Endoscopic Submucosal Dissection For Treatment Research Articles

Feasibility and Safety of Endoscopic Submucosal Dissection (ESD) for Treatment of Colorectal Tumors and Effectiveness of Measures to Prevent Complications. -Compared to Therapeutic Results from Gastric ESD-

Background: Endoscopic submucosal dissection (ESD) is now widely accepted for treatment of early gastric cancer and ESD is currently being applied to treat colorectal cancer . There are concerns, however, about the possible high risk of peritonitis caused by perforations during ESD in the colon due to its thin wall and the presence of stool. Objective: Evaluate feasability and safety of colonic ESD and effectiveness of preventive measures against complications in comparison with therapeutic results from gastric ESD. Patients: In the gastric group (male/female: 67/9; mean age: 68.7 ± 8.6 years), 76 patients with 81 lesions were treated at Tokyo Medical University Hospital from April 2005 to November 2007. In the colonic group (male/female: 6/5; mean age: 64.0 ± 7.8 years), 11 patients with 11 lesions were treated at the same facility from June 2006 to November 2007. Methods: We compared lesion sizes, en-bloc resection rates, procedure times, length of hospital stays following ESD procedures and incidence of complications between the two groups. As for preventive measures taken to prevent complications during colonic ESDs, carbon dioxide insufflation was utilized to reduce patient discomfort and a bipolar needle-knife (B-knife) and an insulation-tip knife (IT knife) were initially used to reduce the risk of perforation. More recently, we have been using a newly designed ball-tip B-knife to further enhance operational safety. In order to prevent peritonitis, patients were given 2000-3000ml of polyethylene glycol (PEG) together with antibiotics the mornings of their procedures. Results: Mean lesion size was 20.7 ± 11.8 mm (range, 5-60 mm) in the gastric group and 50 ± 33mm (range, 20-110 mm) in the colonic group. The en-bloc resection rate was 90.6% compared to 72.2% and mean procedure time was 104.0 ± 70.5 minutes compared to 200.2 ± 188.3 minutes in the gastric and colonic groups, respectively. Mean length of hospital stay following ESD was shorter in the colonic group; 7.3 ± 3.9 days (range, 3-10 days) compared to in the gastric group; 10.2 ± 8.3 days (range, 5-31 days). The incidence of complications was 6 cases (7.4%) of delayed bleeding and 2 cases (2.5%) of perforation in the gastric group while there were no complications whatsoever in the colonic group. Conclusions: It is possible that colonic ESD is as safe as gastric ESD provided instruments developed specifically for use in the colon are used and adequate measures are taken to prevent complications. Under such circumstances, we consider ESD to be a feasible therapy for colorectal tumors.

Transjugular intrahepatic portosystemic shunt and endoscopic submucosal dissection for treatment of early gastric cancer in a cirrhotic patient

Transjugular intrahepatic portosystemic shunt and endoscopic submucosal dissection for treatment of early gastric cancer in a cirrhotic patient

Endoscopic submucosal dissection with insulated-tip knife for large mucosal early gastric cancer: a feasibility study (with videos)

According to clinicopathologic studies, differentiated-type mucosal early gastric cancers without ulcer or ulcer scar have little risk of lymph-node metastasis, irrespective of tumor size. However, patients with large mucosal early gastric cancer have been subjected to surgery because conventional EMR methods could not resect large tumors en bloc. To evaluate the feasibility and the efficacy of endoscopic submucosal dissection for treatment of early gastric cancers larger than 3 cm in diameter. Case series study. Referral cancer center. A total of 30 consecutive patients were enrolled with the following characteristics: diagnosis of differentiated-type early gastric cancer larger than 3 cm, lack of ulcerative change, no endoscopic evidence for submucosal invasion, and no evidence of lymph-node or distant metastasis (22 men and 8 women; median age, 69 years; median tumor size, 40 mm). Tumors were resected by endoscopic submucosal dissection with an insulated-tip knife. Complete resection, complication rate, and operation time. Complete resection was obtained in 23 of 30 cases (77%). Complications included hemorrhage (n=4), perforation (n=1), and pyloric stenosis (n=1), but no severe complications occurred that required surgery or that led to major morbidity. Complete resection and complication rates improved in the last 10 cases (90% and 0%, respectively), though operation time was not shortened. Small sample size and lack of controls. Endoscopic submucosal dissection when using the insulated-tip knife is feasible and efficacious for selected patients with mucosal early gastric cancer larger than 3 cm.

Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma

Early detection of hypopharyngeal carcinoma is increasingly possible and patients with such early lesions can be treated with endoscopic resection. To identify the optimal relationship between the mucosal defect of the hypopharynx and malfunction of the hypopharynx after endoscopic resection of early hypopharyngeal carcinoma. Case series. Referral center in Japan. Four patients with early-stage squamous cell carcinoma of the hypopharynx underwent endoscopic submucosal dissection (ESD). By using ESD, an accurate incision line close to the tumor margin could be confirmed while performing treatment. ESD was performed with a small-caliber-tip transparent hood (ST-hood) to open the incision line for better visualization of the submucosa. Feasibility of en bloc resection, complications, and recurrence after ESD. No early or late complications due to treatment occurred in the patients. Histological examination of resected specimens revealed that 2 patients had carcinoma in situ and 2 patients had tumor invasion of the subepithelium. There was no local recurrence or distant metastasis in any of the patients during the follow-up period (3-14 months). We consider that ESD is the optimal method for endoscopic resection not only because it enables an en bloc resected specimen to be obtained but also because it can prevent removal of excess mucosa of the hypopharynx, which is a very narrow and important organ related to swallowing and speech.