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Submucosal Dissection (submucosal + dissection)
Kinds of Submucosal Dissection Selected AbstractsSUCCESSFUL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR MUCOSAL CANCER OF THE DUODENUMDIGESTIVE ENDOSCOPY, Issue 1 2010Masahiro Shinoda We report a case of mucosal duodenal cancer in a 62-year-old woman, which was successfully removed en bloc by endoscopic submucosal dissection (ESD). The patient underwent an upper gastrointestinal endoscopy at our hospital, which revealed an elevated flat mucosal lesion (type IIa) measuring 10 mm in diameter in the second portion of the duodenum. Histopathological examination of a biopsy specimen revealed features suggestive of a tubulovillous adenoma with severe atypia. As the findings suggested that the lesion had an adenocarcinoma component but was confined to the mucosal layer, we decided to carry out ESD and successfully removed the tumor in one piece. The resected tumor was 20 × 15 mm in size. Histopathological examination revealed that the lesion was a well-differentiated mucosal adenocarcinoma with no lymphovascular invasion. Mucosal duodenal cancer is extremely rare, and ESD of a lesion in the duodenum requires a high level of skill. To the best of our knowledge, this case is the first report of successful ESD carried out in a case of mucosal duodenal cancer. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE UPPER GASTROINTESTINAL TRACT: PRESENT AND FUTURE VIEW OF EUROPEDIGESTIVE ENDOSCOPY, Issue 2009Horst Neuhaus In Western countries endoscopic mucosal resection (EMR) has been widely accepted for treatment of early Barrett`s neoplasia and flat or depressed colorectal adenomas. In contrast endoscopic submucosal dissection (ESD) is infrequently performed for several reasons. It seems to be difficult to overcome the learning curve of this difficult technique because of the low case volume of early gastric cancer. On the other hand ESD of esophageal or colorectal lesions is even more challenging and is considered to be inappropriate for learning. In addition the indication for esophageal or colorectal ESD is controversial in view of excellent results of the well established EMR technique which is less time-consuming and safer than ESD. A recent survey of leading Western endoscopy centers indicated the limited experience with ESD with a low number of cases for all potential indications. Only a few training courses have been established and the number of ongoing clinical studies is limited. Only 12 out of 340 published articles on "endoscopic mucosal dissection" were reported from Western countries. A better acceptance of ESD requires improvement of the technique to allow an easier, faster and safer approach. There is a strong demand for structured training courses and limitations of human cases to selected centers which participate in prospective trials. A close collaboration between Western and Asian centers is recommended for improvement of the ESD technique and its clinical application. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL NEOPLASMSDIGESTIVE ENDOSCOPY, Issue 2 2009Mitsuhiro Fujishiro Endoscopic submucosal dissection (ESD) has gradually gained acceptance as one of the standard treatments for early esophageal cancer, as well as for early gastric cancer in Japan, but standardization of the knowledge is still incomplete. The final goal to perform ESD is not to resect the lesion in an en bloc fashion, but to save the patient from esophageal cancer-related death. Thus, the indications should be considered based on the entire patient, not just the target lesion itself, and pre-, peri- and postoperative management of the patient is also very important, as well as technical aspects of ESD. In terms of the techniques of ESD, owing to refinement of the procedural strategy, invention of the devices, and the learning curve, acceptable safety and favorable middle-term efficacy have been obtained. We believe that ESD will become a standard treatment for early esophageal cancer not only in Japan but also worldwide in the near future. [source] CURRENT TECHNIQUES AND DEVICES FOR SAFE AND CONVENIENT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND KOREAN EXPERIENCE OF ESDDIGESTIVE ENDOSCOPY, Issue 3 2008Sang-Yong Seol Conventional endoscopic mucosal resection (EMR) technique has limitations in its capacity of achieving en bloc resection and, for lesions greater than 20 mm, removal in a piecemeal resection is often required. This leads to uncertainty as to whether or not the lesion has been completely removed and to an increase in local recurrence. To overcome this limitation, a new technique using specifically designed cutting devices, termed endoscopic submucosal dissection (ESD) has been developed. The present article discuss the current indication, new diagnostic, cutting and hemostatic devices and long-term outcomes of EMR and ESD in early gastric cancer in Korea. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER USING MAGNIFYING ENDOSCOPY WITH A COMBINATION OF NARROW BAND IMAGING AND ACETIC ACID INSTILLATIONDIGESTIVE ENDOSCOPY, Issue 3 2008Kyosuke Tanaka Demarcation of early gastric cancers is sometimes unclear. Enhanced-magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72-year-old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well-differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER: TECHNICAL FEASIBILITY, OPERATION TIME AND COMPLICATIONS FROM A LARGE CONSECUTIVE SERIESDIGESTIVE ENDOSCOPY, Issue 1 2005Ichiro Oda Background:, Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods:, We reviewed all patients with EGC who underwent ESD using the IT knife at National Cancer Center Hospital in the period between January 2000 and December 2003. Results:, During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions (, 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10,540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment. Conclusion:, The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC. [source] CURRENT STATUS IN THE OCCURRENCE OF POSTOPERATIVE BLEEDING, PERFORATION AND RESIDUAL/LOCAL RECURRENCE DURING COLONOSCOPIC TREATMENT IN JAPANDIGESTIVE ENDOSCOPY, Issue 4 2010Shiro Oka Bleeding, perforation, and residual/local recurrence are the main complications associated with colonoscopic treatment of colorectal tumor. However, current status regarding the average incidence of these complications in Japan is not available. We conducted a questionnaire survey, prepared by the Colorectal Endoscopic Resection Standardization Implementation Working Group, Japanese Society for Cancer of the Colon and Rectum (JSCCR), to clarify the incidence of postoperative bleeding, perforation, and residual/local recurrence associated with colonoscopic treatment. The total incidence of postoperative bleeding was 1.2% and the incidence was 0.26% with hot biopsy, 1.3% with polypectomy, 1.4% with endoscopic mucosal resection (EMR), and 1.7% with endoscopic submucosal dissection (ESD). The total incidence of perforation was 0.74% (0.01% with the hot biopsy, 0.17% with polypectomy, 0.91% with EMR, and 3.3% with ESD). The total incidence of residual/local recurrence was 0.73% (0.007% with hot biopsy, 0.34% with polypectomy, 1.4% with EMR, and 2.3% with ESD). Colonoscopic examination was used as a surveillance method for detecting residual/local recurrence in all hospitals. The surveillance period differed among the hospitals; however, most of the hospitals reported a surveillance period of 3,6 months with mainly transabdominal ultrasonography and computed tomography in combination with the colonoscopic examination. [source] SUCCESSFUL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR MUCOSAL CANCER OF THE DUODENUMDIGESTIVE ENDOSCOPY, Issue 1 2010Masahiro Shinoda We report a case of mucosal duodenal cancer in a 62-year-old woman, which was successfully removed en bloc by endoscopic submucosal dissection (ESD). The patient underwent an upper gastrointestinal endoscopy at our hospital, which revealed an elevated flat mucosal lesion (type IIa) measuring 10 mm in diameter in the second portion of the duodenum. Histopathological examination of a biopsy specimen revealed features suggestive of a tubulovillous adenoma with severe atypia. As the findings suggested that the lesion had an adenocarcinoma component but was confined to the mucosal layer, we decided to carry out ESD and successfully removed the tumor in one piece. The resected tumor was 20 × 15 mm in size. Histopathological examination revealed that the lesion was a well-differentiated mucosal adenocarcinoma with no lymphovascular invasion. Mucosal duodenal cancer is extremely rare, and ESD of a lesion in the duodenum requires a high level of skill. To the best of our knowledge, this case is the first report of successful ESD carried out in a case of mucosal duodenal cancer. [source] TOWARD THE GLOBAL STANDARDIZATION OF ENDOSCOPIC SUBMUCOSAL DISSECTION PROPOSAL FOR 10 YEARS FROM NOW , PRESENT AND FUTURE VIEW OF KOREADIGESTIVE ENDOSCOPY, Issue 2009Joo Young Cho Endoscopic submucosal dissection (ESD) is the main treatment of early gastric cancer in Korea. The Korean Society of Gastrointestinal Endoscopy (KSGE) has organized an ESD research group and made several plans to standardize pathologic and therapeutic points of view. This article is to introduce the present and future view of ESD in Korea. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE UPPER GASTROINTESTINAL TRACT: PRESENT AND FUTURE VIEW OF EUROPEDIGESTIVE ENDOSCOPY, Issue 2009Horst Neuhaus In Western countries endoscopic mucosal resection (EMR) has been widely accepted for treatment of early Barrett`s neoplasia and flat or depressed colorectal adenomas. In contrast endoscopic submucosal dissection (ESD) is infrequently performed for several reasons. It seems to be difficult to overcome the learning curve of this difficult technique because of the low case volume of early gastric cancer. On the other hand ESD of esophageal or colorectal lesions is even more challenging and is considered to be inappropriate for learning. In addition the indication for esophageal or colorectal ESD is controversial in view of excellent results of the well established EMR technique which is less time-consuming and safer than ESD. A recent survey of leading Western endoscopy centers indicated the limited experience with ESD with a low number of cases for all potential indications. Only a few training courses have been established and the number of ongoing clinical studies is limited. Only 12 out of 340 published articles on "endoscopic mucosal dissection" were reported from Western countries. A better acceptance of ESD requires improvement of the technique to allow an easier, faster and safer approach. There is a strong demand for structured training courses and limitations of human cases to selected centers which participate in prospective trials. A close collaboration between Western and Asian centers is recommended for improvement of the ESD technique and its clinical application. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL NEOPLASMSDIGESTIVE ENDOSCOPY, Issue 2 2009Mitsuhiro Fujishiro Endoscopic submucosal dissection (ESD) has gradually gained acceptance as one of the standard treatments for early esophageal cancer, as well as for early gastric cancer in Japan, but standardization of the knowledge is still incomplete. The final goal to perform ESD is not to resect the lesion in an en bloc fashion, but to save the patient from esophageal cancer-related death. Thus, the indications should be considered based on the entire patient, not just the target lesion itself, and pre-, peri- and postoperative management of the patient is also very important, as well as technical aspects of ESD. In terms of the techniques of ESD, owing to refinement of the procedural strategy, invention of the devices, and the learning curve, acceptable safety and favorable middle-term efficacy have been obtained. We believe that ESD will become a standard treatment for early esophageal cancer not only in Japan but also worldwide in the near future. [source] CURRENT TECHNIQUES AND DEVICES FOR SAFE AND CONVENIENT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AND KOREAN EXPERIENCE OF ESDDIGESTIVE ENDOSCOPY, Issue 3 2008Sang-Yong Seol Conventional endoscopic mucosal resection (EMR) technique has limitations in its capacity of achieving en bloc resection and, for lesions greater than 20 mm, removal in a piecemeal resection is often required. This leads to uncertainty as to whether or not the lesion has been completely removed and to an increase in local recurrence. To overcome this limitation, a new technique using specifically designed cutting devices, termed endoscopic submucosal dissection (ESD) has been developed. The present article discuss the current indication, new diagnostic, cutting and hemostatic devices and long-term outcomes of EMR and ESD in early gastric cancer in Korea. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER USING MAGNIFYING ENDOSCOPY WITH A COMBINATION OF NARROW BAND IMAGING AND ACETIC ACID INSTILLATIONDIGESTIVE ENDOSCOPY, Issue 3 2008Kyosuke Tanaka Demarcation of early gastric cancers is sometimes unclear. Enhanced-magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72-year-old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well-differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer. [source] ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER: TECHNICAL FEASIBILITY, OPERATION TIME AND COMPLICATIONS FROM A LARGE CONSECUTIVE SERIESDIGESTIVE ENDOSCOPY, Issue 1 2005Ichiro Oda Background:, Endoscopic mucosal resection (EMR) is a recognized treatment for early gastric cancer (EGC). One-piece resection is considered to be a gold standard of EMR, as it provides accurate histological assessment and reduces the risk of local recurrence. Endoscopic submucosal dissection (ESD) is a new technique developed to obtain one-piece resection even for large and ulcerative lesions. The present study aims to identify the technical feasibility, operation time and complications from a large consecutive series. Methods:, We reviewed all patients with EGC who underwent ESD using the IT knife at National Cancer Center Hospital in the period between January 2000 and December 2003. Results:, During the study period of 4 years we identified a total of 1033 EGC lesions in 945 consecutive patients who underwent ESD using the IT knife. We found a one-piece resection rate (OPRR) of 98% (1008/1033). Our OPRR with tumor-free margins was 93% (957/1033). On subgroup analysis it was found to be 86% (271/314) among large lesions (, 21 mm) and 89% (216/243) among ulcerative lesions. The overall non-evaluable resection rate was 1.8% (19/1033). The median operation time was 60 min (range; 10,540 min). Evidence of immediate bleeding was found in 7%. Delayed bleeding after ESD was seen in 6% and perforation in 4% of the cases. All cases with complications except one were successfully treated by endoscopic treatment. Conclusion:, The present study shows the technical feasibility of ESD, which provides one-piece resections even in large and ulcerative EGC. [source] Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancerDISEASES OF THE ESOPHAGUS, Issue 7 2009H. Mizuta SUMMARY Endoscopic submucosal dissection (ESD) has been utilized as an alternative treatment to endoscopic mucosal resection for superficial esophageal cancer. We aimed to evaluate the complications associated with esophageal ESD and elucidate predictive factors for post-ESD stenosis. The study enrolled a total of 42 lesions of superficial esophageal cancer in 33 consecutive patients who underwent ESD in our department. We retrospectively reviewed ESD-associated complications and comparatively analyzed regional and technical factors between cases with and without post-ESD stenosis. The regional factors included location, endoscopic appearance, longitudinal and circumferential tumor sizes, depth of invasion, and lymphatic and vessel invasion. The technical factors included longitudinal and circumferential sizes of mucosal defects, muscle disclosure and cleavage, perforation, and en bloc resection. Esophageal stenosis was defined when a standard endoscope (9.8 mm in diameter) failed to pass through the stenosis. The results showed no cases of delayed bleeding, three cases of insidious perforation (7.1%), two cases of endoscopically confirmed perforation followed by mediastinitis (4.8%), and seven cases of esophageal stenosis (16.7%). Monovalent analysis indicated that the longitudinal and circumferential sizes of the tumor and mucosal defect were significant predictive factors for post-ESD stenosis (P < 0.005). Receiver operating characteristic analysis showed the highest sensitivity and specificity for a circumferential mucosal defect size of more than 71% (100 and 97.1%, respectively), followed by a circumferential tumor size of more than 59% (85.7 and 97.1%, respectively). It is of note that the success rate of en bloc resection was 95.2%, and balloon dilatation was effective for clinical symptoms in all seven patients with post-ESD stenosis. In conclusion, the most frequent complication with ESD was esophageal stenosis, for which the sizes of the tumor and mucosal defect were significant predictive factors. Although ESD enables large en bloc resection of esophageal cancer, practically, in cases with a lesion more than half of the circumference, great care must be taken because of the high risk of post-ESD stenosis. [source] Endoscopic resection of gastrointestinal lesions: Advancement in the application of endoscopic submucosal dissectionJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 8 2010Abby Conlin Abstract Curative endoscopic resection is now a viable option for a range of neoplastic lesions of the gastrointestinal tract (GIT) with low invasive potential. Risk of lymph node metastasis is the most important prognostic factor in selecting appropriate lesions for endoscopic therapy, and assessment of invasion depth is vital in this respect. To determine appropriate treatment, detailed endoscopic diagnosis and estimation of depth using magnifying chromoendoscopy is the gold standard in Japan. En bloc resection is the most desirable endoscopic therapy as risk of local recurrence is low and accurate histological diagnosis of invasion depth is possible. Endoscopic mucosal resection is established worldwide for the ablation of early neoplasms, but en bloc removal using this technique is limited to small lesions. Evidence suggests that a piecemeal resection technique has a higher local recurrence risk, therefore necessitating repeated surveillance endoscopy and further therapy. More advanced endoscopic techniques developed in Japan allow effective en bloc removal of early GIT neoplasms, regardless of size. This review discusses assessment of GIT lesions and options for endoscopic therapy with special reference to the introduction of endoscopic submucosal dissection into Western countries. [source] Gastrointestinal: Intramucosal gastric cancer treated by endoscopic submucosal dissectionJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2008N Kobayashi [source] The performance of a novel ball-tipped Flush knife for endoscopic submucosal dissection: a case,control studyALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010T. Toyonaga Aliment Pharmacol Ther 2010; 32: 908,915 Summary Background, Endoscopic submucosal dissection (ESD) using short needle knives is safe and effective, but bleeding is a problem due to low haemostatic capability. Aim, To assess the performance of a novel ball-tipped needle knife (Flush knife-BT) for ESD with particular emphasis on haemostasis. Methods, A case,control study to compare the performance for ESD of 30 pairs of consecutive early gastrointestinal lesions (oesophagus: 12, stomach: 32, colorectum: 16) with standard Flush knife (F) vs. Flush knife-BT (BT). Primary outcome was efficacy of intraprocedure haemostasis. Secondary outcomes included procedure time, procedure speed (dividing procedure time into the area of resected specimen), en bloc resection rate and recurrence rate. Results, Median intraoperative bleeding points and bleeding points requiring haemostatic forceps were smaller in the BT group than in the F group (4 vs. 8, P < 0.0001, 0 vs. 3, P < 0.0001). There was no difference between groups for procedure time; however, procedure speed was shorter in the BT group (P = 0.0078). En bloc and en bloc R0 resection rates were 100%, with no perforation or post-operative bleeding. No recurrence was observed in either group at follow-up 1 year postprocedure. Conclusions, Ball-tipped Flush knife (Flush knife-BT) appears to improve haemostatic efficacy and dissection speed compared with standard Flush knife. [source] Laparoscopic sentinel node navigation surgery for early gastric cancerASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2009H Takeuchi Abstract The sentinel node (SN) concept has revolutionized how the surgical staging of both melanoma and breast cancer are approached. Applying this concept can yield benefits for the patient by avoiding various complications relating to unnecessary prophylactic regional lymph node dissection in cases with negative SN for cancer metastasis. Clinical application of SN mapping for early gastric cancer had been controversial for years. However, single institutional results of laparoscopic SN mapping for early gastric cancer are considered acceptable in terms of detection rate and accuracy in determining lymph node status. For early stage gastric cancer such as cT1N0M0 , in which a better prognosis was generally achieved through conventional surgical approaches , an individualized, minimally invasive surgery that might retain the patient's quality of life should be established as the next surgical challenge. Although there are many issues still to resolve, laparoscopic minimized gastrectomy with SN navigation surgery or combined endoscopic mucosal resection and endoscopic submucosal dissection has the potential to achieve this goal. [source] | ||||||||||