Clinical Outcomes and Adverse Events of Endoscopic Submucosal Dissection for Gastric Tube Cancer after Esophagectomy

Background and Aim. The clinical outcomes of endoscopic submucosal dissection (ESD) for gastric tube cancer (GTC) after esophagectomy remain unclear. The aim of this study was to evaluate the clinical outcomes and safety of ESD for GTC. Patients and Methods. Twenty GTC lesions in 18 consecutive patients who underwent ESD between February 2008 and June 2018 were included in this retrospective study. The endpoints were the treatment outcomes of ESD (i.e., en bloc resection rate, complete en bloc resection rate, and curative resection rate), the adverse events following ESD, and the long-term outcomes. Results. The en bloc resection rate was 100%, while the complete en bloc resection rate and curative resection rate were 80% each. Adverse events were observed in 16.7% (3/18) of patients: one postoperative bleeding, 1 intraoperative perforation that required emergency surgery, and 1 pyothorax that required chest drainage. The 1-, 3-, and 5-year overall survival rates were 100%, 70.9%, and 70.9%, respectively. Although local recurrence was detected in 1 case of noncurative resection, no GTC- or ESD-related deaths were observed. Conclusion. ESD for GTC was feasible and acceptable to enable en bloc resection and to prevent cancer death. However, ESD for GTC should be performed more carefully than common gastric ESD because serious adverse events specific to the gastric tube may occur.

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ENDOSCOPIC SUBMUCOSAL DISSECTION WITH CIRCUMFERENTIAL INCISION VERSUS TUNNELING METHOD FOR TREATMENT OF SUPERFICIAL ESOPHAGEAL CANCER

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.202100000-35 ◽

2021 ◽

Author(s):

Tarso Magno Leite RIBEIRO ◽

Vitor N ARANTES ◽

Jonas Augusto RAMOS ◽

Peter V DRAGANOV ◽

Dennis YANG ◽

...

Keyword(s):

Esophageal Cancer ◽

Local Recurrence ◽

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Curative Resection ◽

R0 Resection ◽

Resection Rate ◽

Superficial Esophageal Cancer ◽

En Bloc ◽

Submucosal Dissection

ABSTRACT BACKGROUND: Endoscopic submucosal dissection (ESD) of esophageal superficial neoplasm is associated with a high en bloc R0 resection rate and low recurrence. OBJECTIVE: We aim to compare the performance and clinical outcomes of ESD via ESD after circumferential incision (ESD-C) versus submucosal tunneling (ESD-T). METHODS: Single-center retrospective analysis of all consecutive patients who underwent ESD for superficial esophageal cancer, between 2009 and 2018. ESD-T was defined as the technique of making the mucosal incisions followed by submucosal tunneling in the oral to anal direction. ESD-C consisted of completing a circumferential incision followed by ESD. Main study outcomes included en bloc and R0 resection rates. Secondary outcomes included procedural characteristics, curative resection rate, local recurrence and adverse events. RESULTS: A total of 65 procedures (23 ESD-T and 42 ESD-C) were performed for ESCC (40; 61.5%) and BE-neoplasia (25; 38.5%). There were no statistically significant differences between patients who underwent ESD-T versus ESD-C in en bloc (91.3% vs 100%, P=0.12), R0 (65.2% vs 78.6%, P=0.24), curative resection rates (65.2% vs 73.8%, P=0.47) and mean procedure time (118.7 min with vs 102.4 min, P=0.35). Adverse events for ESD-T and ESD-C were as follows: bleeding (0 versus 2.4%; P=0.53), perforation (4.3% vs 0; P=0.61), esophageal stricture (8.7% versus 9.5%; P=0.31). Local recurrence was encountered in 8.7% after ESD-T and 2.4% after ESD-C (P=0.28) at a mean follow-up of 8 and 2.75 years, respectively (P=0.001). CONCLUSION: ESD-T and ESD-C appear to be equally effective with similar safety profiles for the management of superficial esophageal neoplasms.

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Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions

Endoscopy International Open ◽

10.1055/a-1268-7353 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1832-E1839

Author(s):

Yuichiro Kuroki ◽

Toshiyuki Endo ◽

Kenta Iwahashi ◽

Naoki Miyao ◽

Reika Suzuki ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Postoperative Bleeding ◽

En Bloc Resection ◽

Tumor Location ◽

Proximal Colon ◽

R0 Resection ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Serrated Lesions

Abstract Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm2/h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.

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Preoperative endoscopic predictors of severe submucosal fibrosis in colorectal tumors undergoing endoscopic submucosal dissection

Endoscopy International Open ◽

10.1055/a-0848-8225 ◽

2019 ◽

Vol 07 (04) ◽

pp. E421-E430 ◽

Cited By ~ 4

Author(s):

Uayporn Kaosombatwattana ◽

Takeshi Yamamura ◽

Julajak Limsrivilai ◽

Masanao Nakamura ◽

Somchai Leelakusolvong ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Curative Resection ◽

Significant Risk ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Submucosal Fibrosis ◽

Severe Fibrosis

Abstract Background and study aims Endoscopic submucosal dissection (ESD) enables en bloc removal of colorectal neoplasms regardless of size. Submucosal fibrosis is a significant factor for technical difficulty and poor outcomes. We assessed the predictive factors for severe submucosal fibrosis and the ESD outcomes. Patients and methods Patients undergoing ESD from January 2006 to September 2017 were retrospectively reviewed. The degree of submucosal fibrosis was classified into three types: no fibrosis (F0), mild fibrosis (F1), and severe fibrosis (F2). F0 and F1 cases were grouped as non-severe fibrosis for comparison with the severe fibrosis group. Predictors of severe submucosal fibrosis and ESD outcomes were evaluated. Results ESD was performed in 524 lesions (60 % male; mean age, 67.8 years). Eighty lesions with severe fibrosis (15.3 %) were observed. The overall en bloc resection rate and curative resection rate were 94.3 % and 77.7 %, respectively. Rates of en bloc resection (91.2 % vs. 94.8 %, P = 0.2) and perforation (7.5 % vs. 5.6 %, P = 0.45) were no different between severe fibrosis and non-severe fibrosis groups. However, incidences of non-curative resection and low resection speed were significantly higher in the severe fibrosis group. Among protruding lesions, tumor height and volume were significantly greater in the severe counterparts. A diameter ≥ 40 mm, endoscopic finding of the tumor beyond fold, and fold convergence were independent risk factors for severe fibrosis. Conclusions Severe submucosal fibrosis is a significant risk factor for non-curative resection and a long procedural time. Tumor size and morphology might help to predict the severity of fibrosis.

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Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

BMC Gastroenterology ◽

10.1186/s12876-021-01700-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ting Fan ◽

Qi Sun ◽

Shouli Cao ◽

Xiangshan Fan ◽

Qin Huang ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Clinical Outcomes ◽

Resection Rate ◽

En Bloc ◽

Cardiac Cancer ◽

Submucosal Dissection ◽

Metastasis Rate ◽

Distant Metastasis Rate

Abstract Background Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P = 0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P < 0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P < 0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P = 0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P = 0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

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A suitable marking method to achieve lateral margin negative in endoscopic submucosal dissection for undifferentiated-type early gastric cancer

Endoscopy International Open ◽

10.1055/a-0812-3222 ◽

2019 ◽

Vol 07 (02) ◽

pp. E274-E281

Author(s):

Shoichi Yoshimizu ◽

Yorimasa Yamamoto ◽

Yusuke Horiuchi ◽

Toshiyuki Yoshio ◽

Akiyoshi Ishiyama ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Endoscopic Submucosal Dissection ◽

Curative Resection ◽

Narrow Band Imaging ◽

Lateral Margin ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Undifferentiated Type

Abstract Background and study aims Delineating undifferentiated-type early gastric cancer (UD-type EGC) from noncancerous areas is difficult. Therefore, the lateral margin negative (LM−) resection rate of endoscopic submucosal dissection (ESD) is lower for UD-type EGC than for differentiated-type EGC. This study aimed to retrospectively evaluate the effectiveness of the marking methods with circumferential biopsies in ESD for UD-type EGC. Patients and methods We analyzed the clinical outcomes of ESD in 127 patients with UD-type EGC between April 2013 and 2017. We performed diagnostic delineation of cancerous areas using magnifying endoscopy with narrow-band imaging, and four or more circumferential biopsies approximately 5 mm apart from the estimated lesion border were obtained to confirm noncancerous areas. The markings were placed on the circumferential biopsy scars, and a mucosal incision line was made outside the markings. Results Median size of the tumors and ESD specimens was 12 and 35 mm, respectively. En-bloc resection rate was 100 % (127/127), and LM− and curative resection rates were 97.6 % (124/127) and 80.3 % (102/127), respectively. Circumferential biopsy in preoperative esophagogastroduodenoscopy has successfully identified the misdiagnosis of cancerous areas of four patients (3.2 %), with three (2.4%) achieving LM− resection. LM + resection was pathologically identified in three patients (2.4 %), with all undergoing non-curative resection due to > 20-mm tumor. The proportion of patients with the shortest distance ≥ 5 mm from the lesion edge to the specimen edge was 88.2 % (112/127). Conclusion Our marking methods with circumferential biopsies may reduce LM + resections in ESD for UD-type EGC.

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Implementation of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms in Sweden

Gastroenterology Research and Practice ◽

10.1155/2013/758202 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 16

Author(s):

Henrik Thorlacius ◽

Noryia Uedo ◽

Ervin Toth

Keyword(s):

Endoscopic Submucosal Dissection ◽

Colorectal Neoplasms ◽

Postoperative Bleeding ◽

En Bloc Resection ◽

Bloc Resection ◽

Colorectal Adenomas ◽

Unexpected Finding ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection

Objectives. Endoscopic submucosal dissection (ESD) is an effective method for en bloc removal of large colorectal tumors in Japan, but this technique is not yet widely established in western countries. The purpose here was to report the experience of implementing colorectal ESD in Sweden.Methods. Twenty-nine patients with primarily nonmalignant and early colorectal neoplasms considered to be too difficult to remove en bloc with EMR underwent ESD. Five cases of invasive cancer underwent ESD due to high comorbidity excluding surgical intervention or as an unexpected finding.Results. The median age of the patients was 74 years. The median tumor size was 26 mm (range 11–89 mm). The median procedure time was 142 min (range 57–291 min). En bloc resection rate was 72% and the R0 resection rate was 69%. Two perforations occurred amounting to a perforation rate of 6.9%. Both patients with perforation could be managed conservatively. One bleeding occurred during ESD but no postoperative bleeding was observed.Conclusion. Our data confirms that ESD is an effective method for en bloc resection of large colorectal adenomas and early cancers. This study demonstrates that implementation of colorectal ESD is feasible in Sweden after proper training, careful patient selection, and standardization of the ESD procedure.

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Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

10.21203/rs.3.rs-18393/v2 ◽

2020 ◽

Author(s):

Ting Fan ◽

Qi Sun ◽

Shouli Cao ◽

Xiangshan Fan ◽

Qin Huang ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Clinical Outcomes ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Cardiac Cancer ◽

Submucosal Dissection ◽

Metastasis Rate

Abstract Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% ( P =0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively ( P <0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% ( P <0.001). The distant metastasis rate was 0.4%, 0% and 2.3% ( P =0.150). The five-year disease-specific survival rate in the BEI group was 96.6% ( P =0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

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Off-label use of 0.4 % sodium hyaluronate teardrops: a safe and effective solution for submucosal injection in gastric endoscopic submucosal dissection

Endoscopy International Open ◽

10.1055/a-1265-6598 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1741-E1747

Author(s):

Vitor Arantes ◽

Josue Aliaga Ramos ◽

Rafiz Abdul Rani ◽

Naohisa Yoshida

Keyword(s):

Clinical Outcome ◽

Adverse Events ◽

Endoscopic Submucosal Dissection ◽

Curative Resection ◽

Sodium Hyaluronate ◽

Off Label Use ◽

Resection Rate ◽

En Bloc ◽

Submucosal Injection ◽

Off Label

Abstract Background and study aims Submucosal (SM) injection is a critical step in endoscopic submucosal dissection (ESD). In Japan, use of viscous solutions such as sodium hyaluronate are recommended; the commercially product available is MucoUp (Seikagaku Co. and Boston Scientific Japan Co., Japan). Nevertheless, MucoUp is expensive and unavailable in many Western countries. For the past 8 years, we have been using low-cost sterile teardrops solution composed of 0.4 % sodium hyaluronate (Adaptis Fresh, Legrand Laboratory, Brazil). This solution is readily available in drugstores with a cost of approximately US$ 10.00 for each 10-cc bottle. The aim of this study was to present the clinical outcome with off-label sodium hyaluronate use for SM injection in gastric ESD. Patients and methods A single-center retrospective study of collected data investigating consecutive patients that underwent gastric ESD between 2012 and 2019. ESD was performed using 0.4 % sodium hyaluronate teardrop for SM injection and Flush Knife BT 2.5 (Fujifilm Co., Japan). The following data were analyzed: clinical-pathological features, en-bloc, R0 and curative resection rate, procedure duration, adverse events, and clinical outcome. Results ESD was performed with sodium hyaluronate for submucosal injection in 78 patients. The en-bloc resection rate and R0 resection rate were 96.1 % and 92.3 %, respectively. The curative resection rate for epithelial lesions was 83.8 %. Adverse events occurred in 5 cases (6.3 %): delayed bleeding (3.8 %, 3 cases) and perforation (2.5 %, 2 cases); all managed successfully by clipping and thermal coagulation. The mean volume of sodium hyaluronate solution used per patient was 10 cc (SD: ± 8 cc). During follow-up (mean: 17 months; SD: ± 14.5 months), two patients developed metachronous lesions (2.5 %). Conclusions Off-label use of teardrops with 0.4 % sodium hyaluronate for submucosal injection was demonstrated to be safe and able to provide an effective submucosal cushion that facilitates SM dissection in gastric ESD procedures.

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Clinical Outcomes of Endoscopic Submucosal Tunnel Dissection Vs Endoscopic Submucosal Dissection in Gastric Lesions: a Systematic Review and Meta-analysis

10.21203/rs.3.rs-545069/v1 ◽

2021 ◽

Author(s):

Jianglei Li ◽

Mengmeng Xu ◽

Yuyong Tan ◽

Yongjun Wang ◽

Deliang Liu

Keyword(s):

Endoscopic Submucosal Dissection ◽

Clinical Outcomes ◽

Recurrence Rate ◽

Precancerous Lesions ◽

Meta Analysis ◽

Cochrane Library ◽

Gastric Lesions ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection

Abstract Background and objectives: Many studies have verified that endoscopic submucosal dissection (ESD) has prominent advantages in en bloc resection and low recurrence rate. However, ESD also has technical difficulty for some large-area gastric lesions. Endoscopic submucosal tunneling dissection (ESTD) combined the tunnel technique with the traditional ESD technique for treating gastrointestinal mucosal lesions under tunnel endoscopy. This technique has been gradually applied to the treatment of large-scale early cancer and precancerous lesions, and has achieved good results. Yet no meta-analysis has been published, so we performed this study to determine the efficacy and safety of ESTD vs ESD in gastric lesions through clinical outcomes.Methods: We performed the literature search in PubMed, Cochrane Library, Web of Science, Embase, Wanfang, and CNKI dating up to February 9, 2021. Studies comparing the clinical outcomes of ESTD and ESD in gastric lesions were enrolled. The Newcastle-Ottawa Quality Assessment Scale was used to evaluate the quality of these studies. Results: Four articles were included that involved a total of 920 patients (187 from the ESTD group and 733 from ESD group). ESTD has higher en bloc resection and R0 resection rate, faster dissection speed, and lower complication rate. The curative resection rate and recurrence rate of ESTD group is comparable with ESD group.Conclusions: ESTD technique is an effective and safe treatment procedure in gastric lesions, and may be prior to ESD for large gastric lesions.

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Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

10.21203/rs.3.rs-18393/v3 ◽

2020 ◽

Author(s):

Ting Fan ◽

Qi Sun ◽

Shouli Cao ◽

Xiangshan Fan ◽

Qin Huang ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Clinical Outcomes ◽

Resection Rate ◽

En Bloc ◽

Cardiac Cancer ◽

Submucosal Dissection ◽

Metastasis Rate ◽

Distant Metastasis Rate

Abstract Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications.Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups.Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P=0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P<0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P<0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P=0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P=0.016), compared to 99.6% in the AI group and 100% in the EI group.Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

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