolution clip’ for the endoscopic closure of iatrogenic upper gastrointestinal (upper GI) perforations, we evaluated the clinical feasibility and safety of ESD for gastric fundus subepithelial tumors originating from the muscularis propria. In this prospective study, 11 consecutive patients who presented with gastric SETs ≤3 cm in diameter were enrolled. Regardless of whether perforation occurred, the gastric wall defect was closed with clips. The patients were followed up after the surgery. Endoscopic resection was successfully performed in 10 patients; however, in one patient a pure endoscopic approach was impossible as the lesion was severely adhered to surrounding tissue, and a switch to laparoscopic wedge resection was necessary. The mean resected tumor size was 18.8×17.2 mm and the mean surgery time of the 10 patients with ESD was 81 min (range 45–130 min). Histological diagnosis was gastrointestinal stromal tumor (GIST) in eight lesions [very low risk according to the National Institutes of Health (NIH) risk classification] and leiomyoma in three lesions. Perforation occurred in 3/10 patients. Gastric closure with the Resolution clips was performed successfully in all cases. Early post-ESD bleeding (EPEB) occurred in one patient. Basic ferric sulfate solution was sprayed during the upper GI endoscopy examination and the bleeding stopped. No complications occurred and the follow-up was unremarkable. In this early study, ESD using the Resolution clip was demonstrated to be a feasible and minimally invasive treatment for gastric fundus subepithelial tumors originating from the muscularis propria.
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Affiliation(s)
- Lei Li
- Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong 250021; ; Department of Gastroenterology, Taian Central Hospital, Taian, Shandong 271000, P.R. China
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Gastric ESD under Heparin Replacement at High-Risk Patients of Thromboembolism Is Technically Feasible but Has a High Risk of Delayed Bleeding: Osaka University ESD Study Group. Gastroenterol Res Pract 2013; 2013:365830. [PMID: 23843783 PMCID: PMC3697307 DOI: 10.1155/2013/365830] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/27/2013] [Indexed: 12/14/2022] Open
Abstract
Objectives. Heparin replacement (HR) is often performed in patients with a high risk of thrombosis undergoing endoscopic procedures. However, information about the influence of HR is scarce. The aim of this study is to assess the clinical impact of HR for gastric endoscopic submucosal dissection (ESD).
Methods. This is a retrospective study comprising approximately 1310 consecutive gastric neoplasms in 1250 patients, who underwent ESD in 5 institutes. We assessed the clinical findings and outcomes of ESD under HR, compared to ESD without HR as control.
Results. A total of 24 EGC lesions in 24 patients were treated by ESD under HR. In the HR group, the complete en-bloc resection rate was 100%. The delayed bleeding rate was, however, higher in the HR group than in the controls (38% versus 4.6%). The timing of bleeding in the HR group was significantly later than in controls. In the control group, 209 patients discontinued antithrombotic therapy during perioperative period, and their delayed bleeding rate was not different from those without antithrombotic therapy (5.7% versus. 4.4%). A thromboembolic event was encountered in 1 patient under HR after delayed bleeding.
Conclusion. ESD under HR is technically feasible but has a high risk of delayed bleeding.
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Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/ endoscopic submucosal dissection) for early gastric cancer. Dig Endosc 2013; 25 Suppl 1:55-63. [PMID: 23362925 DOI: 10.1111/den.12003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 10/04/2012] [Indexed: 12/12/2022]
Abstract
Endoscopic resection of early gastric cancer is a well-established standard therapy in Japan and Korea, and is increasingly used in other countries. Endoscopic resection should be curative for patients, and safe, easy and effective not only for patients, but also for endoscopists. Endoscopic submucosal dissection (ESD) is superior to standard endoscopic mucosal resection (EMR) as it is designed to provide en bloc R0 resection regardless of size and/or location. Correct pathological assessment of en bloc resected specimens is crucial for accurate diagnosis and patient stratification for the risk of metastasis. Outcome studies in Japan and Korea, countries with the highest incidence of gastric cancer, have shown that ESD is efficacious in leading to a good long-term outcome; however, ESD requires an experienced endoscopist with a high skill level. Expanded indications for endoscopic resection have been proposed, especially after large en bloc resection have been accomplished using ESD. The use of ESD could be of huge benefit for the management of gastrointestinal superficial neoplasms. However, for ESD to become a viable therapeutic option, it requires close and supportive working relationships between endoscopists, pathologists and surgeons.
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Affiliation(s)
- Takuji Gotoda
- Department of Gastroenterology and Hepatology, Tokyo Medical University Hospital, Tokyo, Japan.
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Koike T, Nakagawa K, Iijima K, Shimosegawa T. Endoscopic resection (endoscopic submucosal dissection/endoscopic mucosal resection) for superficial Barrett's esophageal cancer. Dig Endosc 2013; 25 Suppl 1:20-8. [PMID: 23480400 DOI: 10.1111/den.12047] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 01/08/2013] [Indexed: 12/16/2022]
Abstract
Recently developed endoscopic resection (endoscopic submucosal dissection [ESD]/ endoscopic mucosal resection) has dramatically changed the therapeutic approach for Barrett's esophageal cancer. The rationale for endoscopic resection is that lesions confined to the mucosal layer have negligible risk for developing lymph node metastasis and can be successfully eradicated by endoscopic treatment as a curative treatment with minimal invasiveness. According to some reports that analyzed the rate of lymph-node involvement relative to the depth of mucosal or submucosal tumor infiltration, endoscopic resection is clearly indicated for intramucosal carcinoma and might be extended to lesions with invasion into the submucosa (<200 μm, sm1) because of the low risk for lymph node metastasis. Most Japanese experts recommend ESD for Barrett's esophageal cancer after accurate diagnosis of the margin of cancer using narrow band imaging with magnifying endoscopy because of its high curative rate. However, few studies have evaluated the long-term outcomes of endoscopic resection for Barrett's esophageal cancer in Japan. Further investigations should be conducted to establish endoscopic resection for Barrett's esophageal cancer.
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Affiliation(s)
- Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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The current state of diagnosis and treatment for early gastric cancer. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:241320. [PMID: 23533320 PMCID: PMC3600289 DOI: 10.1155/2013/241320] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/24/2013] [Indexed: 12/22/2022]
Abstract
The prognosis for gastric cancer depends on its stage; so, detection in the early stage of disease is important, when complete and curative removal is possible. Accurate diagnosis can be facilitated by a sound understanding of the basic findings of white light endoscopy of early gastric cancer, and diagnosis can be refined further by the combined use of other imaging modalities such as image-enhanced endoscopy including chromoendoscopy and endoscopic ultrasonography. Minimally invasive endoscopic treatment has come to be the preferred therapeutic approach for early gastric cancer. In addition to conventional endoscopic mucosal resection, a new technique known as endoscopic submucosal dissection (ESD) has spread rapidly worldwide. Indeed, strategies for ESD have been established, devices developed, its indications expanded, and its safety and long-term results extensively reported. Some unique combination therapies involving endoscopy and surgical treatment have also been reported. It is anticipated that the number of patients undergoing endoscopic therapy will continue to increase, and the ongoing developments in endoscopic treatment are expected not only to improve gastric cancer prognosis but also to maintain good quality of life after treatment.
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Man-i M, Morita Y, Fujita T, East JE, Tanaka S, Wakahara C, Yoshida M, Hayakumo T, Kutsumi H, Inokuchi H, Toyonaga T, Azuma T. Endoscopic submucosal dissection for gastric neoplasm in patients with co-morbidities categorized according to the ASA Physical Status Classification. Gastric Cancer 2013; 16:56-66. [PMID: 22382930 DOI: 10.1007/s10120-012-0145-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 01/26/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has come to be widely performed for reduced invasiveness; however, its safety in patients with co-morbidities is not fully examined. We aimed to evaluate the safety and efficacy of gastric ESD with co-morbidities categorized according to ASA Physical Status Classification. METHODS Two hundred and forty patients of ASA 1 (no co-morbidities), 268 of ASA 2 (mild), and 19 of ASA 3 (severe) were treated by ESD for gastric neoplasms. We retrospectively compared clinicopathological features and treatment results of these three groups. RESULTS Cases (by percent) treated with anticoagulant/platelet agents were more common in the higher ASA grades (ASA 1, 5.8%; ASA 2, 29.1%; ASA 3, 31.6%; P < 0.0001). There were no significant differences in case numbers treated under guideline criteria, curative resection (ASA 1, 79.6%; ASA 2, 79.9%; ASA 3, 78.9%), or complications related to the ESD procedure (e.g., postoperative bleeding, perforation, thermal injury). By a patient risk prediction model on surgery, i.e., P-POSSUM, morbidity was halved, and no patients died compared to a predicted death rate of 0.5-2%; however, total and complications unrelated to ESD procedure (e.g., aspiration pneumonia, ischemic heat attack) were more common in higher ASA grades (ASA 1, ASA 2, ASA 3: 15.4, 23.9, 26.3%, respectively, P = 0.014; 0.4, 7.1, 0%, respectively, P = 0.00087). Deviation rates from clinical pathway were more frequent and hospital stay (days) longer in higher ASA grades (ASA 1, ASA 2, ASA 3: 11.3, 17.9, 26.3%, respectively, P = 0.014; 8, 8, 9%, respectively, P = 0.0053). CONCLUSIONS ESD is an efficient treatment for gastric neoplasms with co-morbidities. However, additional caution is required because co-morbidity is a risk factor for both total complications and complications unrelated to the ESD procedure, and may cause deviations in the clinical course and prolonged hospital stay.
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Affiliation(s)
- Mariko Man-i
- Department of Gastroenterology, Kobe University, Kobe, Japan.
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Lim SM, Park JC, Lee H, Shin SK, Lee SK, Lee YC. Impact of cumulative time on the clinical outcomes of endoscopic submucosal dissection in gastric neoplasm. Surg Endosc 2012; 27:1397-403. [PMID: 23233016 DOI: 10.1007/s00464-012-2643-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/29/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) can be technically demanding and requires great attention to detail and prolonged concentration. We assumed that clinical outcomes of ESDs may be affected by cumulative time, and we aimed to compare complete resection rates and adverse events according to cumulative ESD time. METHODS This study involved 1,328 consecutive patients with 1,461 gastric tumors who underwent ESD from January 2008 to July 2011 in a tertiary-care academic medical center. The main outcome measurements were en bloc resection rate, complete resection rate, bleeding rate and perforation rate. RESULTS Patients were divided into three groups according to cumulative time intervals (<2 h vs. 2-4 h vs. ≥ 4 h). Complete resection rate did not differ among the three groups, but early post-ESD bleeding (EPEB) rate was significantly different among the three groups (2.5 vs. 3.5 % vs. 6.6 %, P = 0.040). In multivariate analysis, cumulative time period was an independent predictor of EPEB (2-4 h odds ratio [OR] 2.29, 95 % confidence interval [CI] 1.05-5.01, P = 0.038; ≥ 4 h OR 3.99; 95 % CI, 2.15-7.65, P < 0.001). The rate of perforation was higher in ESDs performed after completing prior endoscopies or outpatient clinic session compared to those performed without prior work (3.8 vs. 1.6 %, P = 0.004). Moreover, prior workload before ESD was an independent predictor of perforation in multivariate analysis (OR 2.77, 95 % CI, 1.37-5.60, P = 0.005). CONCLUSIONS Our data suggest that cumulative ESD time did not influence en bloc or complete resection rate of ESD, but increased the rate of acute bleeding. Moreover, prior workload before ESDs may increase the risk of perforation.
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Affiliation(s)
- Sun Min Lim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Watari J, Tomita T, Toyoshima F, Sakurai J, Kondo T, Asano H, Yamasaki T, Okugawa T, Tanaka J, Daimon T, Oshima T, Fukui H, Hori K, Matsumoto T, Miwa H. The incidence of "silent" free air and aspiration pneumonia detected by CT after gastric endoscopic submucosal dissection. Gastrointest Endosc 2012; 76:1116-23. [PMID: 23164512 DOI: 10.1016/j.gie.2012.07.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 07/30/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although endoscopic submucosal dissection (ESD) is feasible as a treatment for early gastric cancer, it requires great skill to perform and may place patients at increased risk of a number of complications, including perforation and aspiration pneumonia. OBJECTIVE To investigate the incidence of "silent" free air without endoscopic perforation and aspiration pneumonia detected by CT after ESD and risk factors for the development of these 2 conditions. DESIGN Prospective cohort study. SETTING Single academic center. PATIENTS This study involved 87 patients with a total of 91 malignancies. INTERVENTION All patients underwent chest and abdominal CT and blood biochemistry analysis before and 1 day after ESD. MAIN OUTCOME MEASUREMENTS The incidence of silent free air and aspiration pneumonia after ESD and the related risk factors. RESULTS Silent free air was identified in 37.3% of patients without perforation. Tumor location (the upper portion of the stomach), the presence of a damaged muscular layer during ESD, and procedure time, but not specimen size, were significantly associated with silent free air (P = .006, P = .04, P = .02, and P = .53, respectively). According to the receiver-operating characteristic analysis, the resulting cutoff value of the procedure time for silent free air was 105 minutes (67.7% sensitivity, 65.4% specificity). Only procedure time (≥ 105 minutes) was an independent predictor of silent free air development (odds ratio 3.23; 95% confidence interval, 1.21-8.64; P = .02). On the other hand, aspiration pneumonia was seen in 6.6% of patients. Silent free air and aspiration pneumonia did not affect hospitalization. LIMITATIONS Single center and small number of patients. CONCLUSIONS Silent free air is frequently observed after ESD, and longer procedure time (≥ 105 minutes) was an independent risk factor for silent free air. However, silent free air and aspiration pneumonia detected by CT are not associated with clinically significant complications.
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Affiliation(s)
- Jiro Watari
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Fukuzawa M, Gotoda T. History of endoscopic submucosal dissection and role for colorectal endoscopic submucosal dissection: A Japanese perspective. GASTROINTESTINAL INTERVENTION 2012. [DOI: 10.1016/j.gii.2012.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Toyonaga T, Nishino E, Man-I M, East JE, Azuma T. Principles of quality controlled endoscopic submucosal dissection with appropriate dissection level and high quality resected specimen. Clin Endosc 2012; 45:362-74. [PMID: 23251883 PMCID: PMC3521937 DOI: 10.5946/ce.2012.45.4.362] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/24/2012] [Accepted: 09/04/2012] [Indexed: 12/13/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) has enabled en bloc resection of early stage gastrointestinal tumors with negligible risk of lymph node metastasis, regardless of tumor size, location, and shape. However, ESD is a relatively difficult technique compared with conventional endoscopic mucosal resection, requiring a longer procedure time and potentially causing more complications. For safe and reproducible procedure of ESD, the appropriate dissection of the ramified vascular network in the level of middle submucosal layer is required to reach the avascular stratum just above the muscle layer. The horizontal approach to maintain the appropriate depth for dissection beneath the vascular network enables treatment of difficult cases with large vessels and severe fibrosis. The most important aspect of ESD is the precise evaluation of curability. This approach can also secure the quality of the resected specimen with enough depth of the submucosal layer.
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Toyonaga T, Man-i M, East JE, Nishino E, Ono W, Hirooka T, Ueda C, Iwata Y, Sugiyama T, Dozaiku T, Hirooka T, Fujita T, Inokuchi H, Azuma T. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2012; 27:1000-8. [PMID: 23052530 PMCID: PMC3572381 DOI: 10.1007/s00464-012-2555-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/21/2012] [Indexed: 12/12/2022]
Abstract
Background Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasms; however, most ESD articles report small series, with short-term outcomes performed by multiple operators on single organ. We assessed short- and long-term treatment outcomes following ESD for early neoplasms throughout the gastrointestinal tract. Methods We performed a longitudinal cohort study in single tertiary care referral center. A total of 1,635 early gastrointestinal neoplasms (stomach 1,136; esophagus 138; colorectum 361) were treated by ESD by single operator. Outcomes were complication rates, en bloc R0 resection rates, and long-term overall and disease-specific survival rates at 3 and 5 years for both guideline and expanded criteria for ESD. Results En bloc R0 resection rates were: stomach: 97.1 %; esophagus: 95.7 %; colorectum: 98.3 %. Postoperative bleeding and perforation rates respectively were: stomach: 3.6 and 1.8 %; esophagus: 0 and 0 %; colorectum: 1.7 and 1.9 %. Intra criteria resection rates were: stomach: 84.9 %; esophagus: 81.2 %; colorectum: 88.6 %. Three-year survival rates for lesions meeting Japanese ESD guideline/expanded criteria were for all organ-combined: 93.4/92.7 %. Five-year rates were: stomach: 88.1/84.6 %; esophagus: 81.6/57.3 %; colorectum: 94.3/100 %. Median follow-up period was 53.4 (range, 0.07–98.6) months. Follow-up rate was 94 % (1,020/1,085). There was no recurrence or disease-related death. Conclusions In this large series by single operator, ESD was associated with high curative resection rates and low complication rates across the gastrointestinal tract. Disease-specific and overall long-term prognosis for patients with lesions within intra criteria after curative resection appeared to be excellent.
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Affiliation(s)
- Takashi Toyonaga
- Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
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Oda I, Shimazu T, Ono H, Tanabe S, Iishi H, Kondo H, Ninomiya M. Design of Japanese multicenter prospective cohort study of endoscopic resection for early gastric cancer using Web registry (J-WEB/EGC). Gastric Cancer 2012; 15:451-4. [PMID: 22549754 DOI: 10.1007/s10120-012-0159-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 04/04/2012] [Indexed: 02/07/2023]
Abstract
A Japanese multicenter prospective cohort study is currently being conducted on endoscopic resection (ER) for early gastric cancer (EGC) using a Web registry system developed to determine short-term and long-term outcomes based on the absolute and expanded indications. All consecutive patients with EGC or suspected EGC undergoing ER at the 41 participating institutions from July 2010 to June 2012 are being enrolled in the study cohort using the Web registry system, and each patient will be followed up for a minimum of 5 years. The study investigation includes baseline patient and lesion characteristics as well as short-term and long-term outcomes. A survey program to collect information on long-term outcomes is also being introduced for patients subsequently followed up in institutions other than their original participating institutions, as well as patients for whom the original participating institutions have been losing track of their follow-up. The primary endpoint is 5-year overall survival, with en bloc resection, curative resection, complication, local recurrence, distant metastasis, metachronous EGC, and recurrence-free survival being secondary endpoints in addition to the successful collection of long-term outcome data on enrolled patients utilizing the survey program.
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Affiliation(s)
- Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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Tomita T, Kim Y, Yamasaki T, Okugawa T, Kondo T, Toyoshima F, Sakurai J, Tanaka J, Morita T, Oshima T, Fukui H, Hori K, Watari J, Matsumoto T, Miwa H. Prospective randomized controlled trial to compare the effects of omeprazole and famotidine in preventing delayed bleeding and promoting ulcer healing after endoscopic submucosal dissection. J Gastroenterol Hepatol 2012; 27:1441-6. [PMID: 22497427 DOI: 10.1111/j.1440-1746.2012.07144.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Proton pump inhibitors (PPIs) are generally used to prevent delayed bleeding after endoscopic submucosal dissection (ESD) and to heal the artificial ulcers. However, it remains controversial whether PPIs or histamine-2 receptor antagonists (H(2) RAs) are more effective in preventing delayed bleeding after ESD. We prospectively compared the effects of omeprazole and famotidine in preventing delayed bleeding and promoting artificial ulcer healing after ESD. METHODS A total of 158 patients (155 early gastric cancers and three adenomas) were randomly assigned to the PPI group (omeprazole 20 mg/day) or H(2) RA group (famotidine 40 mg/day) in a prospective randomized controlled trial. The primary end point was the incidence of hematemesis, melena, and/or a decrease in hemoglobin level of 2 g/dL or more requiring endoscopic hemostatic treatment. ESD-induced ulcer healing and changes in ulcer size were also compared at 6 weeks after ESD as a secondary end point. RESULTS Of the 158 patients, two were excluded from analysis because they had been treated with a PPI before the present study. Accordingly, data from 77 PPI and 79 H(2) RA subjects were included for analysis. Delayed bleeding after ESD occurred in 6.5% of subjects (PPI group) and in 6.3% (H(2) RA group); there was no significant difference between the two groups. Likewise, the two groups were not significantly different with respect to ulcer stage or ulcer size reduction rate. CONCLUSIONS Proton pump inhibitors are not superior to H(2) RAs for the prevention of delayed bleeding or the healing of artificially induced ulcers after ESD.
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Affiliation(s)
- Toshihiko Tomita
- Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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