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Esaki M, Minoda Y, Ihara E. Reply. Clin Gastroenterol Hepatol 2023; 21:2437-2438. [PMID: 36539003 DOI: 10.1016/j.cgh.2022.12.004] [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: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Mitsuru Esaki
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Yosuke Minoda
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Eikichi Ihara
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan; Kyushu University, Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Fukuoka City, Japan
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Esaki M, Ihara E, Sumida Y, Fujii H, Takahashi S, Haraguchi K, Iwasa T, Somada S, Minoda Y, Ogino H, Tagawa K, Ogawa Y. Hybrid and Conventional Endoscopic Submucosal Dissection for Early Gastric Neoplasms: A Multi-Center Randomized Controlled Trial. Clin Gastroenterol Hepatol 2023; 21:1810-1818.e8. [PMID: 36343845 DOI: 10.1016/j.cgh.2022.10.030] [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: 06/22/2022] [Revised: 10/18/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS Hybrid endoscopic submucosal dissection (H-ESD), which incorporates endoscopic submucosal dissection (ESD) with endoscopic mucosal resection, has been developed to make ESD technically easier. This study aimed to determine if H-ESD is superior to conventional ESD (C-ESD) for small early gastric neoplasms (EGNs). METHODS We conducted a multi-center, prospective, open-label, randomized controlled trial to compare the treatment outcomes of H-ESD and C-ESD (Hybrid-G Trial). Patients with differentiated type intramucosal EGN ≤20 mm in diameter and without ulceration were randomly assigned (1:1) to groups that underwent H-ESD or C-ESD. A single multi-functional snare, SOUTEN (ST1850-20, Kaneka, Medix, Tokyo, Japan), was used for H-ESD. The primary outcome was procedure time. Secondary outcomes included mucosal incision time, time and speed of submucosal dissection, curability, and endoscopic procedural adverse events. RESULTS A total of 39 and 40 patients underwent H-ESD and C-ESD, respectively. The procedure time of H-ESD was significantly shorter than that of C-ESD (33.16 min vs 62.46 min; H-ESD/C-ESD ratio: 0.53; 95% confidence interval, 0.41-0.69; P < .0001). There was no significant difference in mucosal incision time between the 2 groups; the time and speed of submucosal dissection of H-ESD were significantly shorter than those of C-ESD. No difference was observed between the 2 groups in other outcomes. CONCLUSIONS H-ESD has significantly shorter procedure time than C-ESD, with high and comparable curability and safety for both H-ESD and C-ESD. H-ESD can be a good option for the endoscopic treatment of small EGNs. (UMIN Clinical Trials Registry, Numbers: UMIN000041244).
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Affiliation(s)
- Mitsuru Esaki
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Eikichi Ihara
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan; Kyushu University, Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Fukuoka City, Japan.
| | - Yorinobu Sumida
- Kitakyushu Municipal Medical Center, Department of Gastroenterology, Kitakyushu, Japan; National Hospital Organization Kyushu Medical Center, Department of Gastroenterology, Clinical Research Institute, Fukuoka, Japan
| | - Hiroyuki Fujii
- National Hospital Organization Fukuokahigashi Medical Center, Department of Gastroenterology and Hepatology, Koga, Japan
| | | | | | - Tsutomu Iwasa
- Fukuokaken Saiseikai Futsukaichi Hospital, Department of Gastroenterology, Fukuoka, Japan
| | - Shinichi Somada
- National Hospital Organization Beppu Medical Center, Department of Gastroenterology, Beppu, Japan
| | - Yosuke Minoda
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Haruei Ogino
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan
| | - Koshiro Tagawa
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshihiro Ogawa
- Kyushu University, Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Fukuoka, Japan
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Esaki M, Maehara R, Nagatomo S, Nishioka K, Minoda Y, Ogino H, Ihara E. Application of traction-method to hybrid endoscopic submucosal dissection for gastrointestinal tumors. Endoscopy 2022; 54:E160-E161. [PMID: 33878790 DOI: 10.1055/a-1422-2902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ryosuke Maehara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuzaburo Nagatomo
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kei Nishioka
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Comparison of the procedure time differences between hybrid endoscopic submucosal dissection and conventional endoscopic submucosal dissection in patients with early gastric neoplasms: a study protocol for a multi-center randomized controlled trial (Hybrid-G trial). Trials 2022; 23:166. [PMID: 35189939 PMCID: PMC8862302 DOI: 10.1186/s13063-022-06099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Endoscopic submucosal dissection (ESD) is widely accepted as a local treatment for gastrointestinal tract tumors. As a simplified endoscopic procedure, hybrid ESD (H-ESD) has been performed for colorectal neoplasms in recent times. However, whether H-ESD is superior to conventional ESD (C-ESD) for patients with early gastric neoplasms (EGN) remains unclear. In this trial, we will compare the treatment outcomes of H-ESD and C-ESD. We hypothesize that the procedure time for H-ESD is shorter than that for C-ESD.
Methods
This is an investigator-initiated, multi-center, prospective, randomized, open-label, parallel-group trial to be conducted beginning in August 2020 at nine institutions in Japan. We will determine if H-ESD is superior to C-ESD in terms of procedure time in patients with EGN diagnosed as macroscopically intramucosal (T1a) differentiated carcinoma ≤ 20 mm in diameter without ulcerative findings according to current Japanese gastric cancer treatment guidelines. A total of 82 patients will be recruited and randomly assigned to either the C-ESD or the H-ESD group. The primary outcome is ESD procedure time. Secondary outcomes include mucosal incision, time and speed of submucosal dissection, en bloc resection, complete resection, curability, adverse events related to the ESD procedure, extent of dissection before snaring, volume of injection solution, number and time of hemostasis, thickness of the submucosal layer in the resected specimen, and handover to another operator. The stated sample size was determined based on the primary outcome. According to a previous report comparing the procedure times of C-ESD and H-ESD, we hypothesized that H-ESD would provide a 0.2 reduction in logarithmically concerted procedure time (−37%). We estimated that a total of 82 participants were needed to reach a power of 80% for a t-test with a significance level of 0.05 and considering a 10% dropout.
Discussion
This trial will provide high-quality data on the benefits and risks of H-ESD for EGN patients. The results of this study could lead to improved outcomes in patients with EGN undergoing ESD. The results will be presented at national and international meetings and published in peer-reviewed journals.
Trial registration
UMIN-CTR UMIN000041244. Registered on July 29, 2020.
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Esaki M, Ihara E, Gotoda T. Endoscopic instruments and techniques in endoscopic submucosal dissection for early gastric cancer. Expert Rev Gastroenterol Hepatol 2021; 15:1009-1020. [PMID: 33909540 DOI: 10.1080/17474124.2021.1924056] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Endoscopic submucosal dissection (ESD) is a less invasive local treatment for early gastric cancer (EGC).Areas covered: Japanese guidelines have recently expanded the endoscopic treatment indications for EGC. ESD is sometimes performed for lesions with a relative indication that has not previously been considered for ESD. ESD procedures are technically difficult, especially for larger and more invasive lesions. Complete resection and accurate histological assessment of EGC lesions are essential to evaluate endoscopic curability. Various endoscopic instruments, including three types of endoscopic knives and specific hemostatic forceps, have been developed, and endoscopic techniques, including the traction method, have been modified to simplify the procedure.Expert opinion: An insulated-tip knife with large tissue contact allows us to perform faster incisions, while a needle-type knife with minimal tissue contact allows us to perform precise incisions. Furthermore, a scissor-type knife with grasping tissues allows us to perform more secure incision. The traction method enables the operator to proceed with submucosal dissection procedures. In cases with small lesions, snaring can be used, as well as knife dissection. Understanding the features of each endoscopic instrument and technique is essential because appropriate selection and usage contribute to successful and safe ESD procedures.
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Affiliation(s)
- Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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Esaki M, Ihara E, Hashimoto N, Abe S, Aratono C, Shiga N, Sumida Y, Fujii H, Haraguchi K, Takahashi S, Iwasa T, Nakano K, Wada M, Somada S, Nishioka K, Minoda Y, Ogino H, Ogawa Y. Efficacy of hybrid endoscopic submucosal dissection with SOUTEN in gastric lesions: An ex vivo porcine model basic study. World J Gastrointest Surg 2021; 13:563-573. [PMID: 34194614 PMCID: PMC8223703 DOI: 10.4240/wjgs.v13.i6.563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/07/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hybrid endoscopic submucosal dissection (ESD) that comprises mucosal incision and partial submucosal dissection followed by snaring in a planned manner, has been developed for endoscopic resection of gastrointestinal neoplasms to overcome the technical barrier of ESD. Although the superiority of hybrid ESD with SOUTEN, a single multifunctional device, over conventional ESD has been indicated, the actual effect of snaring itself remains unclear since SOUTEN could be applied to hybrid ESD group, but not to the conventional ESD group, due to ethical issue in clinical practice.
AIM To determine whether and how hybrid ESD was superior to conventional ESD in the endoscopic treatment of gastric lesions in an ex vivo porcine model basic study.
METHODS Sixteen endoscopists participated in this basic study in August 2020 at Kyushu University, performing 32 procedures each for hybrid ESD and conventional ESD. Mock lesions (10-15 mm, diameter) were created in the porcine stomach. The primary outcome was total procedure time and secondary outcomes were en bloc or complete resection, perforation, procedure time/speed for both, mucosal incision, and submucosal dissection. Factors associated with difficulty in ESD including longer procedure time, incomplete resection, and perforation, were also investigated. Categorical and continuous data were analyzed using the chi-square test or Fisher’s exact test and the Mann-Whitney U test, respectively.
RESULTS The median total procedure time of hybrid ESD was significantly shorter than that of conventional ESD (median: 8.3 min vs 16.2 min, P < 0.001). Time, speed, and the amount of hyaluronic acid during submucosal dissection were more favorable in hybrid ESD than conventional ESD (time, 5.2 min vs 10.4 min, P < 0.001; speed, 43.7 mm2/min vs 23.8 mm2/min, P < 0.00; injection volume, 1.5 mL vs 3.0 mL, P < 0.001), although no significant differences in those factors were observed between both groups during mucosal incision. There was also no significant difference between both groups in the en bloc/complete resection rate and perforation rate (complete resection, 93.8% vs 87.5%, P = 0.67; perforation, 0% vs 3.1%, P = 1). Selection of conventional ESD as the treatment method was significantly associated with difficulties during ESD (odds ratio = 10.2; highest among factors).
CONCLUSION Hybrid ESD with SOUTEN improves the treatment outcomes of gastric lesions. It also has the potential to reduce medical costs since SOUTEN is a single multifunctional device that is inexpensive.
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Affiliation(s)
- Mitsuru Esaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Eikichi Ihara
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
- Department of Gastroenterology and Metabolism, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Norikazu Hashimoto
- Department of Gastroenterology, Fukuoka City Hospital, Fukuoka 811-1394, Japan
| | - Shuichi Abe
- Department of Gastroenterology, Harasanshin Hospital, Fukuoka 812-0033, Japan
| | - Chihoko Aratono
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Koga 811-3195, Japan
| | - Noriko Shiga
- Department of Gastroenterology, Fukuokaken Saiseikai Futsukaichi Hospital, Futsukaichi 811-8516, Fukuoka, Japan
| | - Yorinobu Sumida
- Department of Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka 810-8564, Japan
| | - Hiroyuki Fujii
- Department of Gastroenterology and Hepatology, National Hospital Organization Fukuokahigashi Medical Center, Koga 811-3195, Japan
| | - Kazuhiro Haraguchi
- Department of Gastroenterology, Harasanshin Hospital, Fukuoka 812-0033, Japan
| | - Shunsuke Takahashi
- Department of Gastroenterology, Fukuoka City Hospital, Fukuoka 811-1394, Japan
| | - Tsutomu Iwasa
- Department of Gastroenterology, Fukuokaken Saiseikai Futsukaichi Hospital, Futsukaichi 811-8516, Fukuoka, Japan
| | - Kayoko Nakano
- Department of Gastroenterology, Fukuoka Central Hospital, Fukuoka 805-0050, Japan
| | - Masafumi Wada
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Shinichi Somada
- Department of Gastroenterology, National Hospital Organization Beppu Medical Center, Beppu 874-0011, Japan
| | - Kei Nishioka
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yosuke Minoda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Haruei Ogino
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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