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Joseph A, Vantanasiri K, Goyal R, Garg N, Leggett C, Codipilly DC, Wang K, Harmsen WS, Vargo JJ, Jang S, Iyer P, Bhatt A. Journey to complete remission of dysplasia and intestinal metaplasia after ESD and EMR of Barrett's esophagus-related neoplasia. Endosc Int Open 2025; 13:a24222815. [PMID: 40376017 PMCID: PMC12080518 DOI: 10.1055/a-2422-2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/25/2024] [Indexed: 05/18/2025] Open
Abstract
Background and study aims Although endoscopic submucosal dissection (ESD) is associated with higher en-bloc and R0 resection rates than cap-assisted endoscopic mucosal resection (cEMR), its comparative impact on achieving complete remission of dysplasia (CRD) and intestinal metaplasia (CRIM) in BE endoscopic eradication therapy (EET) is not well defined. We aimed to compare the journey of patients from initial endoscopic resection (ER) with ESD and cEMR to achieving CRD and CRIM. Patients and methods Patients undergoing ESD or cEMR followed by ablation for BE neoplasia at two academic institutions in the United States were included. Primary outcomes included CRD and CRIM rates following ER in the two groups. Secondary outcomes included the number of resection/ablative procedures from initial ER to achieving CRD and CRIM. Inverse probability treatment weighting (IPTW) was used to balance confounding variables between groups. Results A total of 801 patients (606 cEMR, 195 ESD) were included. ESD group patients had higher en-bloc resection rates (ESD 94.4%, cEMR 44.7%). Higher rates of CRD were observed in patients undergoing initial ESD (HR 1.53, P < 0.01). With time-to-event and IPTW analyses, rates of achieving CRD and CRIM were comparable between the groups. There were no significant differences in mean number of endoscopic resection or ablative procedures among patients undergoing initial cEMR resection compared with those treated with initial ESD. Conclusions Despite larger lesion sizes and more cancers in patients undergoing ESD, the EET journey to achieving CRD and CRIM was comparable to that in patients receiving cEMR. Prospective studies are required to further study differences between these two treatment approaches.
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Affiliation(s)
- Abel Joseph
- Internal Medicine, Cleveland Clinic Foundation, Cleveland, United States
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, United States
| | - Kornpong Vantanasiri
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Rohit Goyal
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Nikita Garg
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Cadman Leggett
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - D. Chamil Codipilly
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Kenneth Wang
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - William S. Harmsen
- Biostatistics, Mayo Clinic, Rochester, MN, USA, Rochester, United States
| | - John J. Vargo
- Section of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Digestive Disease Surgical Institute, Cleveland Clinic Foundation, Cleveland, United States
| | - Sunguk Jang
- Section of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, United States
| | - Prasad Iyer
- Barrett's Esophagus Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States
| | - Amit Bhatt
- Section of Therapeutic Endoscopy, Department of Gastroenterology and Hepatology, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, United States
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Ito M, Dobashi A, Tominaga T, Futakuchi T, Tamai N, Suka M, Sumiyama K. The competency of the novel through-the-scope suture device for gastric mucosal defects: In vivo study in a porcine model (with video). DEN OPEN 2025; 5:e70037. [PMID: 39534406 PMCID: PMC11556257 DOI: 10.1002/deo2.70037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 10/19/2024] [Accepted: 10/27/2024] [Indexed: 11/16/2024]
Abstract
Objectives Endoscopic closures of mucosal defects following endoscopic resection can be challenging and time-consuming. The novel through-the-scope suture device has demonstrated acceptable closure times, but its learning curve is still unknown. This study aims to evaluate the number of cases required to achieve competency in this device. Methods Two endoscopists participated; a novice with less than 400 experiences in upper gastrointestinal endoscopy and an expert with over 500 experiences in endoscopic submucosal dissection. Neither endoscopist had previous exposure to the device. In four porcine models, 24 gastric mucosal defects, each 2-4 cm in diameter, were created by endoscopic mucosal resection with ligation. Each endoscopist performed endoscopic closure for 12 mucosal defects with a single through-the-scope suture device per lesion. The primary endpoint was the number of cases needed to reach competency, defined as achieving a procedure time below the average closure time reported in the literature. Secondary endpoints included procedure time, complete closure success rates, and incidence of adverse events. Results The mean defect size was 2.9 (±0.2) cm. Competency was achieved after six cases in the expert and seven cases in the novice. The median closure time was 9.0 (interquartile range [IQR]: 6.0-11.0) min for the expert and 8.0 (IQR: 6.2-9.7) min for the novice (p = 0.862). Complete closure success rates were 75.0% (n = 9) for the expert and 83.3% (n = 10) for the novice. No adverse events were reported. Conclusions A small number of cases were required for both expert and novice endoscopists to reach competency in the novel through-the-scope suture device.
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Affiliation(s)
- Mamoru Ito
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Akira Dobashi
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Takanori Tominaga
- Department of Gastroenterology and HepatologyThe Jikei University School of MedicineTokyoJapan
| | - Toshiki Futakuchi
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Naoto Tamai
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
| | - Machi Suka
- Department of Public Health and Environmental MedicineThe Jikei University School of MedicineTokyoJapan
| | - Kazuki Sumiyama
- Department of EndoscopyThe Jikei University School of MedicineTokyoJapan
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Fan X, Cai X, Jiao J, Luo L, Maihemuti A, Wang T, Chen X, Zheng Z, Liu W. Efficacy analysis of modified double band ligation-assisted endoscopic submucosal resection and endoscopic mucosal dissection in the treatment of gastric gastrointestinal stromal tumors (≤ 1.5 cm). Surg Endosc 2025; 39:2471-2480. [PMID: 39994050 DOI: 10.1007/s00464-025-11598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 01/29/2025] [Indexed: 02/26/2025]
Abstract
BACKGROUND Recently, the application of double band ligation-assisted endoscopic submucosal resection (ESMR-DL) in the resection of rectal endocrine tumors ≤ 10 mm has shown promising prospects. However, the use of ESMR-DL has not been reported for gastric gastrointestinal stromal tumors (gGISTs). In this study, we aimed to compare the application of modified ESMR-DL with ESD in gGISTs (≤ 1.5 cm). METHODS Data were retrospectively collected from 472 patients who underwent modified ESMR-DL or endoscopic submucosal dissection (ESD) for resection of gGISTs (≤ 1.5 cm). To overcome selection bias, a propensity score matching method was applied using four covariates for 1:1 matching: sex, age, tumor size, and tumor location. Clinical data, surgical status, and postoperative outcomes were compared between the two groups. RESULTS Of the 472 patients, 78 (16.5%) received modified ESMR-DL and 394 (83.5%) received ESD; after matching, there were 78 patients in each group. There was no statistical difference in the baseline characteristics between the two groups after matching (p > 0.05). Compared to ESD, modified ESMR-DL resulted in shorter operation time, time to a liquid diet and postoperative hospitalization time, but had a higher incidence of intraoperative perforation (p < 0.05). There was no significant difference in the R0 resection rate of tumors, incidence of postoperative complications, and average hospitalization costs between the two groups after matching (p > 0.05). Univariate and multivariate analyses showed that the maximum dimension of the lesion (7 mm increments) and the surgical method were factors affecting procedure time, and the maximum dimension of the lesion (7 mm increments) and operator (novice vs instructor) were factors affecting intraoperative perforation in modified ESMR-DL (P < 0.05). During the follow-up, there were no recurrences or metastases of gGISTs in either group. CONCLUSIONS Modified ESMR-DL is noninferior to ESD with a similar complete resection rate. In addition, modified ESMR-DL had shorter procedure time and hospitalization time.
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Affiliation(s)
- Xiaofei Fan
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Xiaohan Cai
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Jiao Jiao
- Department of Gastroenterology, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lili Luo
- Department of Geriatric, Tianjin Medical University General Hospital, Tianjin, China
| | - Ayixie Maihemuti
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Tao Wang
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Xin Chen
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Zhongqing Zheng
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China
| | - Wentian Liu
- Department of Gastroenterology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China.
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Kitagawa Y, Suzuki T, Miyakawa A, Okimoto K, Matsumura T, Shiratori T, Ishigami H, Mine T, Takashiro H, Saito H, Kato N. Comparison of endoscopic submucosal dissection and modified endoscopic mucosal resection for rectal neuroendocrine tumors. Sci Rep 2025; 15:5424. [PMID: 39948094 PMCID: PMC11825951 DOI: 10.1038/s41598-024-82082-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 12/02/2024] [Indexed: 02/16/2025] Open
Abstract
Although some studies have compared the treatment outcomes between modified endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs), the results are based on the experience of experts from a single high-volume center. This multicenter study aimed to compare the outcomes between m-EMR and ESD for rectal NETs, with emphasis on the operator's level. Data of patients with rectal NETs treated using m-EMR or ESD at seven institutions that included general hospitals in Japan were retrospectively reviewed. Patients treated using m-EMR and those treated using ESD were matched for age, sex, lesion size, lesion location, and operator level through propensity score matching. The treatment outcomes were compared between the two groups. In total 304 patients (m-EMR = 178, ESD = 126) were included, with 218 in the matched groups (m-EMR = 109, ESD = 109). The R0 resection rate was not significantly different between the two groups (90.0% vs. 82.3%, P = .221). However, the procedural time was significantly shorter for the m-EMR group than that for the ESD group (6 vs. 26 min, P < .001). No significant difference in adverse events was observed between the two groups (postprocedure bleeding rate: 5.5% vs. 2.8%, P = .335; perforation rate: 0.9% vs. 0.9%, P = 1.00). Subgroup analysis revealed that the R0 resection rate for the trainees was significantly higher in the m-EMR group than in the ESD group (87.9% vs. 64.5%, P = .017). m-EMR is the preferred technique for the treatment of rectal NETs and should be considered, particularly for the trainees.
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Affiliation(s)
- Yoshiyasu Kitagawa
- Endoscopy Division, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba, Japan.
| | - Takuto Suzuki
- Endoscopy Division, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba, Japan
| | - Akihiro Miyakawa
- Department of Gastroenterology, Asahi General Hospital, Chiba, Japan
| | | | | | | | - Hideaki Ishigami
- Department of Gastroenterology, Chiba Rosai Hospital, Chiba, Japan
| | - Takeshi Mine
- Department of Gastroenterology, Kimitsu Chuo Hospital, Chiba, Japan
| | - Hideyuki Takashiro
- Department of Gastroenterology, Chiba Kaihin Municipal Hospital, Chiba, Japan
| | - Hirofumi Saito
- Department of Gastroenterology, Chiba Kaihin Municipal Hospital, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Chiba University, Chiba, Japan
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Liu-Burdowski J, Park J. Treatment of Early Gastric Cancer. Surg Clin North Am 2025; 105:55-63. [PMID: 39523076 DOI: 10.1016/j.suc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Gastric cancer is a highly prevalent malignancy in Asia; however, its incidence is rising in the United States. Traditionally, methods of treatment include surgery and chemotherapy. Endoscopy has become an alternative method with a low recurrence rate when used to treat early gastric cancers. Endoscopic mucosal resection and endoscopic submucosal dissection are the 2 mainstay methods of endoscopy treatment. They are advantageous compared to surgery as they are less invasive and maintain anatomic integrity for the patient. However, lesion selection is crucial for success. In this article, the authors describe the 2 methods in detail in the treatment of early gastric cancers.
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Affiliation(s)
- Jennifer Liu-Burdowski
- Department of Gastroenterology, Danbury Hospital, Nuvance Health, 111 Osborne Street, Danbury, CT 06801, USA.
| | - Jiyoon Park
- Norwalk Hospital, Nuvance Health, 34 Maple Street, Norwalk, CT 06856, USA
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Yang D, Hasan MK, Jawaid S, Singh G, Xiao Y, Khalaf M, Tomizawa Y, Sharma NS, Draganov PV, Othman MO. Hybrid Versus Conventional Colorectal Endoscopic Submucosal Dissection: A Multicenter Randomized Controlled Trial (Short-Endoscopic Submucosal Dissection). Am J Gastroenterol 2024; 119:2436-2443. [PMID: 38912697 DOI: 10.14309/ajg.0000000000002897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION Hybrid endoscopic submucosal dissection (H-ESD), which utilizes ESD knife along with snare-based resection, has been developed to overcome the technical complexity of conventional ESD (C-ESD). The aim of this study was to compare the therapeutic outcomes of H-ESD vs C-ESD for nonpedunculated colorectal lesions ≥20 mm in size. METHODS We conducted a multicenter randomized controlled trial to compare H-ESD and C-ESD (Short-ESD trial). Patients with colorectal lesions between 20 and 50 mm in size were randomly assigned (1:1) to H-ESD or C-ESD. Primary outcome was procedure time/speed. Secondary outcomes were en bloc and complete (R0) resection rates and adverse event rates. RESULTS A total of 89 patients (median age 63 years; 49.3% women) with the median polyp size of 30 mm underwent H-ESD (n = 40) and C-ESD (n = 49). The mean procedure time of H-ESD was significantly shorter than that of C-ESD (41.1 ± 16.3 vs 54.3 ± 28.2 minutes; P = 0.007). The en bloc and R0 resection rates trended lower in the H-ESD vs C-ESD groups (77.5% vs 87.8%; P = 0.26% and 72.5% vs 79.6%; P = 0.46) without reaching statistical significance. Adverse event rate was similar between H-ESD and C-ESD (10% vs 8.2%; P = 1.00). DISCUSSION Both H-ESD and C-ESD were safe and effective for resection of large colorectal lesions. H-ESD was associated with a shorter procedure time. H-ESD may represent a viable alternative to C-ESD, with the main advantage being easy applicability of a snare-based technique for colorectal lesions. Future studies are needed to further define the most suitable lesions for H-ESD, as to optimize efficiency and safety without compromising resection outcomes. ClinicaTrials.gov NCT NCT05347446.
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Affiliation(s)
- Dennis Yang
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Muhammad K Hasan
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Salmaan Jawaid
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Gurdeep Singh
- Internal Medicine, AdventHealth Medical Group, Orlando, Florida, USA
| | - Yasi Xiao
- Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA
| | - Mai Khalaf
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Yutaka Tomizawa
- Division of Gastroenterology, University of Washington Harborview Medical Center, Seattle, Washington, USA
| | - Neil S Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA
| | - Mohamed O Othman
- Division of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
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Vongsavath T, Tun KM, Saghir SM, Bapaye J, Verma R, Lo CH, Gill A, Dhindsa BS, Chandan S, Adler DG. Efficacy and safety of over-the-scope endoscopic suturing device for closure of defects after endoscopic submucosal dissection: a systematic review and meta-analysis. IGIE 2024; 3:527-532.e2. [DOI: 10.1016/j.igie.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2025]
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Suzuki Y, Kikuchi D, Nakamura S, Iizuka T, Ochiai Y, Hayasaka J, Ueno M, Udagawa H, Hoteya S. Endoscopic submucosal dissection for superficial esophageal cancer in the remnant esophagus after esophagectomy. Dis Esophagus 2024; 37:doae070. [PMID: 39186312 DOI: 10.1093/dote/doae070] [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: 05/15/2024] [Revised: 07/30/2024] [Indexed: 08/27/2024]
Abstract
Treatment of esophageal cancer in the remnant esophagus after esophagectomy is highly invasive, therefore, early detection and minimally invasive treatment are considered necessary. Consequently, we aimed to clarify the safety and efficacy of endoscopic submucosal dissection (ESD) for residual esophageal cancer compared to that for esophageal cancer in a normal cervical esophagus. This study involved 47 patients with 59 residual esophageal cancers and 92 patients with 107 cervical esophageal cancers in normal esophagus who underwent ESD between January 2008 and December 2023. Their clinicopathological findings and long-term outcomes were retrospectively collected and evaluated. The median tumor diameter was 13 mm, and the median procedure time was 31 minutes in remnant esophagus group, with no significant difference between the two groups. No serious complications such as perforation, massive intraoperative bleeding, and pneumonia were observed in the remnant group, except for one case of postoperative bleeding. The rates of complete resection and disease specific survival were not significantly different between two groups, with complete resection rate of 86.4% and 5-year disease-specific survival rate of 95.7% in the remnant esophagus group. No local recurrence was observed during the median observation period of 43 months in the remnant esophagus group. ESD for superficial cancer of the remnant esophagus showed a high complete resection rate without serious complications and good local-regional control with no evidence of local recurrence. This indicates that ESD is a safe and useful treatment for superficial cancer of the remnant esophagus.
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Affiliation(s)
- Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Satoshi Nakamura
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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Löfdahl P, Edebo A, Wolving M, Bratlie SO. Endoscopic Resections for Barrett's Neoplasia: A Long-Term, Single-Center Follow-Up Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1074. [PMID: 39064503 PMCID: PMC11278854 DOI: 10.3390/medicina60071074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/12/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are both well-established and effective treatments for dysplasia and early cancer in Barrett's esophagus (BE). This study aims to compare the short- and long-term outcomes associated with these procedures in treating Barrett's neoplasia. Materials and Methods: This single-center retrospective cohort study included 95 patients, either EMR (n = 67) or ESD (n = 28), treated for Barrett's neoplasia at Sahlgrenska University Hospital between 2004 and 2019. The primary outcome was the complete (en-bloc) R0 resection rate. Secondary outcomes included the curative resection rate, additional endoscopic resections, adverse events, and overall survival. Results: The complete R0 resection rate was 62.5% for ESD compared to 16% for EMR (p < 0.001). The curative resection rate for ESD was 54% versus 16% for EMR (p < 0.001). During the follow-up, 22 out of 50 patients in the EMR group required additional endoscopic resections (AERs) compared to 3 out of 21 patients in the ESD group (p = 0.028). There were few adverse events associated with both EMR and ESD. In both the stratified Kaplan-Meier survival analysis (Log-rank test, Chi-square = 2.190, df = 1, p = 0.139) and the multivariate Cox proportional hazards model (hazard ratio of 0.988; 95% CI: 0.459 to 2.127; p = 0.975), the treatment group (EMR vs. ESD) did not significantly impact the survival outcomes. Conclusions: Both EMR and ESD are effective and safe treatments for BE neoplasia with few adverse events. ESD resulted in higher curative resection rates with fewer AERs, indicating its potential as a primary treatment modality. However, the survival analysis showed no difference between the methods, highlighting their comparable long-term outcomes.
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Affiliation(s)
- Per Löfdahl
- Department of Surgery, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden (S.O.B.)
| | - Anders Edebo
- Department of Surgery, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden (S.O.B.)
| | - Mats Wolving
- Department of Pathology, Sahlgrenska University Hospital, 413 46 Göteborg, Sweden
| | - Svein Olav Bratlie
- Department of Surgery, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden (S.O.B.)
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10
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Denzer UW. Endoscopic Resection of Malignancies in the Upper GI Tract: A Clinical Algorithm. Visc Med 2024; 40:116-127. [PMID: 38873624 PMCID: PMC11166903 DOI: 10.1159/000538040] [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: 11/21/2023] [Accepted: 02/25/2024] [Indexed: 06/15/2024] Open
Abstract
Background Malignancies in the upper gastrointestinal tract are amenable to endoscopic resection at an early stage. Achieving a curative resection is the most stringent quality criterion, but post-resection risk assessment and aftercare are also part of a comprehensive quality program. Summary Various factors influence the achievement of curative resection. These include endoscopic assessment prior to resection using chromoendoscopy and HD technology. If resectability is possible, it is particularly important to delineate the lateral resection margins as precisely as possible before resection. Furthermore, the correct choice of resection technique depending on the lesion must be taken into account. Endoscopic submucosal dissection is the standard for esophageal squamous cell carcinoma and gastric carcinoma. In Western countries, it is becoming increasingly popular to treat Barrett's neoplasia over 2 cm in size and/or with suspected submucosal infiltration with en bloc resection instead of piece meal resection. After resection, risk assessment based on the histopathological resection determines the patient's individual risk of lymph node metastases, particularly in the case of high-risk lesions. This is categorized according to the current literature. Key Messages This review presents clinical algorithms for endoscopic resection of esophageal SCC, Barrett's neoplasia, and gastric neoplasia. The algorithms include the pre-resection assessment of the lesion and the resection margins, the adequate resection technique for the respective lesion, as well as the post-resection risk assessment with an evidence-based recommendation for follow-up therapy and surveillance.
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Affiliation(s)
- Ulrike Walburga Denzer
- Section of Endoscopy, Department of Gastroenterology, University Hospital Marburg, Marburg, Germany
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11
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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Maan ADI, Sharma P, Koch AD. Curative criteria for endoscopic treatment of oesophageal adenocarcinoma. Best Pract Res Clin Gastroenterol 2024; 68:101886. [PMID: 38522884 DOI: 10.1016/j.bpg.2024.101886] [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: 08/28/2023] [Accepted: 01/23/2024] [Indexed: 03/26/2024]
Abstract
The incidence of oesophageal adenocarcinoma has been increasing rapidly in the Western world. A well-known risk factor for developing this type of tumour is reflux disease, which can cause metaplasia from the squamous cell mucosa to columnar epithelium (Barrett's Oesophagus) which can progress to dysplasia and eventually adenocarcinoma. With the rise of the incidence of oesophageal adenocarcinoma, research on the best way to manage this disease is of great importance and has changed treatment modalities over the last decades. The gold standard for superficial adenocarcinoma has shifted from surgical to endoscopic management when certain criteria are met. This review will discuss the different curative criteria for endoscopic treatment of oesophageal adenocarcinoma.
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Affiliation(s)
- Annemijn D I Maan
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, University of Kansas and VA Medical Centre, 4801 E Linwood Blvd, Kansas City, USA.
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
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Bomman S, Klair JS, Canakis A, Muthusamy AK, Nagra N, Chandra S, Shanmugam M, Perisetti A, Aggarwal A, Gavini HK, Krishnamoorthi R. Safety and Efficacy of Endoscopic Full Thickness Resection of Upper Gastrointestinal Lesions Using a Full Thickness Resection Device: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:46-52. [PMID: 36730483 DOI: 10.1097/mcg.0000000000001803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/17/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) is a promising technique that allows for a minimally invasive resection of mucosal and submucosal lesions in the gastrointestinal (GI) tract. The data regarding the efficacy and safety of performing EFTR of upper GI lesions using a full-thickness resection device (FTRD) is limited. Hence, we performed a systematic review and meta-analysis of the studies that evaluated this technique. METHODS We performed a comprehensive systematic search of multiple electronic databases and conference proceedings that reported outcomes of EFTR using the FTRD system. The weighted pooled rates of technical success, complete (R0) resection, adverse events (AE), and residual or recurrent lesions were analyzed with 95% CI using the random effects model. RESULTS Eight studies with a total of 139 patients who underwent EFTR of upper GI lesions were included in the study. The pooled, weighted rate of technical success was 88.2% (95% CI: 81.4-92.7%, I2 : 0). The R0 resection rate was 70.7% (95% CI: 62.5-77.8%, I2 : 0). Overall AE rates were 22.1% (95% CI: 15.8-30.1%, I2 : 0), however, most of the AEs were minor. Of the patients who had follow-up endoscopies, the residual and/or recurrent lesion rate was 6.1% (95% CI: 2.4-14.4%, I2 : 0). Heterogeneity in the analysis was low. CONCLUSIONS EFTR using the FTRD seems to be effective and safe with acceptable R0 resection rates and low recurrence rates. Further prospective studies are required to validate our results and to compare various modalities of endoscopic resection with this single-step EFTR device.
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Affiliation(s)
| | - Jagpal S Klair
- Center for Digestive Health, Virginia Mason Franciscan Health
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | | | - Navroop Nagra
- Division of Gastroenterology and Hepatology, University of Louisville School of Medicine, Louisville, KY
| | - Shruti Chandra
- Division of Gastroenterology, Mayo Clinic, Rochester, MN
| | | | | | - Avin Aggarwal
- Division of Gastroenterology and Hepatology, University of Arizona, Tucson, AZ
| | - Hemanth K Gavini
- Division of Gastroenterology and Hepatology, University of Arizona, Tucson, AZ
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Yamaguchi H, Fukuzawa M, Kawai T, Muramatsu T, Matsumoto T, Uchida K, Koyama Y, Madarame A, Morise T, Kono S, Naito S, Nagata N, Sugimoto M, Itoi T. Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases. Clin Endosc 2023; 56:778-789. [PMID: 37491992 PMCID: PMC10665627 DOI: 10.5946/ce.2022.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND/AIMS Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). METHODS We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. RESULTS Resection time was significantly shorter in the following order: RH-ESD (149 [90-197] minutes) >C-ESD (90 [60-140] minutes) >SH-ESD (52 [29-80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%-30%]) than in the en bloc resection group (40% [20%-60%]). CONCLUSION RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.
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Affiliation(s)
- Hayato Yamaguchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Kawai
- Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takahiro Muramatsu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Taisuke Matsumoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kumiko Uchida
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yohei Koyama
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Akira Madarame
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Morise
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shin Kono
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Sakiko Naito
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Naoyoshi Nagata
- Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
| | | | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Nishimura Y, Ono M, Okubo N, Sone T, Higashino M, Matsumoto S, Kubo M, Yamamoto K, Ono S, Ohnishi S, Sakamoto N. Application of polyglycolic acid sheets and basic fibroblast growth factor to prevent esophageal stricture after endoscopic submucosal dissection in pigs. J Gastroenterol 2023; 58:1094-1104. [PMID: 37635203 PMCID: PMC10590298 DOI: 10.1007/s00535-023-02032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/05/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has been the first-line treatment for early-stage esophageal cancer. However, it often causes postoperative stricture in cases requiring wide dissection. Basic fibroblast growth factor (bFGF) reportedly has anti-scarring effects during cutaneous wound healing. We hypothesized that suppressing myofibroblast activation will prevent stricture after esophageal ESD. METHODS We resected a complete porcine esophagus circumference section by ESD. To investigate the preventive effect of bFGF on esophageal stricture formation after ESD, we endoscopically applied bFGF-soaked poly-glycolic acid (PGA) sheets onto the wound bed after ESD and fixed them by spraying fibrin glue (PGA + bFGF group), PGA sheets alone onto the wound bed and fixed them by spraying fibrin glue (PGA group), or nothing (control group). After removing the esophagus on day 22, we evaluated the mucosal constriction rate. RESULTS Compared with those in the control group, esophageal stricture was significantly reduced in the PGA + bFGF group, and the areas stained with α-SMA and calponin-1 antibodies were significantly inhibited in the PGA + bFGF and PGA groups. The thickness of the fibrous layer in the PGA + bFGF group was uniform compared to that of the other groups. Thus, PGA + bFGF inhibited the development of unregulated fibroblasts in the acute phase, leading to uniform wound healing. CONCLUSIONS Stenosis after esophageal ESD is related to fibrosis in the acute phase. Administration of PGA and bFGF suppresses myofibroblast activation in the acute phase, thereby preventing esophageal constriction in pigs.
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Affiliation(s)
- Yusuke Nishimura
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-14-Jo Nishi-5-Chome Kita-Ku Sapporo, Hokkaido, 060-8648, Japan
| | - Masayoshi Ono
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-14-Jo Nishi-5-Chome Kita-Ku Sapporo, Hokkaido, 060-8648, Japan.
| | - Naoto Okubo
- Laboratory of Molecular and Cellular Medicine, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Takayuki Sone
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-14-Jo Nishi-5-Chome Kita-Ku Sapporo, Hokkaido, 060-8648, Japan
| | - Masayuki Higashino
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-14-Jo Nishi-5-Chome Kita-Ku Sapporo, Hokkaido, 060-8648, Japan
| | - Shogo Matsumoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-14-Jo Nishi-5-Chome Kita-Ku Sapporo, Hokkaido, 060-8648, Japan
| | - Marina Kubo
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-14-Jo Nishi-5-Chome Kita-Ku Sapporo, Hokkaido, 060-8648, Japan
| | - Keiko Yamamoto
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Shoko Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Shunsuke Ohnishi
- Laboratory of Molecular and Cellular Medicine, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-14-Jo Nishi-5-Chome Kita-Ku Sapporo, Hokkaido, 060-8648, Japan
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Yin Z, Li J, Yang W, Huang W, Xu D, Lei X, Zhang J. Underwater Endoscopic Mucosal Resection Versus Conventional Endoscopic Mucosal Resection for Superficial Non-ampullary Duodenal Epithelial Tumors ≤20 mm: A Systematic Review With Meta-analysis. J Clin Gastroenterol 2023; 57:928-936. [PMID: 36084162 DOI: 10.1097/mcg.0000000000001763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/10/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Underwater endoscopic mucosal resection (UEMR) is increasingly applied in the treatment of superficial non-ampullary duodenal epithelial tumors (SNADETs). This meta-analysis aimed to assess the efficacy and safety of UEMR for SNADETs ≤20 mm in comparison with conventional endoscopic mucosal resection (CEMR). METHODS The following electronic databases were searched from 2012 until November 20, 2021: PubMed, Embase, Scopus, Web of Science databases, and Cochrane Library. The primary outcomes were the rates of en bloc resection and complete (R0) resection, and the secondary outcomes were procedure time, adverse events (delayed bleeding and delayed perforation), and recurrence rate. RESULTS A total of 6 studies with 679 lesions (331 underwent UEMR and 348 CEMR) were included in this study. The pooled analysis showed that UMER achieves a similar en bloc resection rate (87.6 vs. 89.9%; odds ratio [OR], 1.29; 95% confidence interval [CI], 0.45 to 3.73; P =0.64; I2 =74%), a similar R0 resection rate (67.3 vs. 73.6%; OR, 1.11; 95% CI, 0.55 to 2.23; P =0.78; I2 =59%), a shorter procedure time (min) (mean difference [MD], -4.05, 95% CI: -6.40 to -1.71; P =0.0007; I2 =70%) compared with CEMR. There were no significant differences in the rates of delayed bleeding, delayed perforation, and recurrence (2.4 vs. 1.7%, 0 vs. 0.6%, 2.2 vs. 4.4%, respectively). CONCLUSION This meta-analysis demonstrated that UEMR appears to be an effective and safe alternative to CEMR for SNADETs ≤20 mm.
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Affiliation(s)
- Zhikun Yin
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian
- Department of Gastroenterology
| | - Ji Li
- Department of Gastroenterology
| | - Weilin Yang
- Endoscopy center, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | | | - Dong Xu
- Department of Gastroenterology
| | | | - Jinyan Zhang
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian
- Department of Gastroenterology
- Endoscopy center, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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17
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Wang N, Shu L, Liu S, Yang L, Bai T, Shi Z, Liu X. Comparing endoscopic mucosal resection with endoscopic submucosal dissection in colorectal adenoma and tumors: Meta-analysis and system review. PLoS One 2023; 18:e0291916. [PMID: 37768914 PMCID: PMC10538725 DOI: 10.1371/journal.pone.0291916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/07/2023] [Indexed: 09/30/2023] Open
Abstract
AIMS This study aimed to evaluate the safety, efficacy, and long-term outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for treating colorectal adenomas and tumors. METHODS A systematic literature review was conducted using databases including PubMed, Web of Science, and Embase. Parameters such as number of patients or lesions, histological diagnosis, lesion size, surgery time, en-bloc resection, R0 resection, severe postoperative complications, and local recurrence were extracted and pooled for analysis. RESULTS A total of 12 retrospective studies involving 1289 patients and 1850 lesions were included in the analysis. EMR was found to have a shorter operation time by 53.6 minutes (95% CI: 51.3, 55.9, P<0.001) and fewer incidences of severe postoperative complications such as perforation and delayed bleeding (OR = 0.40, 95%CI: 0.23, 0.71, P<0.001). On the other hand, ESD had higher rates of en-bloc resection (OR = 0.15, 95%CI: 0.07, 0.30, P<0.001) and R0 resection (OR = 0.32, 95%CI: 0.16, 0.65, P<0.001). Recurrence after EMR was found to be significantly higher than that after ESD surgery (OR = 5.88, 95%CI: 2.15, 16.07, P = 0.037). CONCLUSIONS The study suggests that the choice of surgical method may have a greater impact on recurrence compared to the pathological type, and that ESD may be more suitable for the treatment of malignant lesions despite its higher rates of severe postoperative complications and longer operation time.
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Affiliation(s)
- Nian Wang
- Division of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, China
| | - Lei Shu
- Division of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, China
| | - Song Liu
- Division of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, China
| | - Lin Yang
- Division of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaohong Shi
- Division of Gastroenterology, Wuhan No. 1 Hospital, Wuhan, China
| | - Xinghuang Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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18
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Steinbrück I, Faiss S, Dumoulin FL, Oyama T, Pohl J, von Hahn T, Schmidt A, Allgaier HP. Predictive Factors for the Outcome of Unsupervised Endoscopic Submucosal Dissection During the Initial Learning Curve with Prevalence-Based Indication. Dig Dis Sci 2023; 68:3614-3624. [PMID: 37421512 DOI: 10.1007/s10620-023-08026-9] [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: 02/11/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND For an adequate educational strategy of ESD in non-Asian settings with prevalence-based indication it is essential to define adequate lesions, suitable for the beginner without on-site expert-supervision. AIMS We analyzed possible predictors for outcome parameters of effectiveness and safety during the initial learning curve. METHODS The first 120 ESDs of four operators (n = 480), performed between 2007 and 2020 in four tertiary hospitals, were enrolled. Uni-/multivariable regression analysis was done with sex, age, pretreated lesion, lesion size, organ, and organ-based localization as possible independent predictors for en bloc resection (EBR), complication, and resection speed. RESULTS Rates of EBR, complication, and resection speed were 84.5%, 14.2%, and 6.20 (± 4.45) cm2/h. Independent predictors for EBR were pretreated lesion (OR 0.27 [0.13-0.57], p < 0.001) and non-colonic ESD (OR 2.29 [1.26-4.17] (rectum)/5.72 [2.36-13.89] (stomach)/7.80 [2.60-23.42] (esophagus), p < 0.001), for complication pretreated lesion (OR 3.04 [1.46-6.34], p < 0.001) and lesion size (OR 1.02 [1.004-1.04], p = 0.012) and for resection speed pretreated lesion (RC - 3.10 [- 4.39 to - 1.81], p < 0.001), lesion size (RC 0.13 [0.11-0.16], p < 0.001) and male patient (RC - 1.11 [- 1.85 to - 0.37], p < 0.001). We found no significant difference in the incidence of technically unsuccessful resections in esophageal (1/84), gastric (3/113), rectal (7/181), and colonic (3/101) ESDs (p = 0.76). Technical failure was mainly caused by complication and fibrosis/pretreatment. CONCLUSION During the initial learning curve of an unsupervised ESD program with prevalence-based indication, pretreated lesions and colonic ESDs should be avoided. In contrast, lesion size and organ-based localizations have less predictive value for the outcome.
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Affiliation(s)
- Ingo Steinbrück
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital of University of Freiburg, Wirthstraße 11, 79110, Freiburg, Germany.
| | - Siegbert Faiss
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Academic Teaching Hospital of University of Berlin, Fanningerstraße 32, 10365, Berlin, Germany
| | - Franz Ludwig Dumoulin
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic teaching Hospital of University of Bonn, Prinz-Albert-Straße 40, 53113, Bonn, Germany
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 3850051, Japan
| | - Jürgen Pohl
- Department of Gastroenterology, Asklepios Klinik Altona, Academic Teaching Hospital of University of Hamburg, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endoscopy, Asklepios Klinik Barmbek, Academic Teaching Hospital of University of Hamburg, Rübenkamp 220, 22307, Hamburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Hans-Peter Allgaier
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital of University of Freiburg, Wirthstraße 11, 79110, Freiburg, Germany
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Keihanian T, Zabad N, Khalaf M, Abdel-Jaber W, Kim YI, Jawaid SA, Abidi WM, Marginean EC, Othman MO. Safety and efficacy of a novel suturing device for closure of large defects after endoscopic submucosal dissection (with video). Gastrointest Endosc 2023; 98:381-391. [PMID: 37061137 DOI: 10.1016/j.gie.2023.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/14/2023] [Accepted: 04/08/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND AIMS Endoscopic suturing enables full closure of large defects after endoscopic submucosal dissection (ESD). However, its use is limited by the need for a double-channel endoscope. A novel closure system, the OverStitch Sx (Apollo Endosurgery, Austin, Tex, USA), compatible with any single-channel endoscope, was introduced to address these shortcomings. The aim of this study was to assess the safety and feasibility of OverStitch Sx for the closure of large defects after ESD. METHODS This is a prospective single-center feasibility study of patients who underwent closure of large defects after ESD using the OverStitch Sx system. Main outcomes of the study are technical and clinical success, same-day discharge rate, and adverse event rate. RESULTS Thirty-three patients were enrolled. The mean diameter of included lesions was 5.38 ± 2.52 cm. The defect occupied ≥50% of the lumen circumference in 70% of the cases. En-bloc resection, R0 resection, and curative resection were achieved in 97%, 87.5%, and 78.8% of patients, respectively. Technical success and clinical success were seen in 93.9% and 90.9% of the cases, respectively. Same-day hospital discharge was achieved in 77.4% of patients. Total adverse event rate was 35.7%, including delayed bleeding in 1 patient after rectal ESD that was managed conservatively, self-resolving rectal pain in 7 patients, rectal stricture requiring dilation in 1 patient, and temporary dysphagia in 1 patient. No immediate or delayed perforation was reported. CONCLUSIONS OverStitch Sx enabled safe and effective closure of large defects after ESD. Future trials are needed to determine its superiority over OverStitch for the closure of defects in challenging locations. (Clinical trial registration number: NCT04361227.).
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Affiliation(s)
| | - Noor Zabad
- Department of Medicine, Division of Gastroenterology
| | - Mai Khalaf
- Department of Medicine, Division of Gastroenterology
| | | | - Young-Il Kim
- Department of Medicine, Division of Gastroenterology
| | | | - Wasif M Abidi
- Department of Medicine, Division of Gastroenterology
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Hayat M, Schlachterman A, Schiavone G, Mizrahi M, Park JK, Kumbhari V, Cheesman A, Draganov PV, Hasan MK, Yang D. Initial multicenter experience using a novel articulating through-the-scope traction device for endoscopic submucosal dissection. Endosc Int Open 2023; 11:E778-E784. [PMID: 37593157 PMCID: PMC10431969 DOI: 10.1055/a-2117-8444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023] Open
Abstract
Background and study aims A single-operator, articulating, through-the-scope (TTS) traction device was recently developed to facilitate endoscopic submucosal dissection (ESD). Clinical data on the performance of this device are limited. We report an initial multicenter experience with ESD using this articulating TTS traction device. Patients and methods Retrospective analysis on all consecutive patients who underwent ESD using this traction device (T-ESD) at five centers between August 2021 and December 2022. Endpoints included: rates of en-bloc resection, R0 resection, curative resection, and adverse events. Results Thirty-six patients (median age 64.8 years; 47.2% women) underwent ESD (median lesion size 40 mm; interquartile range [IRQ]: 27.5-67.5) for lesions in the esophagus (n=2), stomach (n=8), sigmoid colon (n=6), and rectum (n=20). Submucosal fibrosis was encountered in one-third of the lesions (33.3%). Median ESD time was 104.6 minutes (IQR: 65-122). En-bloc, R0 and curative resection were achieved in 94.4%, 91.6%, and 97.2%, respectively. The single patient with non-curative resection of an invasive rectal adenocarcinoma underwent surgery. There were no cases of delayed bleeding or perforation. There was no recurrence on surveillance endoscopy (n=20) at a median of 6 months (IQR: 3.75-6). Conclusions This initial multicenter experience demonstrates high resection rates and excellent safety profile when performing ESD with this novel articulating TTS device. Dynamic real-time traction may lower the technical difficulty of ESD. Additional studies are needed to assess its cost-effectiveness and compare its usefulness with other traction devices and techniques during ESD.
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Affiliation(s)
- Maham Hayat
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Alexander Schlachterman
- Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, United States
| | - Grace Schiavone
- Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, United States
| | - Meir Mizrahi
- Gastroenterology, Florida Center for Gastroenterology, Key Largo, United States
| | - Jong Kyu Park
- Gastroenterology, Mayo Clinic in Florida, Jacksonville, United States
| | - Vivek Kumbhari
- Gastroenterology, Mayo Clinic in Florida, Jacksonville, United States
| | | | - Peter V Draganov
- Medicine/Gastroenterology, University of Florida, Gainesville, United States
| | - Muhammad Khalid Hasan
- Center for Interventional Endoscopy, Florida Hospital Orlando, Orlando, United States
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
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Authors, und die Mitarbeiter der Leitlinienkommission, Collaborators:. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Sugimoto M, Murata M, Kawai T. Assessment of delayed bleeding after endoscopic submucosal dissection of early-stage gastrointestinal tumors in patients receiving direct oral anticoagulants. World J Gastroenterol 2023; 29:2916-2931. [PMID: 37274799 PMCID: PMC10237096 DOI: 10.3748/wjg.v29.i19.2916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/03/2023] [Accepted: 04/24/2023] [Indexed: 05/16/2023] Open
Abstract
Delayed bleeding is a major and serious adverse event of endoscopic submucosal dissection (ESD) for early-stage gastrointestinal tumors. The rate of post-ESD bleeding for gastric cancer is higher (around 5%-8%) than that for esophagus, duodenum and colon cancer (around 2%-4%). Although investigations into the risk factors for post-ESD bleeding have identified several procedure-, lesion-, physician- and patient-related factors, use of antithrombotic drugs, especially anticoagulants [direct oral anticoagulants (DOACs) and warfarin], is thought to be the biggest risk factor for post-ESD bleeding. In fact, the post-ESD bleeding rate in patients receiving DOACs is 8.7%-20.8%, which is higher than that in patients not receiving anticoagulants. However, because clinical guidelines for management of ESD in patients receiving DOACs differ among countries, it is necessary for endoscopists to identify ways to prevent post-ESD delayed bleeding in clinical practice. Given that the pharmacokinetics (e.g., plasma DOAC level at both trough and Tmax) and pharmacodynamics (e.g., anti-factor Xa activity) of DOACs are related to risk of major bleeding, plasma DOAC level and anti-FXa activity may be useful parameters for monitoring the anti-coagulate effect and identifying DOAC patients at higher risk of post-ESD bleeding.
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Affiliation(s)
- Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo 160-0023, Japan
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23
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Keating E, Bennett G, Murray MA, Ryan S, Aird J, O'Connor DB, O'Toole D, Lahiff C. Rectal neuroendocrine tumours and the role of emerging endoscopic techniques. World J Gastrointest Endosc 2023; 15:368-375. [PMID: 37274556 PMCID: PMC10236980 DOI: 10.4253/wjge.v15.i5.368] [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: 02/03/2023] [Revised: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023] Open
Abstract
Rectal neuroendocrine tumours represent a rare colorectal tumour with a 10 fold increased prevalence due to incidental detection in the era of colorectal screening. Patient outcomes with early diagnosis are excellent. However endoscopic recognition of this lesion is variable and misdiagnosis can result in suboptimal endoscopic resection with subsequent uncertainty in relation to optimal long-term management. Endoscopic techniques have shown particular utility in managing this under-recognized neuroendocrine tumour.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gayle Bennett
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Michelle A Murray
- School of Medicine, University College Dublin, Dublin 4, Ireland
- National Lung Transplant Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sinead Ryan
- Department of Pathology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John Aird
- School of Medicine, University College Dublin, Dublin 4, Ireland
- Department of Pathology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Dermot O'Toole
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Department of Clinical Medicine and Gastroenterology, St. James Hospital, Dublin 8, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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24
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Park JY, Kim MS, Kim BJ, Kim JG. A 6-year nationwide population-based study on the current status of gastric endoscopic resection in Korea using administrative data. Sci Rep 2023; 13:7203. [PMID: 37137946 PMCID: PMC10156708 DOI: 10.1038/s41598-023-34215-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/26/2023] [Indexed: 05/05/2023] Open
Abstract
Gastric endoscopic resection (ER) is widely performed in Korea. This study aimed to investigate the overall status of gastric ER in Korea. We enrolled ESD or EMR cases performed for gastric cancer and adenoma from 2012 to 2017 by searching the NHIS database. The annual trend of gastric ER and the clinical characteristics were investigated. Institutions were classified into very high-, high-, low-, and very low volume centers (VHVC, HVC, LVC, and VLVC) by the procedure numbers, and institutional types, regional distributions, and medical resources were investigated accordingly. There were 175,370 ER cases during the study period, with an increasing trend over time. The average annual ESD procedure numbers were 3.9, 54.5, 249.5, and 540.3 cases in 131 VLVCs, 119 LVCs, 24 HVCs, and 12 VHVCs, respectively. Among ESD-performing institutions, 44.8% were located in the Seoul Capital Area. The distribution of medical resources showed a positive correlation with the procedural volume. Similar tendencies were also demonstrated in EMR, with some differences in hospital types and regional distribution. Gastric ER and ESD are increasing in Korea. There was a significant variance in the number of ER procedures and the distribution of types, regions, and medical resources according to the procedural volume.
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Affiliation(s)
- Jae Yong Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea
- Biomedical Research Institute, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Mi-Sook Kim
- Division of Clinical Epidemiology, Medical Research Collaborating Center, Biomedical Research Institution, Seoul National University Hospital, Seoul, Republic of Korea
| | - Beom Jin Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea
| | - Jae Gyu Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea.
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25
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Wang ZJ, Lv XH, Yang JL. Methodological Issues to Be Considered in Evaluating Advanced Endoscopic Resection Techniques in Cirrhosis. Dig Dis Sci 2023; 68:699-700. [PMID: 36538277 DOI: 10.1007/s10620-022-07767-3] [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: 02/12/2022] [Accepted: 05/03/2022] [Indexed: 02/09/2023]
Affiliation(s)
- Zi-Jing Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiu-He Lv
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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26
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Gao SG, Qi ZP, Qi YJ, Hou YY, Liu YW, Li MX, Li B, Sun D, Shi Q, Cai SL, Zhou PH, Zhong YS. Porphyromonas gingivalis predicts local recurrence after endoscopic submucosal dissection of early esophageal squamous cell carcinoma or precancerous lesion. BMC Cancer 2023; 23:43. [PMID: 36635649 PMCID: PMC9837911 DOI: 10.1186/s12885-022-10469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Porphyromonas gingivalis plays an oncogenic role in development and progression of esophageal squamous cell carcinoma (ESCC). However, the impact of P. gingivalis on local recurrence of early ESCC or precancerous lesion after ESD treatment remains unknown. The present study aimed to evaluate the impact of P. gingivalis on local recurrence after ESD treatment of early ESCC or high-grade dysplasia (HGD). METHODS The amount of P. gingivalis was assessed by immunohistochemistry in 205 patients with early ESCC or HGD. Univariate and multivariate Cox regression analyses were performed to determine the effect of P. gingivalis on local recurrence. Propensity score matching analysis was performed to reduce the imbalance of baseline characteristics. A nomogram integrating significant prognostic factors was built for local recurrence prediction. RESULTS The amount of P. gingivalis increased significantly in neoplasms that invaded up to muscularis mucosa and submucosa compared with lesions confined to epithelium or lamina propria. Overabundance of P. gingivalis was positively associated with invasion depth, post-ESD stricture and local recurrence. Univariate and multivariate Cox regression analyses revealed that P. gingivalis, longitudinal length of lesion and lymphovascular invasion were independent predictors for post-ESD recurrence. A nomogram comprising P. gingivalis, lymphovascular involvement, and lesion length performed well for prediction of post-ESD local recurrence with the concordance indices of 0.72 (95%CI, 0.62 to 0.80), 0.72 (95%CI, 0.63 to 0.80), and 0.74 (95%CI, 0.65 to 0.83) in the validation cohort, the entire cohort, and the subcohort after PSM, respectively. CONCLUSION P. gingivalis overabundance is a risk factor and a potential predictor for local recurrence of early ESCC or HGD after ESD treatment. Thus, clearance of P. gingivalis represents an attractive strategy for prognosis improvement and for prevention of ESCC.
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Affiliation(s)
- She-Gan Gao
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Henan Key Laboratory of Microbiome and Esophageal Cancer Prevention and Treatment, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, 471003, Luoyang, China.
| | - Zhi-Peng Qi
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Henan Key Laboratory of Microbiome and Esophageal Cancer Prevention and Treatment, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, 471003, Luoyang, China
- Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China
- Endoscopy Research Institute of Fudan University, 200032, Shanghai, China
| | - Yi-Jun Qi
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Henan Key Laboratory of Microbiome and Esophageal Cancer Prevention and Treatment, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, 471003, Luoyang, China
| | - Ying-Yong Hou
- Department of Pathology, Zhongshan Hospital of Fudan University, 200032, Shanghai, China
| | - Yi-Wen Liu
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Henan Key Laboratory of Microbiome and Esophageal Cancer Prevention and Treatment, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, 471003, Luoyang, China
| | - Meng-Xiang Li
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Henan Key Laboratory of Microbiome and Esophageal Cancer Prevention and Treatment, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, 471003, Luoyang, China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China
- Endoscopy Research Institute of Fudan University, 200032, Shanghai, China
| | - Di Sun
- Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China
- Endoscopy Research Institute of Fudan University, 200032, Shanghai, China
| | - Qiang Shi
- Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China
- Endoscopy Research Institute of Fudan University, 200032, Shanghai, China
| | - Shi-Lun Cai
- Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China
- Endoscopy Research Institute of Fudan University, 200032, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China
- Endoscopy Research Institute of Fudan University, 200032, Shanghai, China
| | - Yun-Shi Zhong
- State Key Laboratory of Esophageal Cancer Prevention & Treatment, Henan Key Laboratory of Microbiome and Esophageal Cancer Prevention and Treatment, Henan Key Laboratory of Cancer Epigenetics, Cancer Hospital, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, 471003, Luoyang, China.
- Endoscopy Center, Zhongshan Hospital of Fudan University, 200032, Shanghai, China.
- Endoscopy Research Institute of Fudan University, 200032, Shanghai, China.
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27
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Burdyukov M, Petrov S, Kuvaev R, Vidyaeva N, Alekseev A, Nikonov E, Duvansky V, Korzheva I, Pirogov S, Prikhodchenko A, Filin A. Upper endoscopy complications: a discussion of the informed consent form by the Association of Expert Physicians in the Quality of Medical Care. DOKAZATEL'NAYA GASTROENTEROLOGIYA 2023; 12:49. [DOI: 10.17116/dokgastro20231201149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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28
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Zhang Y, Wen J, Zhang S, Liang X, Ren L, Wang L, Sun Y, Li S, Wang K, Lv S, Qiao X. Clinical study of submucosal tunneling endoscopic resection and endoscopic submucosal dissection in the treatment of submucosal tumor originating from the muscularis propria layer of the esophagus. Medicine (Baltimore) 2022; 101:e32380. [PMID: 36595766 PMCID: PMC9794317 DOI: 10.1097/md.0000000000032380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Herein, we aimed to evaluate the clinical value and safety of transendoscopic submucosal tunnel tumor resection (STER) and endoscopic submucosal dissection (ESD) for the resection of esophageal submucosal intrinsic muscle tumors. We retrospectively analyzed the clinical data of 68 patients with esophageal submucosal intrinsic muscle tumors treated with STER (STER group, n = 38, March 2018 to January 2020) or ESD (ESD group, n = 30, January 2017 to January 2020) at the First People's Hospital of Lianyungang to compare the treatment efficacy, hospitalization time and costs, and postoperative complications between the 2 groups. All 68 cases were of single lesions. The mean operative duration was shorter in the STER group (53.39 ± 11.57 min) than in the ESD group (68.33 ± 18.52 min, P < .05). The postoperative hospital stay duration was significantly shorter in the STER group (5.86 ± 1.01 days; P < .05) than in the ESD group (8.2 ± 3.4 days, P < .05). The mean hospitalization cost was significantly lower in the STER group than in the ESD group (12,468.8 + 4966.8 yuan vs 17,033.3 ± 4547.2 yuan; P < .05). Only 1 case of intraoperative perforation occurred in ESD group. There were no other complications in both groups. The wound healed in both groups, and no residual or recurrent tumors were detected during the follow-up period. Both STER and ESD can be used for the treatment of esophageal intrinsic muscular layer (MP) tumors, and STER is safer and more efficient for lesions with a diameter <3.5 cm.
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Affiliation(s)
- Yue Zhang
- Jinzhou Medical University, Jiangsu, China
| | - Jing Wen
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Shuxian Zhang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xuyang Liang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Ling Ren
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Lu Wang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Yunliang Sun
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Shouying Li
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Kun Wang
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Shengxiang Lv
- Department of Gastroenterology, Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- * Correspondence: Shengxiang Lv, Department of Gastroenterology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang 222000, China (e-mail: ) and Xiao Qiao, Department of Gastroenterology, Huai'an Hospital, Xuzhou Medical University, Huai'an, Jiangsu 223002, China (e-mail: )
| | - Xiao Qiao
- Department of Gastroenterology, Huai’an Hospital of Xuzhou Medical University, Jiangsu, China
- * Correspondence: Shengxiang Lv, Department of Gastroenterology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No. 6 Zhenhua East Road, Lianyungang 222000, China (e-mail: ) and Xiao Qiao, Department of Gastroenterology, Huai'an Hospital, Xuzhou Medical University, Huai'an, Jiangsu 223002, China (e-mail: )
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29
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Learning curve of endoscopic submucosal dissection (ESD) with prevalence-based indication in unsupervised Western settings: a retrospective multicenter analysis. Surg Endosc 2022; 37:2574-2586. [PMID: 36344898 DOI: 10.1007/s00464-022-09742-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS As there is still no consensus about the adequate training strategy for ESD in Western countries, we evaluated unsupervised prevalence-based learning curves including detailed organ-specific subgroup analysis. METHODS The first 120 ESDs of four operators (n = 480) were divided into three groups (1: ESD 1-40, 2: ESD 41-80, 3: ESD 81-120). Outcome parameters were rates of technical success, en bloc and R0 resection, the resection speed, rates of conversion to EMR, curative resection, adverse events, surgery due to adverse events, and recurrence. In addition, we analyzed the achievement of quality benchmarks indicating levels of expertise. RESULTS After exclusion of pretreated lesions, 438 procedures were enrolled in the final analysis. Technical success rates were > 96% with significant improvements regarding rate of en bloc resection (from 82.6 to 91.2%), resection speed (from 4.54 to 7.63 cm2/h), and rate of conversion to EMR (from 22.0 to 8.1%). No significant differences could be observed for rates of R0 resection (65.9 vs. 69.6%), curative resection (55.8 vs. 55.7%), adverse events (16.3 vs. 11.7%), surgery due to adverse events (1.5 vs. 1.3%), and recurrence (12.5 vs. 4.5%). Subgroup and benchmark analysis revealed an improvement in esophageal, gastric, and rectal ESD with achievement of competence levels for the esophagus and stomach within 80 and most of the benchmarks for proficiency level within 120 procedures. Some of the benchmarks could also be achieved in rectal ESD. CONCLUSIONS This trial confirms safety and feasibility of unsupervised ESD along the initial learning curve with prevalence-based indication and exclusion of colonic cases.
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30
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Yang D, Aihara H, Hasan MK, Simsek C, Khan H, Brar TS, Gorrepati VS, Forde JJ, Kadkhodayan K, Arain MA, Draganov PV. Novel single-operator through-the-scope traction device for endoscopic submucosal dissection: Outcomes of a multicenter randomized pilot ex-vivo study in trainees with limited endoscopic submucosal dissection experience (with video). DEN OPEN 2022; 3:e174. [PMID: 36247316 PMCID: PMC9549878 DOI: 10.1002/deo2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/14/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
Objectives Endoscopic submucosal dissection is a technically demanding procedure. The pilot study aimed to prospectively evaluate the efficacy and safety of a novel single‐operator through‐the‐scope dynamic traction device among trainees with limited endoscopic submucosal dissection (ESD) experience. Methods Randomized, controlled, pilot study comparing traction‐assisted ESD (T‐ESD) versus conventional ESD (C‐ESD) in an ex‐vivo porcine stomach model. Trainees were randomized to group 1 (T‐ESD followed by C‐ESD) and group 2 (C‐ESD followed by T‐ESD). Lesions were created on the gravity‐dependent area of the stomachs. The primary outcome was submucosal dissection speed. Secondary outcomes included differences in en‐bloc resection, adverse events, and workload, assessed by the National Aeronautical and Space Administration Task Load Index (NASA‐TLX). Results Five trainees performed two T‐ESD and two C‐ESD each, for a total of 20 procedures. Submucosal dissection speed was significantly faster in the T‐ESD group compared to the C‐ESD group (43.32 ± 22.61 vs. 24.19 ± 15.86 mm2/min; p = 0.042). En‐bloc resection was achieved in 60% with T‐ESD and 70% with C‐ESD (p = 1.00). The muscle injury rate was higher in the C‐ESD group (50% vs. 10%; p = 0.21) with 1 perforation reported with C‐ESD and none with T‐ESD. NASA‐TLX physical demand was lower with T‐ESD compared to C‐ESD (4.5 ± 2.17 vs. 6.9 ± 2.50; p = 0.03). Conclusion T‐ESD resulted in faster submucosal dissection and less physical demand when compared to C‐ESD, as performed by trainees in an ex‐vivo gravity‐dependent model. Future studies are needed to assess its role in human ESD cases.
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Affiliation(s)
- Dennis Yang
- Center for Interventional EndoscopyAdventHealthOrlandoUSA
| | - Hiroyuki Aihara
- Division of GastroenterologyHepatology, and EndoscopyBrigham and Women's HospitalHarvard Medical SchoolBostonUSA
| | | | - Cem Simsek
- Division of GastroenterologyHepatology, and EndoscopyBrigham and Women's HospitalHarvard Medical SchoolBostonUSA
| | - Hafiz Khan
- Center for Interventional EndoscopyAdventHealthOrlandoUSA
| | - Tony S. Brar
- Center for Interventional EndoscopyAdventHealthOrlandoUSA
| | | | - Justin J. Forde
- Division of Gastroenterology and HepatologyUniversity of FloridaGainesvilleUSA
| | | | | | - Peter V. Draganov
- Division of Gastroenterology and HepatologyUniversity of FloridaGainesvilleUSA
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31
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Obermannová R, Alsina M, Cervantes A, Leong T, Lordick F, Nilsson M, van Grieken NCT, Vogel A, Smyth EC. Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:992-1004. [PMID: 35914638 DOI: 10.1016/j.annonc.2022.07.003] [Citation(s) in RCA: 305] [Impact Index Per Article: 101.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- R Obermannová
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Alsina
- Department of Medical Oncology, Hospital Universitario de Navarra (HUN), Pamplona; Gastrointestinal Tumours Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - T Leong
- The Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - F Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases), University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - M Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - N C T van Grieken
- Department of Pathology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - E C Smyth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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32
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Rodríguez-Carrasco M, Libânio D, Pimentel-Nunes P, Barreiro P, Ferreira A, Küttner-Magalhães R, Pinho R, Boal Carvalho P, Areia M, Lage J, Serrano M, Silva J, Dias-Pereira A, Carvalho L, Cadime AT, Cotter J, Carvalho J, Pedroto I, Gonçalves R, Chagas C, Dinis-Ribeiro M. Endoscopic submucosal dissection: a country dissemination experience and outcomes. Eur J Gastroenterol Hepatol 2022; 34:1042-1046. [PMID: 36062495 DOI: 10.1097/meg.0000000000002426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE An increasing use of endoscopic submucosal dissection (ESD) has been reported in Western countries, although some differences in training schemes and outcomes have been described. We aimed to report the training model, implementation, and outcomes of ESD in Portugal. METHODS All endoscopists trained at our center from our country (n = 9) were invited to a survey regarding: (a) training period; (b) ESD outcomes and (c) implementation of ESD in each respective center. RESULTS All endoscopists completed the survey. Learning ESD was centered on human ESD assistance in a high-volume center during a median time of 6 months and complemented mainly by hands-on courses (89%). During the surveyed period, a total of 1229 ESD were performed, mostly in gastric locations (74%). Median complete R0 and curative resection rate were 92% (IQR, 81-96.8) and 87% (IQR, 74-93.3), respectively, and median perforation rate was 0.89% (IQR, 0.25-6.22). The main limitations encountered during the implementation of ESD were related to the lack of initial mentoring or insufficient expertise to progress to more difficult lesions. CONCLUSION Learning ESD through participation in hands-on courses and visiting high-volume centers seems to be adequate to achieve a good competence at the initial stage of ESD, which in fact is in consonance with the European Society of Gastrointestinal Endoscopy recommendations. However, mentoring is essential for technical progression, and this represents the fundamental barrier during the adoption of ESD, which may be overcome by increasing hands-on training in animal or artificial simulators, but preferably with the implementation of a structured training program.
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Affiliation(s)
| | - Diogo Libânio
- Gastroenterology Department, Portuguese Oncology Institute of Porto
- MEDCIDS - Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto
- MEDCIDS - Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto
| | - Pedro Barreiro
- Gastroenterology Department, Lisboa Ocidental Hospital Center, Egas Moniz Hospital
- Gastroenterology Department, Lusíadas Hospital, Lisbon
| | | | - Ricardo Küttner-Magalhães
- Gastroenterology Department, Porto University Hospital Center
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto
| | - Rolando Pinho
- Gastroenterology Department, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia
| | - Pedro Boal Carvalho
- Gastroenterology Department, Senhora da Oliveira Hospital, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães
| | - Miguel Areia
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra
| | - Jorge Lage
- Gastroenterology Department, Trás-os-Montes e Alto Douro Hospital Center, Vila Real
| | - Miguel Serrano
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - João Silva
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - António Dias-Pereira
- Gastroenterology Department, Portuguese Oncology Institute of Lisbon, Lisbon, Portugal
| | - Laura Carvalho
- Gastroenterology Department, Trás-os-Montes e Alto Douro Hospital Center, Vila Real
| | - Ana Teresa Cadime
- Gastroenterology Department, Portuguese Oncology Institute of Coimbra, Coimbra
| | - José Cotter
- Gastroenterology Department, Senhora da Oliveira Hospital, Guimarães
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga
- ICVS/3B's, PT Government Associate Laboratory, Braga/Guimarães
| | - João Carvalho
- Gastroenterology Department, Vila Nova de Gaia Hospital Center, Vila Nova de Gaia
| | - Isabel Pedroto
- Gastroenterology Department, Porto University Hospital Center
| | | | - Cristina Chagas
- Gastroenterology Department, Lisboa Ocidental Hospital Center, Egas Moniz Hospital
| | - Mário Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto
- MEDCIDS - Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto
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Joseph A, Draganov PV, Maluf-Filho F, Aihara H, Fukami N, Sharma NR, Chak A, Yang D, Jawaid S, Dumot J, Alaber O, Chua T, Singh R, Mejia-Perez LK, Lyu R, Zhang X, Kamath S, Jang S, Murthy S, Vargo J, Bhatt A. Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study. Gastrointest Endosc 2022; 96:445-453. [PMID: 35217020 PMCID: PMC9488538 DOI: 10.1016/j.gie.2022.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC. METHODS We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates. RESULTS Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023). CONCLUSIONS EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.
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Affiliation(s)
- Abel Joseph
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter V. Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Neil R. Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | - Amitabh Chak
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Salmaan Jawaid
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - John Dumot
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Omar Alaber
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Tiffany Chua
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Rituraj Singh
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA
| | | | - Ruishen Lyu
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xuefeng Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suneel Kamath
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
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Wang N, Chai N, Li L, Li H, Zhai Y, Feng X, Liu S, Zhang W, Linghu E. Comparison of Endoscopic Radiofrequency Ablation and Argon Plasma Coagulation in Patients with Gastric Low-Grade Intraepithelial Neoplasia: A Large-Scale Retrospective Study. Can J Gastroenterol Hepatol 2022; 2022:2349940. [PMID: 35782636 PMCID: PMC9242788 DOI: 10.1155/2022/2349940] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/30/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Gastric low-grade intraepithelial neoplasia (LGIN) is a precancerous lesion of gastric cancer. Endoscopic therapies represented by radiofrequency ablation (RFA) and argon plasma coagulation (APC) have been applied to treat gastric LGIN in recent years. However, no comparative study examining the effectiveness and safety profiles of RFA and APC has been reported. METHODS A single-center, large-scale, retrospective study, including 73 and 50 patients treated with RFA and APC, respectively, was conducted in the First Medical Center of Chinese PLA General Hospital from October 2015 to October 2020, with a two-year follow-up. Effectiveness, complications, operative factors, and other data were assessed. RESULTS At 2 years of follow-up, cure, relapse, recurrence, and progression rates were 90.4%, 9.6%, 9.6%, and 2.7% in the RFA group, respectively, versus 90%, 10%, 12%, and 4% in the APC group, respectively, with no statistically significant differences between the two groups (all p > 0.05). However, the mean lesion size was significantly larger in the RFA group (2.6 ± 1.0 cm) than in the APC group (1.5 ± 0.6 cm) (p < 0.001); there was also a significant difference in the composition ratio of large lesions between the two groups (p < 0.001). No serious postoperative complications showed in either group, and the abdominal pain was the most common symptom in the short term after surgery. CONCLUSIONS RFA and APC are both safe and effective destructive therapies for gastric LGIN. RFA is more suitable for flat and large lesions, while APC is more suitable for small lesions, especially those with slight local uplift or depression. An intraoperative submucosal injection is expected to be an effective method for relieving postoperative abdominal pain.
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Affiliation(s)
- Nanjun Wang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ningli Chai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Longsong Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Huikai Li
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yaqi Zhai
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiuxue Feng
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shengzhen Liu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wengang Zhang
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Enqiang Linghu
- Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, Esposito G, Lemmers A, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, van Hooft JE, Deprez PH, Dinis-Ribeiro M. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2022; 54:591-622. [PMID: 35523224 DOI: 10.1055/a-1811-7025] [Citation(s) in RCA: 342] [Impact Index Per Article: 114.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and chromoendoscopy (virtual or dye-based).ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.For Barrett's esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.
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Affiliation(s)
- Pedro Pimentel-Nunes
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Department of Surgery and Physiology, Porto Faculty of Medicine, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, The Netherlands
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia and Western Clinical School, University of Sydney, Sydney, Australia
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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Cho JH, Shin CM, Yoon H, Park YS, Kim N, Lee DH. Comparison of endoscopic treatments for small gastric adenomas. Surg Endosc 2022; 36:3920-3931. [PMID: 34480218 DOI: 10.1007/s00464-021-08710-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/25/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Gastric adenomas can be successfully treated with endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR). The aim of this study was to evaluate and compare the efficacy of ESD and EMR with circumferential precutting (EMR-P) in the treatment of small gastric adenomas. METHODS This study included 1014 gastric adenomas ≤ 15 mm in diameter treated with ESD or EMR-P from 2012 to 2019, retrospectively. Propensity score matching between the ESD and EMR-P groups (1:1 to 3:1) was performed according to age, sex, tumor size, tumor location (upper, middle, and lower thirds), morphology, and preprocedural histology. The procedure time and the rates of en bloc resection, complete resection, adverse events, and local recurrence were compared between the two groups. RESULTS After propensity score matching, 478 lesions (ESD: 295, EMR-P: 183) were analyzed. The rates of en bloc resection (94.9% vs. 93.4%, p = 0.498), complete resection (93.6% vs. 90.2%, p = 0.177), bleeding (8.1% vs. 3.8%, p = 0.063), and local recurrence (0.0% vs. 1.4%, p = 0.185) did not significantly differ between the two groups. The procedure time was significantly longer for ESD than for EMR-P (p < 0.001). In the EMR-P group, the complete resection rate was significantly lower in the upper third than in the middle and lower thirds (p < 0.001). CONCLUSION EMR-P is as effective as ESD for the treatment of small gastric adenomas. However, the efficacy of EMR-P is lower for gastric adenomas in the proximal stomach.
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Affiliation(s)
- Jae Ho Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea.
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea
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37
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Ahn JY. Endoscopic treatment for early gastric cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.5.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: In Korea, the number of screening endoscopies to detect early stage gastric neoplasms has increased exponentially following the active implementation of the National Cancer Screening Program.Current Concepts: Endoscopic treatment, including endoscopic mucosal resection and endoscopic submucosal dissection, is recognized as a minimally invasive treatment method with low morbidity and mortality for gastric dysplasia or early gastric cancer. Owing to improvement in the detection of early gastric cancer and advances in techniques, cases of endoscopic resection have increased and indications have been expanded. Endoscopic resection can preserve gastric function with excellent maintenance of the patient’s quality of life, and previous studies have shown better long-term follow-up outcomes compared to those with surgery. However, the fundamental limitation of endoscopic procedures is that gastric lymph-node dissection is not possible using endoscopic resection.Discussion and Conclusion: Although the usefulness of endoscopic resection is proven for tumors with a very low risk of lymph-node metastasis, follow-up examination using endoscopy and computed tomography should be performed for at least 5 years after curative resection of early gastric cancer.
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Mejia Perez LK, Yang D, Draganov PV, Jawaid S, Chak A, Dumot J, Alaber O, Vargo JJ, Jang S, Mehta N, Fukami N, Chua T, Gabr M, Kudaravalli P, Aihara H, Maluf-Filho F, Ngamruengphong S, Pourmousavi Khoshknab M, Bhatt A. Endoscopic submucosal dissection vs. endoscopic mucosal resection for early Barrett's neoplasia in the West: a retrospective study. Endoscopy 2022; 54:439-446. [PMID: 34450667 DOI: 10.1055/a-1541-7659] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The difference in clinical outcomes after endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for early Barrett's esophagus (BE) neoplasia remains unclear. We compared the recurrence/residual tissue rates, resection outcomes, and adverse events after ESD and EMR for early BE neoplasia. METHODS We included patients who underwent EMR or ESD for BE-associated high grade dysplasia (HGD) or T1a esophageal adenocarcinoma (EAC) at eight academic hospitals. We compared demographic, procedural, and histologic characteristics, and follow-up data. A time-to-event analysis was performed to evaluate recurrence/residual disease and a Kaplan-Meier curve was used to compare the groups. RESULTS 243 patients (150 EMR; 93 ESD) were included. EMR had lower en bloc (43 % vs. 89 %; P < 0.001) and R0 (56 % vs. 73 %; P = 0.01) rates than ESD. There was no difference in the rates of perforation (0.7 % vs. 0; P > 0.99), early bleeding (0.7 % vs. 1 %; P > 0.99), delayed bleeding (3.3 % vs. 2.1 %; P = 0.71), and stricture (10 % vs. 16 %; P = 0.16) between EMR and ESD. Patients with non-curative resections who underwent further therapy were excluded from the recurrence analysis. Recurrent/residual disease was 31.4 % [44/140] for EMR and 3.5 % [3/85] for ESD during a median (interquartile range) follow-up of 15.5 (6.75-30) and 8 (2-18) months, respectively. Recurrence-/residual disease-free survival was significantly higher in the ESD group. More patients required additional endoscopic resection procedures to treat recurrent/residual disease after EMR (EMR 24.2 % vs. ESD 3.5 %; P < 0.001). CONCLUSIONS ESD is safe and results in more definitive treatment of early BE neoplasia, with significantly lower recurrence/residual disease rates and less need for repeat endoscopic treatments than with EMR.
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Affiliation(s)
| | - Dennis Yang
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, USA
| | - Salmaan Jawaid
- Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - Amitabh Chak
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - John Dumot
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - Omar Alaber
- Digestive Health Institute, University Hospitals, Cleveland, Ohio, USA
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sunguk Jang
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neal Mehta
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Norio Fukami
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Tiffany Chua
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Moamen Gabr
- Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Praneeth Kudaravalli
- Department of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo, São Paulo, Brazil
| | - Saowanee Ngamruengphong
- Department of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
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Hu W, Yu J, Yao N, Li X, Yang Y, Wang L, Sun M, Guo Y, Wang H, Yan S, Li B. Efficacy and Safety of Four Different Endoscopic Treatments for Early Esophageal Cancer: a Network Meta-analysis. J Gastrointest Surg 2022; 26:1097-1108. [PMID: 35194712 DOI: 10.1007/s11605-022-05276-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/11/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Cap-assisted endoscopic mucosal resection (EMRC), ligation-assisted endoscopic mucosal resection (EMRL), endoscopic submucosal dissection (ESD), and multiband mucosectomy (MBM) are used for treating early esophageal cancer patients. Our aim was to compare the efficacy and safety of four different endoscopic treatments. METHODS Electronic databases (PubMed, Cochrane, Embase, and Web of Science) were systematically searched to include relevant studies published from database inception until February 15, 2021. There were no date or language restrictions. Data related to study such as characteristics, methods, outcomes, and risks of bias were extracted by two reviewers. RESULTS A total of 11 articles with 1880 patients were included. The results of the network meta-analysis showed that ESD was a better choice considering the efficacy of en bloc resection rate (surface under the cumulative ranking curves (SUCRA) = ESD: 99.5%, EMRC: 26.5%, MBM: 24.1%) and local recurrence rate (SUCRA = EMRC: 95.6%, MBM: 42.9%, ESD: 11.6%). MBM had a lower rate of side effects compared to the other treatments: perforation rate (SUCRA = ESD: 100%, EMRC: 48.1%, MBM: 1.9%), stricture rate (SUCRA = ESD: 99.8%, MBM: 40.8%, EMRC: 9.4%), and bleeding rate (SUCRA = EMRC: 69.4%, ESD: 62.2%, EMRL: 61.6%, MBM: 6.8%). MBM also had the shortest operation time and smallest diameter of the specimens. CONCLUSION The MBM endoscopic treatment was recommended for early esophageal cancer patients, but considering the increase in lesion size, ESD would be better.
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Affiliation(s)
- Wenyu Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Jia Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Xiaotong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Yixue Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Ling Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Mengzi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Yinpei Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Han Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Shoumeng Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, People's Republic of China.
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Dalal I, Andalib I. Advances in endoscopic resection: a review of endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER). Transl Gastroenterol Hepatol 2022; 7:19. [PMID: 35548477 PMCID: PMC9081920 DOI: 10.21037/tgh-2020-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/21/2020] [Indexed: 08/30/2023] Open
Abstract
Subepithelial lesions are often detected incidentally in patients undergoing an endoscopy. They are common tumors of the gastrointestinal (GI) tract which can originate from different layers of the GI tract wall. These lesions can be further classified based on GI layer of origin and unique histochemical staining. While most are benign and asymptomatic, some of these lesions have malignant potential with distant metastases. However, current diagnostic modalities including endoscopy with biopsy or endoscopic ultrasound with fine needle aspiration are not always reliable. In addition, management of these lesions has historically involved surgical resection via open or laparoscopic approaches. In recent years, with advancement in endoscopic techniques and improvement in endoscopists' skills, less invasive procedures such as endoscopic submucosal dissection (ESD), endoscopic full thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER) have been developed and now are being used by endoscopists worldwide. Upon reviewing the literature, multiple studies have shown the advantages of these endoscopic techniques when compared with surgical treatment. As a result, there has been a dramatic shift towards minimally invasive endoscopic procedures for the management of these subepithelial lesions. In this review article, we will discuss these endoscopic resection techniques in detail, their safety and efficacy, as well as comparison studies to other therapeutic modalities.
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Affiliation(s)
- Ishita Dalal
- Department of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson, New Brunswick, New Jersey, USA
| | - Iman Andalib
- Department of Gastroenterology and Hepatology, Mount Sinai South Nassau, Oceanside, New York, USA
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Kitagawa Y, Ishigaki A, Nishii R, Sugita O, Suzuki T. Randomized study of two endo-knives for the traction-assisted endoscopic submucosal dissection of early esophageal squamous cell carcinoma. Sci Rep 2022; 12:4619. [PMID: 35301345 PMCID: PMC8931055 DOI: 10.1038/s41598-022-08348-0] [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: 11/29/2021] [Accepted: 03/03/2022] [Indexed: 11/09/2022] Open
Abstract
Needle-type devices, such as the DualKnife (Olympus, Tokyo, Japan), are widely used for traction-assisted esophageal endoscopic submucosal dissection (ESD) but require a prolonged operation time. An improved model of the ITknife (Olympus), the ITknife nano, may allow faster and easier ESD than the DualKnife. We conducted a randomized study to compare the performances of the DualKnife and the ITknife nano for traction-assisted esophageal ESD. Patients with early esophageal squamous cell carcinoma were eligible for this study. The primary outcome was the total procedure time. The secondary outcomes were submucosal dissection time, en bloc, and complete resection rates, perforation rate, and adverse events. Results Fifty patients were equally divided into two groups: the DualKnife group (D-group) and the ITknife nano group (I-group), and all underwent the assigned treatment. The I-group had significantly shorter total procedure time (36.8 vs. 60.7 min; P < 0.01) and submucosal dissection time (17.2 vs. 35.8 min; P < 0.01) than the D-group. The en bloc and complete resection rates were sufficiently high in both groups (100% and 100% in the D-group and 100% and 96% in the I-group, respectively). Significantly fewer hemostatic procedures due to intraoperative bleeding were performed in the I-group than in the D-group (0.2 vs. 1.4; P < 0.01). Delayed bleeding, perforation, or esophageal stricture did not occur in either group. The ITknife nano exhibited lower procedure time for traction-assisted esophageal ESD than the DualKnife, without increasing adverse events.
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Affiliation(s)
- Yoshiyasu Kitagawa
- Endoscopy Division, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba, Japan.
| | - Asuka Ishigaki
- Endoscopy Division, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba, Japan
| | - Rino Nishii
- Endoscopy Division, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba, Japan
| | - Osamu Sugita
- Endoscopy Division, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba, Japan
| | - Takuto Suzuki
- Endoscopy Division, Chiba Cancer Center, 666-2 Nitonacho, Chuo-ku, Chiba, Japan
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Polypectomy, Endoscopic Mucosal Resection, and Endoscopic Submucosal Dissection in the Cirrhotic Population. Clin Liver Dis 2022; 26:13-19. [PMID: 34802659 DOI: 10.1016/j.cld.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Endoscopic mucosal resection and dissection are advanced endoscopic procedures that have proven essential for resecting premalignant and early malignant lesions throughout the gastrointestinal tract. Over time, these procedures have proven to play a key role in avoiding more invasive surgical approaches and thus decrease overall mortality. However, the success of these procedures does come with a slightly increased risk of adverse events such as bleeding and perforation. In this article, we review the literature for reported adverse events, specifically in the cirrhotic population. This article also discusses experts' opinions on approaches taken to perform these procedures with acceptable risks.
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Effectiveness of S-O Clip-Assisted Colorectal Endoscopic Submucosal Dissection. J Clin Med 2021; 11:jcm11010141. [PMID: 35011881 PMCID: PMC8745244 DOI: 10.3390/jcm11010141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/28/2022] Open
Abstract
This study aimed to assess the utility of the S-O clip during colorectal endoscopic submucosal dissection (ESD). We conducted a retrospective study on 185 patients who underwent colorectal ESD from January 2015 to January 2020. The patients were divided into two groups: before and after the introduction of the S-O clip. Forty-two patients underwent conventional ESD (CO group) and 29 patients underwent ESD using the S-O clip (SO group). We compared the surgery duration, dissection speed, en bloc resection rate, and complication rate between both groups. Compared with the CO group, the SO group had a significantly shorter surgery duration (70.7 ± 37.9 min vs. 51.2 ± 18.6 min; p = 0.017), a significantly higher dissection speed (15.1 ± 9.0 min vs. 26.3 ± 13.8 min; p < 0.001), a significantly higher en bloc resection rate (80.9% vs. 98.8%; p ≤ 0.001), and a significantly lower perforation rate (4.3% vs. 1.3%). In the right colon, the surgery duration was significantly shorter and the dissection speed was significantly higher in the SO group than in the CO group. Moreover, the rate of en bloc resection improved significantly in the right colon. S-O clip-assisted ESD reduces the procedure time and improves the treatment effects, especially in the right colon.
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44
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Rudiman R. Advances in gastrointestinal surgical endoscopy. Ann Med Surg (Lond) 2021; 72:103041. [PMID: 34888040 PMCID: PMC8636781 DOI: 10.1016/j.amsu.2021.103041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/22/2022] Open
Abstract
Surgeons have a role in observing, detect abnormalities, disease, and other deficiencies in function which could be treated. Diagnosing and treating back days were challenging for many reasons. However, technology's innovation enhances surgeons' ability to treat their patients. The term endoscopy refers to the Greek prefix endo- ("within") and the verb skopein ("to view or observe"). Endoscopy is practical both in the diagnosis and treatment of various pathologies. Technological advances, especially in endoscopy, gradually progress and discover many possibilities which allow rapid advancement. Endoscopy development aims to assess human orifice that has not been inspected, probed, and examined over the centuries. Endoscopy over these decades is improving, which led to new problem solving using advanced technological approaches. Thus, a surgeon can solve any issues from examination, diagnosis, and treatment using progressive endoscopy evolution. This review delivers a brief history of advances in surgical endoscopy and describes current endoscopy development.
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
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45
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Othman MO, Bahdi F, Ahmed Y, Gagneja H, Andrawes S, Groth S, Dhingra S. Short-term clinical outcomes of non-curative endoscopic submucosal dissection for early esophageal adenocarcinoma. Eur J Gastroenterol Hepatol 2021; 33:e700-e708. [PMID: 34091478 DOI: 10.1097/meg.0000000000002223] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Few Western studies highlighted the outcomes of endoscopic submucosal dissection (ESD) for early esophageal adenocarcinoma (EAC). Data regarding the outcomes of noncurative ESDs remains scarce. In this study, we share our experience with ESD for early EAC with a focus on noncurative ESDs. METHODS A retrospective single-center analysis of consecutive patients who underwent ESD for early EAC from August 2015 through February 2020. Primary outcomes included the clinical outcomes of noncurative ESDs along with overall en bloc, R0 and curative resection rates. Secondary outcomes included comparing results between T1a and T1b tumors. RESULTS Final group included 23 T1a and 17 T1b EAC patients. Patients' median Charlson comorbidity index was five. En bloc resection rate was (97.5%). Compared to the T1b group, the T1a group had a statistically significantly higher R0 (78.3 vs. 41.2%; P = 0.0235), curative (73.9 vs. 11.8%; P = 0.0001) and accumulative endoscopic curative resection rates (82.6 vs. 23.5%; P = 0.0003). A study flowchart is presented in (Fig. 1). Out of the 21 noncurative ESDs, 10 patients (47.6%) underwent R0 esophagectomy, 6 patients (28.6%) are undergoing surveillance endoscopies without additional therapy, 3 patients (14.3%) underwent repeat curative ESD and 1 patient (4.76%) is receiving chemotherapy with surveillance endoscopy. Over median endoscopic follow-up of 22.5 months (IQR, 14.25-30.75), 2 out of 10 patients with noncurative ESDs had recurrent disease. CONCLUSIONS ESD achieved a higher curative resection rate in T1a EAC when compared to T1b. Despite a lower curative resection rate in T1b EAC, certain patients might benefit from a conservative multimodal therapy.
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Affiliation(s)
- Mohamed O Othman
- Department of Medicine, Section of Gastroenterology and Hepatology, Baylor College of Medicine.,Baylor St Luke's Medical Center
| | - Firas Bahdi
- Baylor St Luke's Medical Center.,Department of Medicine, Baylor College of Medicine, Houston
| | | | | | - Sherif Andrawes
- Division of Gastroenterology, Staten Island University Hospital, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Staten Island University Hospital, Staten Island, New York
| | - Shawn Groth
- Baylor St Luke's Medical Center.,Division of General Thoracic Surgery, Baylor College of Medicine
| | - Sadhna Dhingra
- Baylor St Luke's Medical Center.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
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Park K, Kim NY, Kim KJ, Oh C, Chae D, Kim SY. A Simple Risk Scoring System for Predicting the Occurrence of Aspiration Pneumonia After Gastric Endoscopic Submucosal Dissection. Anesth Analg 2021; 134:114-122. [PMID: 34673667 DOI: 10.1213/ane.0000000000005779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aspiration pneumonia after endoscopic submucosal dissection (ESD) is rare, but can be fatal. We aimed to investigate risk factors and develop a simple risk scoring system for aspiration pneumonia. METHODS We retrospectively reviewed medical records of 7833 patients who underwent gastric ESD for gastric neoplasm under anesthesiologist-directed sedation. Candidate risk factors were screened and assessed for significance using a least absolute shrinkage and selection operator (LASSO)-based method. Top significant factors were incorporated into a multivariable logistic regression model, whose prediction performance was compared with those of other machine learning models. The final risk scoring system was created based on the estimated odds ratios of the logistic regression model. RESULTS The incidence of aspiration pneumonia was 1.5%. The logistic regression model showed comparable performance to the best predictive model, extreme gradient boost (area under receiver operating characteristic curve [AUROC], 0.731 vs 0.740). The estimated odds ratios were subsequently used for the development of the clinical scoring system. The final scoring system exhibited an AUROC of 0.730 in the test dataset with risk factors: age (≥70 years, 4 points), male sex (8 points), body mass index (≥27 kg/m2, 4 points), procedure time (≥80 minutes, 5 points), lesion in the lower third of the stomach (5 points), tumor size (≥10 mm, 3 points), recovery time (≥35 minutes, 4 points), and desaturation during ESD (9 points). For patients with total scores ranging between 0 and 33 points, aspiration pneumonia probabilities spanned between 0.1% and 17.9%. External validation using an additional cohort of 827 patients yielded AUROCs of 0.698 for the logistic regression model and 0.680 for the scoring system. CONCLUSIONS Our simple risk scoring system has 8 predictors incorporating patient-, procedure-, and sedation-related factors. This system may help clinicians to stratify patients at risk of aspiration pneumonia after ESD.
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Affiliation(s)
| | - Na Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ki Jun Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chaerim Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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[Treatment recommendations for early esophageal cancer : Endoscopic and surgical options]. Chirurg 2021; 92:1077-1084. [PMID: 34622303 DOI: 10.1007/s00104-021-01513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Esophageal cancer represents a complex tumor entity with an increasing proportion of adenocarcinomas. Early esophageal cancer is staged as m1-m3 depending on the depth of infiltration into the mucosa and as sm1-sm3 depending on invasion into the submucosa. The risk of lymph node metastasis is strongly correlated with the depth of invasion and increases by leaps and bounds with submucosal infiltration. MATERIAL AND METHODS This review is based on publications retrieved by a selective database search (MEDLINE, PubMed, Cochrane Library, International Standard Randomised Controlled Trial Number, ISRCTN, registry) on the current management of early esophageal cancer. RESULTS The endoscopic diagnostics and evaluation of the dignity of superficial esophageal cancer by traditional staining techniques have been expanded by virtual chromoendoscopy. Endoscopic resection is the diagnostic and therapeutic procedure of choice for mucosal low risk adenocarcinomas (grade 1 or 2, no blood or lymph vessel invasion). Under certain prerequisites adenocarcinomas of the upper submucosa (sm1) can also be endoscopically removed. All other stages necessitate surgical treatment. In squamous cell carcinoma without risk factors a surgical oncological esophageal resection is indicated after infiltration of the third mucosal layer (m3). Endoscopic submucosal dissection (ESD) shows high rates of en bloc and R0 (curative) resections even with large lesions. CONCLUSION Borderline cases between endoscopic and surgical treatment of early esophageal cancer necessitate an interdisciplinary approach and individually adapted management, which in the locally advanced stage are always embedded in a multimodal concept.
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48
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Hoffman A, Atreya R, Rath T, Neurath MF. Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection. Visc Med 2021; 37:358-371. [PMID: 34722719 PMCID: PMC8543363 DOI: 10.1159/000515354] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4-1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. SUMMARY Endoscopic treatment is now regarded as first-line therapy for benign lesions. KEY MESSAGE Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.
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Affiliation(s)
- Arthur Hoffman
- Department of Internal Medicine III, Aschaffenburg-Alzenau Clinic, Aschaffenburg, Germany
| | - Raja Atreya
- First Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, DZI, Erlangen, Germany
| | - Timo Rath
- First Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, DZI, Erlangen, Germany
| | - Markus Ferdinand Neurath
- First Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, DZI, Erlangen, Germany
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49
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Endoscopic Submucosal Dissection for Resolution of a Symptomatic Pancreatic Rest in a Pediatric Patient: A Case Report and Literature Review. Case Rep Gastrointest Med 2021; 2021:8853120. [PMID: 34557316 PMCID: PMC8455212 DOI: 10.1155/2021/8853120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/11/2021] [Accepted: 08/21/2021] [Indexed: 11/18/2022] Open
Abstract
The pancreatic rest, aberrant, or heterotopic pancreas is a normal function pancreas found in the submucosal layer of the greater curvature of the gastric antrum and occasionally in the duodenum. Most of the patients are asymptomatic and the finding is usually incidental. We describe the case of a child with abdominal pain and history of recurrent ulcers that necessitated esophagogastroduodenoscopy and further evaluation with endoscopic ultrasound that confirmed a submucosal lesion consistent with a pancreatic rest. Endoscopic submucosal dissection was performed without complication, and complete symptom resolution was achieved after dissection of the pancreatic rest.
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50
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Sugimoto M, Hatta W, Tsuji Y, Yoshio T, Yabuuchi Y, Hoteya S, Doyama H, Nagami Y, Hikichi T, Kobayashi M, Morita Y, Sumiyoshi T, Iguchi M, Tomida H, Inoue T, Mikami T, Hasatani K, Nishikawa J, Matsumura T, Nebiki H, Nakamatsu D, Ohnita K, Suzuki H, Ueyama H, Hayashi Y, Murata M, Yamaguchi S, Michida T, Yada T, Asahina Y, Narasaka T, Kuribayashi S, Kiyotoki S, Mabe K, Fujishiro M, Masamune A, Kawai T. Risk Factors for Bleeding After Endoscopic Submucosal Dissection for Gastric Cancer in Elderly Patients Older Than 80 Years in Japan. Clin Transl Gastroenterol 2021; 12:e00404. [PMID: 34644281 PMCID: PMC8659993 DOI: 10.14309/ctg.0000000000000404] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION As the aging of people in a society advances, the number of elderly patients older than 80 years in Japan with gastric cancer continues to increase. Although delayed ulcer bleeding is a major adverse event after endoscopic submucosal dissection (ESD), little is known about characteristic risk factors for bleeding in elderly patients undergoing ESD. This study aimed to evaluate risk factors for delayed bleeding after ESD for gastric cancer in elderly patients older than 80 years. METHODS We retrospectively evaluated the incidence of delayed bleeding after ESD in 10,320 patients with early-stage gastric cancer resected by ESD between November 2013 and January 2016 at 33 Japanese institutions and investigated risk factors for delayed bleeding in elderly patients older than 80 years. RESULTS The incidence of delayed bleeding in elderly patients older than 80 years was 5.7% (95% confidence interval [CI]: 4.6%-6.9%, 95/1,675), which was significantly higher than that in nonelderly (older than 20 years and younger than 80 years) patients (4.5%, 4.1%-5.0%, 393/8,645). Predictive factors for ESD-associated bleeding differed between nonelderly and elderly patients. On multivariate analysis of predictive factors at the time of treatment, risk factors in elderly patients were hemodialysis (odds ratio: 4.591, 95% CI: 2.056-10.248, P < 0.001) and warfarin use (odds ratio: 4.783, 95% CI: 1.689-13.540, P = 0.003). DISCUSSION This multicenter study found that the incidence of delayed bleeding after ESD in Japanese patients older than 80 years was high, especially in patients receiving hemodialysis and taking warfarin. Management of ESD to prevent delayed bleeding requires particular care in patients older than 80 years.
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Affiliation(s)
- Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
- Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Shiga, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yohei Yabuuchi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Masakuni Kobayashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan
- Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideomi Tomida
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Takuya Inoue
- Division of Gastroenterology and Hepatology, Osaka General Medical Center, Osaka, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan
| | - Kenkei Hasatani
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Japan
| | - Jun Nishikawa
- Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Dai Nakamatsu
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Ken Ohnita
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Murata
- Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Shiga, Japan
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | - Tomoki Michida
- Department of Gastroenterology and Hepatology, Saitama Medical Center, Saitama, Japan
- Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomoyuki Yada
- Division of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Yoshiro Asahina
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Toshiaki Narasaka
- Division of Endoscopic Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shiko Kuribayashi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yamaguchi, Japan
| | - Katsuhiro Mabe
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Tokyo, Japan
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