Endoscopic Microwave Coagulation Therapy Research Articles

中枢気道病変に対する内視鏡下マイクロ波凝固療法

中枢気道病変に対する内視鏡下マイクロ波凝固療法

Endoscopic Treatment of Rectal Carcinoid Tumors

Various methods have been reported for the endoscopic treatment of rectal carcinoid tumors. The present study was designed to identify the optimal treatment strategy for an endoscopic resection. Forty rectal carcinoid tumors of 38 patients were treated endoscopically. The indication criteria, complete resection rate, selection of treatment, local recurrence, distant metastases, and complications were analyzed. All tumors were estimated to measure 1 cm or less in diameter, without muscular invasion, atypical features, and lymph node metastases to the pararectal region. Complete resection of the lesions was obtained in 75.0% (30/40). The complete resection rates were 20.0% (1/5) by conventional polypectomy, 84.6% (22/26) by a two-channel endoscopic mucosal resection, and 77.8% (7/9) by endoscopic submucosal dissection. The 10 cases that did not show a clear submucosal layer after initial endoscopic treatment received additional endoscopic microwave coagulation therapy. There were no local or distant recurrences in the followed-up periods (median, 6.4 years). No difference was observed in the complete resection rate between two-channel endoscopic mucosal resection and endoscopic submucosal dissection. Small carcinoid tumors measuring less than 1 cm in diameter can therefore be managed endoscopically with no recurrence or spread. The selection of endoscopic treatment should be made after taking such factors as cost-effectiveness, expertise, and experience into careful consideration.

Endoscopic microwave coagulation therapy for early recurrent T1 nasopharyngeal carcinoma

The result of reirradiation in recurrent T1 (rT1) nasopharyngeal carcinoma (NPC) is unsatisfactory. We sought to study the efficacy and complications of endoscopic microwave coagulation therapy (MCT) in salvaging rT1 NPC after primary radiotherapy. Between August 1994 and April 2005, 55 patients with rT1 NPC were treated with endoscopic MCT. With a median follow-up of 102.1months, 52 of 55 patients are still alive. Five patients had local failure after retreatment. The overall survival and local progression-free survival were 100% (95% CI, 99.4% to 100%) and 94.5% (95% CI, 94.1% to 94.9%) at 2years, respectively, and 93.6% (95% CI, 93.5% to 94.4%) and 90.7% (95% CI, 90.2% to 91.2%) at 5years. The common complications of endoscopic MCT were mild postoperative pain and headache. Nasopharyngeal necrosis was transient in one patient and subsided in 1month. Endoscopic MCT achieved significant survival and tumour control without severe complications in selective rT1 NPC.

Endoscopic microwave coagulation therapy for the case of re-obstructive jaundice after expandable metallic stent therapy due to malignant biliary obstruction

Endoscopic microwave coagulation therapy for the case of re-obstructive jaundice after expandable metallic stent therapy due to malignant biliary obstruction

Endoscopic microwave coagulation therapy for the malignant biliary obstruction

Endoscopic microwave coagulation therapy (EMCT) was successfully applied to two male patients aged 94 and 84 with obstructive jaundice due to upper bile duct and lower bile duct carcinoma, because of their refusal of resection. A single 15-second exposure of microwave (30 W) was delivered during each treatment to the cancerous tissue using a monopolar shielded wire electrode under guidance of percutaneous cholangioendoscopy. Treatment was repeated a total of two times at interval of a week and no complication was encountered. Patients have subsequently lived for 26 and 20 months without jaundice. These results indicate that EMCT for patients with bile duct cancer without no metastasis and high operative risk might be an effective therapy for local control.

Advances in endoscopic surgery for hepatocellular carcinoma

Endoscopic microwave coagulation therapy (MCT) or radio-frequency ablation (RFA) was developed in 1994. 213 endoscopic ablations (37% of 570 ablations) and 40 endoscopic hepatectomies (12% of 328 hepatectomies) were performed in our department. Appropriate selection of thoraco- and laparoscopic approach, marginal pre-ablation method, pre-coagulation method using RFA, and laparoscopic hand-assisted approach are important points. To evaluate the efficacy of endoscopic surgery, the operative outcomes were compared to 86 patients who underwent open non-systematic partial hepatectomy, smaller than 4 cm, and up to three tumors, in the same period. In endoscopic ablation, endoscopic hepatectomy, and open hepatectomy, the percent of liver damage B/C, intraoperative blood loss, operating time, percent requiring blood product, postoperative hospital stay, 5-year cumulative survival rate and complication rate was 49%, 20%, 17%, 23g, 346g, 850g, 3.2 hrs, 5.2 hrs, 6.6 hrs, 1%, 12%, 21%, 8 days, 9 days, 18 days, 54%, 68%, 63%, and 8.2%, 6.7%, 12% respectively. No implantation of malignant cells was encountered in endoscopic surgery. Endoscopic surgery can become a new therapeutic modality in treatment strategy for HCC.

Biliary tract cancer

Advances in cellular and molecular biology of extrahepatic cholangiocarcinoma and gallbladder adenocarcinoma are providing innovative means for the diagnosis and treatment of biliary tract cancer. Similarly, refinements in noninvasive studies--including helical computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasonography--are enabling more accurate diagnosis, staging, and treatment planning for these tumors. Complete resection remains the only means for cure, and recent reports from major hepatobiliary centers support aggressive wide resection for bile duct and gallbladder cancer. Palliation of malignant strictures has improved with advanced endoscopic techniques, newer polyurethane-covered stents, endoscopic microwave coagulation therapy, and radiofrequency intraluminal endohyperthermia. The preliminary data on such minimally invasive techniques suggest an improvement in quality of life and survival for selected patients.

A case of gastric body predominant diffuse antrial vascular ectasia(DAVE) succesfully treated with endoscopic microwave coagulation therapy(EMCT).

A case of gastric body predominant diffuse antrial vascular ectasia(DAVE) succesfully treated with endoscopic microwave coagulation therapy(EMCT).

Intraductal ultrasonographic assessment of coagulation depth during endoscopic microwave coagulation therapy in a canine model.

In order to examine the feasibility of endoscopic microwave coagulation therapy (MCT) for the treatment of common bile duct cancer in humans, we investigated the safety and effectiveness of endoscopic MCT with the assistance of intraductal ultrasonography (IDUS). We performed MCT in the canine small intestine as a model because of its similarity in size to the obstructed human common bile duct. Multiple coagulation lesions were made in anesthetized dogs, with the endoscope inserted through a jejunostomy. Under condition "A", the tip of the MCT probe was kept in a fixed position in contact with the mucosa of the intestine, and coagulation was performed with an output of 30 or 50 W for 30 or 10 s, respectively. Under condition "B", the tip of the MCT probe was moved along the intestinal mucosa, and coagulation was performed with an output of 50, 40, or 30 W, all for 10 s. After coagulation, a thin-caliber ultrasonic probe was inserted endoscopically for observation of the effects of coagulation. Each coagulation under condition "A" resulted in degeneration of all layers of the intestine. Coagulation under condition "B" resulted in more localized degeneration, extending from the mucosal layer to the proper muscle layer. By comparison with histologic observations, the accuracy of IDUS in assessing depth of degeneration was 87.5%. Endoscopic microwave coagulation was considered safe and effective, and IDUS was able to accurately assess the effects of microwave coagulation.

3562 Effect of endoscopic microwave coagulation therapy in patients with benign stricture of the upper gastrointestinal tract.

Background: Endoscopic dilation is considered the best treatment for most cases of benign esophageal stricture. However an absolute best dilation technique and kind of stricture most amenable to treatment is still controversial. Aim: To evaluate the effectiveness of endoscopic microwave coagulation therapy(EMCT) in benign stricture retrospectively. Meterials and methods: EMCT (Microtaze® HS-15M, Japan)was performed on 35 patients (postoperative stricture 20, lye stricture 11, and benign stricture of unknown 4). Dysphagia was classified into 0 to 5 (grading system by British Surgeons) before and after therapy. Effectiveness of treatment was judged by the Luna grade. We assessed change of clinical symptoms and complications after endoscopic dilatation, and treatment sessions according to the causes of strictures. Results: 1) Grade of dysphagia was improved significantly after treatment (pre-dilatation: 2.8 ± 1.1, postdilatation: 0.6 ± 0.9, p<0.05). 2) Patients with lye stricture needed more treatment sessions for adequate dilation compare to patients with postoperative strictures (2.6 ± 1.7 vs. 2.3 ± 0.8, p <0.05). 3) Improvement of stricture (good or moderate by Luna grade scale) showed in all 20 patients with postoperative stricture (100%), 9 out of 11 patients with lye strictures(81%) and all 4 patients with strictures of unknown origin(100%). 4) One of each patients with lye stricture or postoperative stricture recurred stricture. There was one perforation which improved with conservative treatment, one hemorrhage and four chest pains. Conclusion: EMCT is safe and effective in relieving dysphagia caused by benign strictures, especially by postoperative stricture, inspite of need for repeated sessions. Background: Endoscopic dilation is considered the best treatment for most cases of benign esophageal stricture. However an absolute best dilation technique and kind of stricture most amenable to treatment is still controversial. Aim: To evaluate the effectiveness of endoscopic microwave coagulation therapy(EMCT) in benign stricture retrospectively. Meterials and methods: EMCT (Microtaze® HS-15M, Japan)was performed on 35 patients (postoperative stricture 20, lye stricture 11, and benign stricture of unknown 4). Dysphagia was classified into 0 to 5 (grading system by British Surgeons) before and after therapy. Effectiveness of treatment was judged by the Luna grade. We assessed change of clinical symptoms and complications after endoscopic dilatation, and treatment sessions according to the causes of strictures. Results: 1) Grade of dysphagia was improved significantly after treatment (pre-dilatation: 2.8 ± 1.1, postdilatation: 0.6 ± 0.9, p<0.05). 2) Patients with lye stricture needed more treatment sessions for adequate dilation compare to patients with postoperative strictures (2.6 ± 1.7 vs. 2.3 ± 0.8, p <0.05). 3) Improvement of stricture (good or moderate by Luna grade scale) showed in all 20 patients with postoperative stricture (100%), 9 out of 11 patients with lye strictures(81%) and all 4 patients with strictures of unknown origin(100%). 4) One of each patients with lye stricture or postoperative stricture recurred stricture. There was one perforation which improved with conservative treatment, one hemorrhage and four chest pains. Conclusion: EMCT is safe and effective in relieving dysphagia caused by benign strictures, especially by postoperative stricture, inspite of need for repeated sessions.

Endoscopic microwave coagulation therapy for the pancreato-biliary carcinoma

Endoscopic microwave coagulation therapy (EMCT) was performed the pancreato-biliary carcinoma with malignant biliary obstruction. There were 10 cases (mean age 71.7 yr) including 6 of bile duct carcinoma, 2 cases of carcinoma of the gallbladder and pancreas, 2 cases of the carcinoma of the Vater papilla. The microwave irradiation of 50W / 10-second or 40W / 15-second was delivered to the carcinoma under cholangioscopy or duodenoscopy. Patency of the biliary obstruction was achieved in all cases after the treatment, and no severe complications were encountered. There out of 7 cases survived for more than one year without jaundice. The present study suggests that EMCT has a beneficial effect on maintaining patency of the bile duct for the treatment of malignant biliary obstruction, resulting in prolonging the patient survival.

Endoscopic microwave coagulation therapy for hepatocellular carcinoma

Background : Usefulness of endoscopic microwave coagulation therapy (E-MCT) was examined in 27 patients with hepatocellular carcinoma (HCC).Material and Methods : HCC was found in 8 patients with type B liver cirrhosis (LC), 16 patients with type C LC, and 3 patients with non B non C LC. Median tumor size was 23 mm (solitary lesion 22, multiple 5). Laparoscopic MCT was performed for S2-6 lesion and thoracoscopic MCT for S8 lesion under general anesthesia. Linear type ultrasonography was used in every case for monitoring lesion ant therapeutic effect.Results : Complete tumor necrosis was obtained in 24 cases (81%) and local recurrence was found in 5 cases after the observation period of maximum 34 months. Pleural abscess, hemorrhage and hepatic infarction were found in 3 cases without serious outcome.Conclusions : We conclude that E-MCT is quite promising therapy for surface type HCC in term of minimally invasive and curative procedure a time. It is important that sufficient marginal coagulation should be obtained.

Endoscopic microwave coagulation therapy for the superficial esophageal cancer

Fifteen patients with superficial esophageal cancer were treated by endoscopically. One patient with submucosal cancer was treated by endoscopic microwave coagulation therapy (EMCT) alone. Another 14 cases were performed EMR before EMCT, but removal of cancer lesion totally by EMR was succeeded in only one patient. The residual lesions in the other 13 patients were treated by additional EMCT.As the results, there was not any recurrence of esophageal cancer in all of the patients during 1 to 48 months of follow-up period.It was concluded that EMCT was effective for not only early gastric cancer but also superficial esophageal cancer patients.

Application of endoscopic microwave coagulation to the treatment of bile duct carcinoma

Endoscopic microwave coagulation therapy (EMCT) was applied to female patients aged 79 and 82 with obstructive jaundice due to lower bile duct carcinoma, because of their refusal pancreatoduodenectomy (PD). A single 10-second exposure of microwave (50W, 2450 MHz) was delivered 15 to 20 times during each treatment to the cancerous tissue using a monopoler shielded wire electrode under guidance of a percutaneous cholangioendoscopy. Treatment was repeated a total of three or six times at intervals of 1 week, and an expandable metallic stent was placed after recanalization of bile duct and negative tests for cancer cells. Supplementary radiation therapy (50.4Gy) was performed after EMCT, and no complications were encountered. Patients have subsequently lived well for 15 and 14 months without jaundice. These results indicate that EMCT for patients with lower bile duct cancer and high operative risk might be an effective alternative for PD.

Long term clinical results of the endoscopic microwave coagulation therapy for early gastric cancer

About 17 years passed since we started clinical application of the endoscopic microwave coagulation therapy (EMCT) in 1981.In this report, we give an outline of recent equipments and techniques of the endoscopic microwave coagulation therapy (EMCT) for early gastric cancer and investigate its position in terms of long term clinical results in our hospital.

Endoscopic microwave coagulation for treatment of a case of unresectable esophageal cancer

A 71-year-old woman was admitted to our hospital with dysphagia. X-ray examination revealed an 11 cm-long stenosis of the esophagus, and a biopsy specimen revealed poorly differentiated squamous cell carcinoma. The patient underwent 60 Gys of radiation therapy for primary esophageal tumor. Endoscopic and X-ray examinations revealed a significant diminution in the lesion, so she was discharged.Six months later, the patient returned to our hospital with dysphagia.We applied endoscopic microwave coagulation therapy (EMCT) for the esophageal stricture. After 4 sessions of EMCT therapy, significant improvements were seen in symptoms and in endoscopic and X-ray findings.We concluded that EMCT can be used accurately and safely as palliative treatment for malignant stricture of the esophagus.

悪性腫瘍による食道狭窄に対する胃瘻からの内視鏡的マイクロ波凝固療法の1例

悪性腫瘍による食道狭窄に対する胃瘻からの内視鏡的マイクロ波凝固療法の1例

Endoscopic microwave coagulation therapy for villous adenoma of the duodenum-A case report

The effects of endoscopic microwave coagulation therapy on duodenal adenoma in a 58-year-old man are reported. The patient had a 35-mm sessile tubulo-villous adenoma in the duodenal bulb. Endoscopic polypectomy followed by microwave coagulation therapy for duodenal adenoma was performed to avoid a major surgical procedure which would disturb the physiological functions of the gastrointestinal tract. After partial polypectomy which included the core of the adenoma, the entire remaining adenoma was destroyed after three microwave therapy sessions. During a follow-up period of 14 months, neither endoscopic nor histologic evidence of recurrence has been noted. Endoscopic microwave coagulation therapy is considered to be useful in the treatment of large sessile duodenal villous adenoma, provided that repeated endoscopic follow-up surveillance is also performed.

Endoscopic microwave coagulation therapy for early gastric cancer: A study on local cure

Endoscopic microwave coagulation therapy for early gastric cancer: A study on local cure

A STUDY ON ENDOSCOPIC MICROWAVE TUMOR COAGULATION

Endoscopic microwave coagulation therapy has already been applied to clinical use. In this study, the purpose of the fundamental examination was to decide the condition of effective coagulation, and, as a result of the examination of egg white coagulation and liver tissue coagulation, we decided that fundamental coagulative conditions would be 40 W, 20 seconds. The purpose of the clinical examination was to reveal the applicability and problems of this method. Form April 1983 to November 1985, we had 24 cases of early gastric cancer and six cases of group III gastric lesion undergoing microwave coagulation therapy at Hiratsuka Gastroenterological Hospital. These patients have been followed up for a maximum 31 months after this therapy. There are five considered to have been radically cured by this method, and, in one of these, no presence of residual lesion has been proved by histological examination of the resected stomach. From this fact, it is expected that this method can be applied to radical tumor therapy, but, the other hand, it can not be disregarded that there are cases with residual lesion. On the occasions of applying this method, it is important to recognize its limitations and to select the indications with care.