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Lin X, Fan L, Lin M. A superficial esophageal cancer with a Rokitansky diverticulum treated by endoscopic submucosal dissection with dental floss clip traction: Letter to the editor. Clin Res Hepatol Gastroenterol 2024; 48:102368. [PMID: 38723945 DOI: 10.1016/j.clinre.2024.102368] [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: 04/10/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Xueyi Lin
- Department of Gastroenterology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, PR China
| | - Li Fan
- Department of Gastroenterology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, PR China
| | - Min Lin
- Department of Gastroenterology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, PR China.
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Ueda T, Ishihara R, Yoshii S, Li JW, Asada Y, Kitagawa D, Kizawa A, Ninomiya T, Okubo Y, Kawakami Y, Tani Y, Shichijo S, Kanesaka T, Yamamoto S, Takeuchi Y, Higashino K, Uedo N, Michida T. Predictors of technical difficulty for trainees in esophageal endoscopic submucosal dissection. Esophagus 2024; 21:58-66. [PMID: 38082187 DOI: 10.1007/s10388-023-01028-6] [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: 06/21/2023] [Accepted: 11/03/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Esophageal endoscopic submucosal dissection (ESD) is technically challenging, especially for trainees, and requires a safe training system. This study aimed to identify predictors of technical difficulty facing trainees performing esophageal ESD to establish such system. METHODS This was a single-center retrospective study of patients with esophageal cancer who underwent ESD performed by trainees between January 2010 and August 2022. Technical difficulties were defined as muscularis propria exposure and long procedure time (≥ 90 min). Factors associated with these technical difficulties were investigated. RESULTS A total of 798 lesions in 721 patients were evaluated. Muscularis propria exposure occurred in 298 lesions (37.3%), including 10 perforations (1.3%). The procedure time was ≥ 90 min in 134 lesions (16.8%). In the multivariate analysis, tumor size ≥ 20 mm, tumors ≥ 1/2 of the circumference, and those close to previous treatment scars significantly increased the incidence of both difficulties, whereas tumors in the upper esophagus significantly decreased this incidence. Furthermore, female sex and tumors in the left wall were independent predictors of muscularis propria exposure, and elevated morphology was an independent predictor of long procedure time. Muscularis propria exposure and long procedure time occurred in more than half of the cases with three or more predictors of each difficulty. CONCLUSIONS Large tumors and tumors close to previous treatment scars increase technical difficulties for trainees in esophageal ESD. Conversely, tumors in the upper esophagus reduce these difficulties. These results enable us to predict the difficulty level preoperatively and select appropriate cases in stepwise training.
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Affiliation(s)
- Tomoya Ueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan.
| | - Shunsuke Yoshii
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - James Weiquan Li
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Yuya Asada
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Daiki Kitagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Atsuko Kizawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Takehiro Ninomiya
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Yuki Okubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Yushi Kawakami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Yasuhiro Tani
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
| | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka, 541-8567, Japan
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Ramos JA, Morita Y, Toyonaga T, Carvalho D, Pedrosa MS, Arantes VN. Management of esophageal neoplasms by endoscopic submucosal dissection: experience over 100 consecutive procedures. Clin Endosc 2023; 56:613-622. [PMID: 37524567 PMCID: PMC10565440 DOI: 10.5946/ce.2022.245] [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: 09/01/2022] [Revised: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic submucosal dissection (ESD) is currently considered the first-line treatment for the eradication of superficial neoplasms of the esophagus in Eastern countries. However, in the West, particularly in Latin America, the experience with esophageal ESD is still limited because of the high technical complexity required for its execution. This study aimed to present the results of the clinical application of ESD to manage superficial esophageal neoplasms in a Latin American center in over 100 consecutive cases. METHODS This retrospective study included consecutive patients who underwent endoscopic ESD for superficial esophageal neoplasms between 2009 and 2022. The following clinical outcomes were assessed: en bloc, complete, and curative resection rates, local recurrence, adverse events, and procedure-related mortality. RESULTS Esophageal ESD was performed mainly for squamous cell carcinoma (66.6%), high-grade intraepithelial neoplasia (17.1%), and adenocarcinoma (11.4%). En bloc and complete resection rates were 96.2% and 81.0%, respectively. The curative resection rate was 64.8%. Adverse events occurred in six cases (5.7%). Endoscopic follow-up was performed for an average period of 29.7 months. CONCLUSION ESD performed by trained operators is feasible, safe, and clinically effective for managing superficial neoplastic lesions of the esophagus in Latin America.
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Affiliation(s)
- Josué Aliaga Ramos
- Department of Gastroenterology, “Jose Agurto Tello-Chosica” Hospital, Lima, Perú
- Digestive Endoscopy Unit of San Pablo Clinic, Lima, Perú
- Faculty of Medicine, Cayetano Heredia Peruvian University, Lima, Perú
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Reserch Center, Kobe, Japan
| | - Takashi Toyonaga
- Department of Gastroenterology, Kobe University International Clinical Cancer Reserch Center, Kobe, Japan
| | - Danilo Carvalho
- Endoscopy Unit, Alfa Institute of Gastroenterology, Belo Horizonte, Brazil
| | - Moises Salgado Pedrosa
- Pathology Department, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Laboratório CEAP, Belo Horizonte, Brazil
| | - Vitor N. Arantes
- Endoscopy Unit, Alfa Institute of Gastroenterology, School of Medicine, Federal University of Minas Gerais, Hospital Mater Dei Contorno, Belo Horizonte, Brazil
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Zheng J, Liu F, Zhang K, Xiang Y, Li L, Zhang H, Zhang Y, Suo N, Wang Z, Han C, Jin X, Wang M, Wei C, Chen J. High-power green-light laser endoscopic submucosal dissection for non-muscle-invasive bladder cancer: A technical improvement and its initial application. J Cancer Res Ther 2023; 19:945-950. [PMID: 37675721 DOI: 10.4103/jcrt.jcrt_674_22] [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: 09/08/2023]
Abstract
Background The technique of laser en bloc resection of bladder tumor (ERBT) has been a valuable alternative technique to transurethral resection of bladder tumor (TURBT). However, the combination of laser ERBT and endoscopic submucosal dissection (ESD) technique has not been well studied. Here, a novel technique integrating a high-power green-light laser with ESD was presented. This study aimed to evaluate the safety and efficacy of high-power green-light laser endoscopic submucosal dissection (HPL-ESD) for the treatment of primary non-muscle-invasive bladder cancer (NMIBC). Materials and Methods From January 2015 to December 2018, a total of 56 patients with NMIBC underwent HPL-ESD. All tumors were transurethral en bloc resected in the ESD technique. Perioperative clinical data were retrospectively collected and analyzed. Results All operations were safely performed by the technique of HPL-ESD without blood transfusion. The mean tumor diameter was 2.04 ± 0.65 cm, ranging from 0.5 to 3.5 cm. The mean operative time was 28.39 ± 16.04 min. The average serum hemoglobin decrease was 0.88 ± 0.54 g/dL. The mean postoperative catheterization time was 2.88 ± 0.94 days. The pathologic stages included pTa (32 cases), and pT1 (24 cases). Double-J stent indwelling was not performed for four patients whose tumors were adjacent to the ureteral orifice and no postoperative hydronephrosis was observed. Only one case of ectopic bladder tumor recurred due to irregular bladder irrigation during the 36-month follow-up. Conclusion HPL-ESD is a safe and effective alternative for the treatment of primary NMIBCs, especially for tumors adjacent to the ureteral orifice.
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Affiliation(s)
- Jilu Zheng
- Department of Urology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao; Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Feifan Liu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Keqin Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Yuzhu Xiang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Lianjun Li
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Haiyang Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Yinan Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Ning Suo
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Zilong Wang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Chenglin Han
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Xunbo Jin
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Muwen Wang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Chunxiao Wei
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
| | - Ji Chen
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandon First Medical University, Jinan, Shandong, China
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Xia SY, Lu Q, Wang ZJ, Gan T, Yang JL, Wang Z. Development and validation of a model to determine the risk of esophageal strictures after endoscopic submucosal dissection for esophageal neoplasms. Surg Endosc 2023; 37:2163-2172. [PMID: 36326932 DOI: 10.1007/s00464-022-09729-2] [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: 01/02/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Currently, endoscopic submucosal dissection (ESD) is widely used as therapeutic methods for superficial esophageal neoplasms (SENs). However, patients are likely to develop esophageal strictures after ESD. Our study aims to explore the possible risk factors for esophageal strictures after ESD and develop and validate a risk model for predicting the progression of postoperative esophageal strictures. METHODS Clinical data of patients who underwent ESD in our hospital for suspected early esophageal squamous cell carcinoma were collected from January 2014 to March 2020. The possible risk factors for postoperative esophageal strictures were analyzed by univariate and multivariate logistic regression analysis. Eventually, a risk-scoring model was built, in which 70% of patients were used to develop the model and the remaining 30% were used for validation. RESULTS A total of 553 patients who received ESD were involved, and the incidence of esophageal strictures after ESD was 16.6% (92/553). In our study, the operating time, circumferential range, lesion location, depth of infiltration, and R0 resection were independent risk factors for esophageal strictures after ESD. According to the risk of postoperative esophageal stenosis, a risk-scoring model for esophageal strictures prediction was developed. The risk score ranged from 0 to 11 points, and the risk scores were divided into low risk (0-3 points), intermediate risk (4-7 points), and high risk (8-11 points). The proportions of esophageal stenosis progression in the corresponding risk categories were 6.33%, 29.14%, and 100%. CONCLUSIONS We developed a risk-scoring model based on factors including circumferential range, lesion location, depth of infiltration, and R0 resection. It stratified patients into low-, intermediate-, and high-risk groups for postoperative esophageal strictures development. This scoring model may have the potential to guide the management of patients after ESD in the future.
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Affiliation(s)
- Si-Yuan Xia
- Department of Gastroenterology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Qing Lu
- Department of Gastroenterology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Zi-Jing Wang
- Department of Gastroenterology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tao Gan
- Department of Gastroenterology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jin-Lin Yang
- Department of Gastroenterology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Zhu Wang
- Department of Gastroenterology, West China Hospital of Sichuan University, 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Feng Y, Wei W, Guo S, Li BQ. Additional endoscopic treatments for patients with positive lateral margins after endoscopic resection of early esophageal squamous cell carcinoma. Oncol Lett 2023; 25:67. [PMID: 36644141 PMCID: PMC9827462 DOI: 10.3892/ol.2022.13653] [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: 08/16/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
There are currently no well-established treatment strategies for early esophageal squamous cell carcinoma (ESCC) for patients with only positive lateral margin (LM+) following endoscopic resection (ER). The present study aimed to find a treatment strategy for patients with early ESCC with non-curative resection (non-CR) and only LM+ following ER. In total, 511 patients with early ESCC treated at the Fourth Hospital of Hebei Medical University (Shijiazhuang, China) with ER were retrospectively analyzed, 41 of which (8%) were patients with only LM+ after non-CR. Of these, 28 patients received re-ER and 13 received additional surgical treatment. The clinicopathological characteristics of patients were analyzed and those who underwent additional surgery vs. re-ER were compared. Residual cancer cells were found in 27 patients (27/41, 65.9%) following re-ER or additional surgery. A significant increase in residual cancer cells was observed in patients with poorly differentiated cancer and patients with multiple LM+ (P=0.03 and P=0.015, respectively). Older patients and patients with single LM+ tended to choose re-ER (P=0.023 and P=0.038, respectively). In addition, there were three cases (3/13, 23.1%) of lymph node metastasis in the additional surgery group. However, within the limited follow-up time (mean, 36.1±24.1 months), no recurrence or metastasis was found in the remaining patients. The results showed that re-ER may be a more suitable additional therapy compared with surgery for patients with LM+ following non-CR, at least in the medium-term.
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Affiliation(s)
- Yong Feng
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Wei Wei
- Department of Outpatient, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Shuo Guo
- Department of Gastroenterology, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
| | - Bao-Qing Li
- Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
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Hatta W, Koike T, Abe H, Ogata Y, Saito M, Jin X, Kanno T, Uno K, Asano N, Imatani A, Masamune A. Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection. DEN OPEN 2022; 2:e60. [PMID: 35310735 PMCID: PMC8828199 DOI: 10.1002/deo2.60] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 12/15/2022]
Abstract
Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction-assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST-J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.
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Affiliation(s)
- Waku Hatta
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Tomoyuki Koike
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Hiroko Abe
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Yohei Ogata
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Masahiro Saito
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Xiaoyi Jin
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Takeshi Kanno
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Kaname Uno
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Naoki Asano
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Akira Imatani
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Atsushi Masamune
- Division of GastroenterologyTohoku University Graduate School of MedicineMiyagiJapan
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Lin N, Lin J, Gong J. Risk factors of postoperative stricture after endoscopic submucosal dissection for superficial esophageal neoplasms: A meta-analysis. Medicine (Baltimore) 2021; 100:e28396. [PMID: 34941174 PMCID: PMC8701733 DOI: 10.1097/md.0000000000028396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/21/2021] [Accepted: 11/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND As larger-sized superficial esophageal neoplasms became candidates for endoscopic submucosal dissection (ESD), post-ESD esophageal stricture has inevitably developed into a significant complication during long-term follow-up. METHOD The PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, as well as China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Biomedical Literature Database, were searched to identify all the appropriate studies published from January 2000 through October 2019. For risk factor assessment between postoperative stricture and control groups, pooled odds ratios (OR) and weighted mean differences (WMD) estimation was done. All meta-analytical procedures were conducted by using Stata version 15.1 software. RESULTS The results showed that 11 studies with 2248 patients (284 structure cases and 1964 controls) were eligible for this meta-analysis. Statistical results indicated 6 substantial risk factors: lesion characteristics involving the upper third of the esophagus (OR 1.51, [1.02-2.25]), macroscopic type of IIa/IIc (OR 2.76, [1.55-4.92]), tumor depth of invasion above m1 (OR 7.47, [3.31-16.86]), and m2 (OR 12.67, [4.00-40.10]), longitudinal length (WMD 13.75 mm, [7.76-19.74]), circumferential diameter (WMD 10.87 mm, [8.13-13.60]), and circumferential range >3/4 (OR 38.17, [9.94-146.52]). Each additional 10% of the circumferential range increased the risk of stricture by 149% (OR 9282.46, [978.14-88089.35]). CONCLUSIONS Six risk factors were assessed to have a key role in the elevated risk levels of post-ESD esophageal stricture. The results can help doctors identify patients with increased risk and thus can guide management of the adequate period of surveillance after ESD and take available approaches of stricture prevention.
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Hatta W, Koike T, Ogata Y, Kondo Y, Ara N, Uno K, Asano N, Imatani A, Masamune A. Comparison of Magnifying Endoscopy with Blue Light Imaging and Narrow Band Imaging for Determining the Invasion Depth of Superficial Esophageal Squamous Cell Carcinoma by the Japanese Esophageal Society's Intrapapillary Capillary Loop Classification. Diagnostics (Basel) 2021; 11:1941. [PMID: 34829288 PMCID: PMC8625194 DOI: 10.3390/diagnostics11111941] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/12/2021] [Accepted: 10/16/2021] [Indexed: 12/24/2022] Open
Abstract
Blue light imaging (BLI) and narrow-band imaging (NBI) are two modalities that enable narrow-band light observation. We aimed to compare the diagnostic ability of magnifying endoscopy with BLI (ME-BLI) and NBI (ME-NBI) for determining the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) by the Japanese Esophageal Society's intrapapillary capillary loop (IPCL) classification. We enrolled 81 patients between 2014 and 2018, and the still endoscopic images for diagnosing the invasion depth at the same part in ME-BLI and ME-NBI were registered. Two blinded investigators reviewed them and diagnosed the invasion depth by the IPCL classification. Subsequently, the diagnostic yields in two modalities were compared. The overall accuracies for the invasion depth by the IPCL classification in ME-BLI and ME-NBI did not differ significantly (67.9-71.6% vs. 72.8-74.1%). In the analysis based on the invasion depth, the sensitivities and positive predictive values in tumors invading the muscularis mucosa or submucosa ≤200 µm were low (23.1-30.8% and 16.7-25.0%, respectively) in both modalities. In conclusion, the diagnostic ability for determining the invasion depth of SESCC by the IPCL classification was relatively similar in ME-BLI and ME-NBI, but diagnosis by magnifying endoscopy alone might not be satisfactory.
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Affiliation(s)
- Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (T.K.); (Y.O.); (K.U.); (N.A.); (A.I.); (A.M.)
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (T.K.); (Y.O.); (K.U.); (N.A.); (A.I.); (A.M.)
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (T.K.); (Y.O.); (K.U.); (N.A.); (A.I.); (A.M.)
| | - Yutaka Kondo
- Division of Gastroenterology, Tohoku Rosai Hospital, 4-3-21 Dainohara, Aoba-ku, Sendai 981-8563, Japan;
| | - Nobuyuki Ara
- National Hospital Organization Sendai Medical Center, Department of Gastroenterology, 2-11-12 Miyagino, Miyagino-ku, Sendai 983-8520, Japan;
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (T.K.); (Y.O.); (K.U.); (N.A.); (A.I.); (A.M.)
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (T.K.); (Y.O.); (K.U.); (N.A.); (A.I.); (A.M.)
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (T.K.); (Y.O.); (K.U.); (N.A.); (A.I.); (A.M.)
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan; (T.K.); (Y.O.); (K.U.); (N.A.); (A.I.); (A.M.)
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10
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Abe H, Hatta W, Ogata Y, Koike T, Saito M, Jin X, Nakagawa K, Kanno T, Uno K, Asano N, Imatani A, Nakamura T, Nakaya N, Tarasawa K, Fujimori K, Fushimi K, Masamune A. Prevention of delayed bleeding with vonoprazan in upper gastrointestinal endoscopic treatment. J Gastroenterol 2021; 56:640-650. [PMID: 33876324 DOI: 10.1007/s00535-021-01781-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/17/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Delayed bleeding is the major adverse event in upper gastrointestinal endoscopic treatment (UGET). We aimed to investigate the efficacy of vonoprazan, which is the novel strong antisecretory agent, to reduce the risk for delayed bleeding in comparison with proton pump inhibitors (PPIs) in UGET. METHODS This retrospective population-based cohort study used the Diagnosis Procedure Combination database in Japan. We included patients on vonoprazan or PPI in UGET between 2014 and 2019. The primary outcome was delayed bleeding. We conducted propensity score matching to balance the comparison groups, and logistic regression analyses to compare the bleeding outcomes. RESULTS We enrolled 124,422 patients, in which 34,822 and 89,600 were prescribed with vonoprazan and PPI, respectively. After propensity score matching, the risk for delayed bleeding was lower in vonoprazan than in PPI (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.71-0.80), consistent with sensitivity analysis results. In the subgroup analyses of seven UGET procedures, vonoprazan was significantly advantageous in esophageal endoscopic submucosal dissection (E-ESD) (OR, 0.71; 95% CI, 0.54-0.94) and gastroduodenal endoscopic submucosal dissection (GD-ESD) (OR, 0.70; 95% CI, 0.65-0.75), although correction for multiple testing of the outcome data removed the significance in E-ESD. These results were also consistent with sensitivity analysis results. In the five other procedures, no significant advantage was found. CONCLUSIONS This nationwide study found that, compared with PPI, vonoprazan can reduce delayed bleeding with approximately 30% in GD-ESD. Vonoprazan has the possibility to become a new treatment method for preventing delayed bleeding in this procedure.
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Affiliation(s)
- Hiroko Abe
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kenichiro Nakagawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tomohiro Nakamura
- Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Naoki Nakaya
- Department of Health Sciences, Saitama Prefectural University, 820 Sannomiya, Koshigaya, Japan
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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11
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Song BG, Kim GH, Cho CJ, Kim HR, Min YW, Lee H, Min BH, Song HJ, Kim YH, Lee JH, Jung HY, Zo JI, Shim YM. Close Observation versus Additional Surgery after Noncurative Endoscopic Resection of Esophageal Squamous Cell Carcinoma. Dig Surg 2021; 38:247-254. [PMID: 33910202 DOI: 10.1159/000515717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/08/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION After noncurative endoscopic submucosal dissection (ESD) of superficial esophageal squamous cell carcinoma (SESCC), additional esophagectomy is generally recommended. However, considering its high mortality and morbidity, it is uncertain if additional surgery improves the clinical outcomes. This study aimed to compare the clinical outcomes between patients who were observed without additional treatment and those who underwent radical esophagectomy. METHODS A total of 52 patients with SESCC who underwent complete but noncurative ESD from January 2008 to December 2016 at the Samsung Medical Center and Asan Medical Center in Korea were retrospectively analyzed. Clinicopathologic characteristics and oncologic outcomes were compared between the observation group (n = 23) and the additional surgery group (n = 29). RESULTS During a mean follow-up of 34.4 and 41.7 months, respectively, the rates of death (observation vs. surgery, 17.4 vs. 10.3%; p = 0.686), recurrence (observation vs. surgery, 13 vs. 17.2%; p = 1.000), and disease-specific death (observation vs. surgery, 4.3 vs. 6.9%; p = 1.000) did not significantly differ between the 2 groups. The 3-year overall survival was 86.3 and 96.4%, respectively (p = 0.776). The 3-year recurrence-free survival (observation vs. surgery, 85.0 vs. 88.7%; p = 0.960) and disease-specific survival (observation vs. surgery, 95.2 vs. 96.4%; p = 0.564) also did not significantly differ. CONCLUSIONS The clinical outcomes of close observation of noncuratively resected SESCC are comparable to those of additional surgery, at least in the midterm. The wait-and-see strategy could be a feasible management option after noncurative ESD of SESCC in selected patients.
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Affiliation(s)
- Byeong Geun Song
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ga Hee Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Charles J Cho
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
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12
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Chen H, Zhou X, Tang X, Li S, Zhang G. Prediction of Lymph Node Metastasis in Superficial Esophageal Cancer Using a Pattern Recognition Neural Network. Cancer Manag Res 2020; 12:12249-12258. [PMID: 33273861 PMCID: PMC7707435 DOI: 10.2147/cmar.s270316] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022] Open
Abstract
Background or Purpose It is important to predict nodal metastases in patients with early esophageal cancer to stratify patients for endoscopic resection or esophagectomy. This study was to establish a novel artificial neural network (ANN) and assess its ability by comparing it with a traditional logistic regression (LR) model for predicting lymph node (LN) metastasis in patients with superficial esophageal squamous cell carcinoma (SESCC). Methods A primary cohort was established, composed of 733 patients who underwent esophagectomy for SESCC from December 2012 to December 2019. The following steps were applied: (i) predictor selection; (ii) development of an ANN and a LR model, respectively; (iii) cross-validation; and (iv) evaluation of performance between the two models. The diagnostic assessment was performed with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results The established ANN model had 6 significant predictors: a past habit of alcohol taking, tumor size, submucosal invasion, histologic grade, lymph-vessel invasion, and preoperative CT result. The ANN model performed better than the LR model in specificity (91.20% vs 72.59%, p=0.006), PPV (56.49% vs 39.78%, p=0.020), accuracy (90.72% vs 74.49%, p<0.0001), C-index (91.5% vs 86.8%, p<0.001), and IDI (improved by 23.3%, p<0.001). There were no differences between these two models in sensitivity (87.06% vs 83.21%, p=0.764), NPV (98.17% vs 95.21%, p=0.627), and NRI (improved by −1.1%, p=0.824). Conclusion This ANN model is superior to the LR model and may become a valuable tool for the prediction of LN metastasis in patients with SESCC.
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Affiliation(s)
- Han Chen
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaoying Zhou
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xinyu Tang
- The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China.,Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Shuo Li
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
| | - Guoxin Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.,The First Clinical Medical College, Nanjing Medical University, Nanjing, People's Republic of China
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13
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Yeh JH, Huang RY, Lee CT, Lin CW, Hsu MH, Wu TC, Hsiao PJ, Wang WL. Long-term outcomes of endoscopic submucosal dissection and comparison to surgery for superficial esophageal squamous cancer: a systematic review and meta-analysis. Therap Adv Gastroenterol 2020; 13:1756284820964316. [PMID: 33224272 PMCID: PMC7656883 DOI: 10.1177/1756284820964316] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023] Open
Abstract
AIM The aim of this study was to investigate the long-term outcomes of endoscopic submucosal dissection (ESD) for superficial esophageal squamous cancer. METHODS A literature search was conducted using PubMed, ProQuest and Cochrane Library databases. Primary outcomes were overall survival, disease-specific survival and recurrence-free survival at 5 years. Secondary outcomes included adverse events, recurrence and metastasis. Hazard ratios were calculated based on time to events for survival analysis, and odds radios were used to compare discrete variables. RESULTS A total of 3796 patients in 21 retrospective studies, including 5 comparative studies for ESD and esophagectomy were enrolled. The invasion depth was 52.0% for M1-M2, 43.2% for M3-SM1 and 4.7% for SM2 or deeper. The 5-year survival rate was: overall survival 87.3%, disease-specific survival 97.7%, and recurrence-free survival 85.1%, respectively. Pooled local recurrence of ESD was 1.8% and metastasis was 3.3%. In terms of the comparison between ESD and esophagectomy, there was no difference in the overall survival (86.4% versus 81.8%, hazard ratio = 0.66, 95% CI = 0.39-1.11) as well as disease-specific and recurrence-free survival. In addition, ESD was associated with fewer adverse events (19.8 % versus 44.0%, odds ratio = 0.3, 95% CI = 0.23-0.39). CONCLUSIONS For superficial esophageal squamous cancer, ESD may be considered as the primary treatment of for mucosal lesions, and additional treatment should be available for submucosal invasive cancers.
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Affiliation(s)
- Jen-Hao Yeh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan,Department of Medical technology, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Ru-Yi Huang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan,Department of Family Medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Ching-Tai Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Wen Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan,Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan
| | - Ming-Hung Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Tsung-Chin Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan,Department of Medical technology, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Jen Hsiao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan
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14
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Hatta W, Gotoda T, Koike T, Masamune A. Management following endoscopic resection in elderly patients with early-stage upper gastrointestinal neoplasia. Dig Endosc 2020; 32:861-873. [PMID: 31802529 DOI: 10.1111/den.13592] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/02/2019] [Indexed: 02/06/2023]
Abstract
With the ongoing increase in the aging population in Japan, the number of elderly patients among the total population with upper gastrointestinal (GI) neoplasia has also been increasing. As elderly patients present unique age-related variations in their physical condition, the therapeutic approach for upper GI neoplasia should be differentiated between elderly and nonelderly patients. According to the existing guidelines, additional treatment is the standard therapy in patients who undergo endoscopic resection (ER) with a possible risk of lymph node metastasis (LNM) for upper GI neoplasia. However, due to the relatively low rate of LNM, applying additional treatment in all elderly patients may be excessive. Although additional treatment has the advantage of reducing cancer-specific mortality, its disadvantages include deteriorated quality of life, complications, and mortality in surgery. In patients with early gastric cancer, we propose treatment decisions be made using a risk-scoring system for LNM and upon considering the physical condition of the patient after ER with curability C-2. In those with superficial esophageal squamous cell carcinoma with a possible risk of LNM after ER, selective chemoradiotherapy may be a less-invasive treatment option, although the present standard treatment is esophagectomy. When considering the treatment decision, achieving a "cure" of the tumor has been regarded as critical. However, as the main cause of mortality in elderly patients with ER for upper GI neoplasia is noncancer-related death, both achieving a "cure" and also a good level of "care" is important in the management of elderly patients.
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Affiliation(s)
- Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Miyagi, Japan
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15
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Endoscopic resection of early squamous neoplasia of the oesophagus: long-term follow-up in a UK population from a tertiary hospital. Eur J Gastroenterol Hepatol 2020; 32:789-796. [PMID: 32302087 DOI: 10.1097/meg.0000000000001692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To review the efficacy and outcomes of endoscopic resection in the diagnosis and treatment of oesophageal squamous dysplasia and early neoplasia. METHODS This was a retrospective study between May 2012-2018. Twenty-one patients were treated with or considered for treatment with endoscopic resection at a tertiary hospital in the UK. The primary outcome was curative resection, defined as histologically proven complete resection of the lesion with deep/vertical margin ≥1 mm from neoplasia. Secondary outcomes were changes in staging from endoscopic resection histology, whether there was a complete reversal of dysplasia at 12-months or the latest endoscopic follow-up and 5-year overall survival rate. RESULTS Seventeen patients (mean age = 66.5 years) with 20 lesions (35% en-bloc; 65% piecemeal resections) had endoscopic resection performed. Complete resection was achieved in 90% of lesions by endoscopic criteria, but this was confirmed in fewer lesions histologically. Curative resection was achieved histologically in 60% of lesions (11 patients) and noncurative resection in 40% of lesions (6 patients). Changes in staging from endoscopic resection histology were found in 79.2% of lesions (41.7% upstaged; 37.5% downstaged). No patients were found to have recurrence at their 12-month endoscopic follow-up. Eight of the 11 patients (72.7%) with curative resection remained clear of dysplasia/neoplasia throughout their follow-up (mean, 24.3 months; median, 19 months). The five-year overall survival rate was 64%. CONCLUSION In UK, endoscopic resection is useful in the management of early squamous neoplasia both for staging and (by piecemeal endoscopic resection in elderly unfit) for medium- to long-term disease clearance.
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16
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17
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Gong EJ, Kim DH. Endoscopic Treatment for Esophageal Cancer. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2019. [DOI: 10.7704/kjhugr.2019.19.3.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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18
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Lorenzo D, Barret M, Leblanc S, Terris B, Beuvon F, Coriat R, Chaussade S, Prat F. Outcomes of endoscopic submucosal dissection for early oesophageal squamous cell neoplasia at a Western centre. United European Gastroenterol J 2019; 7:1084-1092. [PMID: 31662865 DOI: 10.1177/2050640619852260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/28/2019] [Indexed: 01/11/2023] Open
Abstract
Background and aims Endoscopic submucosal dissection is the reference treatment for early oesophageal squamous cell carcinoma. However, data from Western centres are scarce. Methods We conducted a retrospective study from a prospectively collected database at a tertiary care centre in France. All consecutive patients undergoing endoscopic submucosal dissection for oesophageal squamous cell carcinoma were included. The main outcome was the curative resection rate. Secondary outcomes were en-bloc resection rates, histologically complete resection rates, morbidity, recurrence-free and overall survival. Results Fifty-six cases of oesophageal squamous cell carcinoma (49 patients; mean age 61.5 ± 10 years; 36 men) were included. En-bloc, histologically complete and curative resection rates were 98%, 86% and 71%, respectively. Fifteen (30%) patients received an additional treatment after endoscopic submucosal dissection, nine treated by chemoradiotherapy, four by surgery and two by further endoscopic submucosal dissection. Within a mean follow-up of 21 ± 15 months, recurrences occurred in 14 (29%) patients (four local, eight metachronous and three distant recurrences). Eight patients died during follow-up, of which two (4%) patients died from oesophageal squamous cell carcinoma. Factors significantly associated with mortality in this series were: moderate or poor differentiation of oesophageal squamous cell carcinoma (p = 0.02) and recurrence of oesophageal squamous cell carcinoma (p = 0.028). Conclusion Moderately or poorly differentiated cancer is a major prognostic factor and should probably be taken into account when indicating an additional treatment after endoscopic submucosal dissection. Close endoscopic follow-up is essential considering the high recurrence rate.
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Affiliation(s)
- Diane Lorenzo
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France
| | - Maximilien Barret
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
| | - Sarah Leblanc
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France
| | - Benoit Terris
- Faculté Paris Descartes, Paris, France.,Pathology Department, Cochin Hospital, Paris, France
| | - Frédéric Beuvon
- Faculté Paris Descartes, Paris, France.,Pathology Department, Cochin Hospital, Paris, France
| | - Romain Coriat
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
| | - Stanislas Chaussade
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
| | - Frédéric Prat
- Gastroenterology Department, Cochin Hospital - APHP, Paris, France.,Faculté Paris Descartes, Paris, France
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19
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Choi SI, Park JC. Commentary on "Efficacy of Endoscopic Submucosal Dissection of Esophageal Neoplasms under General Anesthesia". Clin Endosc 2019; 52:205-206. [PMID: 31117338 PMCID: PMC6547344 DOI: 10.5946/ce.2019.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/03/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Soo In Choi
- Division of Gastroenterology, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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20
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Endoscopic Submucosal Single- or Multi-tunnel Dissection for Near-Circumferential and Circumferential Superficial Esophageal Neoplastic Lesions. Gastroenterol Res Pract 2019; 2019:2943232. [PMID: 30992701 PMCID: PMC6434308 DOI: 10.1155/2019/2943232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 12/29/2018] [Accepted: 02/07/2019] [Indexed: 02/05/2023] Open
Abstract
This study reports the outcomes of endoscopic submucosal single-tunnel dissection or endoscopic submucosal multi-tunnel dissection for the treatment of esophageal neoplastic lesions of at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions. From July 2014 to February 2018, a total of 124 lesions underwent endoscopic submucosal tunnel dissection at our hospital. One to four submucosal tunnels were created in the oral to anal direction. Of the 124 lesions, there were 83 noncomplete circumferential lesions and 41 circumferential lesions. Endoscopic submucosal single-tunnel dissection was performed in 54 patients, two-tunnel dissection in 43 patients, three-tunnel dissection in 19 patients, and four-tunnel dissection in 8 patients. The mean dissection speed was 22.8 ± 12.7 mm2/min. En bloc dissection was achieved in all lesions, and the R0 resection rate was 70.2 percent. No matter how large the lesion area was, there were no significant differences in the dissection speed and the R0 resection rate when lesions were at least three-quarters of the esophageal circumference. Esophageal stricture was observed in 54 patients and was relieved by placement of a retrievable metal stent or by endoscopic water balloon dilation. No recurrence was noted after 19.1 ± 12.4 months of follow-up. Our large sample size study showed that endoscopic submucosal tunnel dissection showed effectiveness and safety for the treatment of large superficial esophageal neoplastic lesions at least three-quarters of the esophageal circumference, including circumferential superficial esophageal neoplastic lesions.
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21
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Suzuki G, Yamazaki H, Aibe N, Masui K, Sasaki N, Shimizu D, Kimoto T, Shiozaki A, Dohi O, Fujiwara H, Ishikawa T, Konishi H, Naito Y, Otsuji E, Yamada K. Endoscopic submucosal dissection followed by chemoradiotherapy for superficial esophageal cancer: choice of new approach. Radiat Oncol 2018; 13:246. [PMID: 30547811 PMCID: PMC6295044 DOI: 10.1186/s13014-018-1195-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 12/02/2018] [Indexed: 12/11/2022] Open
Abstract
Background The standard treatment for superficial esophageal cancer (SEC) involving muscularis mucosal (T1a-MM) or submucosal (T1b) invasion has been the surgical resection of the esophagus. However, esophagectomy with extended lymph node dissection is highly invasive. Recent reports have shown that endoscopic submucosal dissection (ESD) followed by chemoradiotherapy (CRT) has promising results and might become a new therapeutic approach. This retrospective study aimed to elucidate the efficacy and safety of this new treatment. Methods Patients with clinical stage T1b tumor without apparent metastasis treated with ESD followed by CRT from 2014 to 2017 (the CRT group) were included. The outcomes on disease-free survival (DFS) of this group were compared with those of consecutive patients in a historical control group who underwent ESD followed by esophagectomy (the esophagectomy group) between 2008 and 2015. Results Of 32 patients analyzed, 16 were in the CRT group and 16 with similar stage cancer were in the esophagectomy group. Radiotherapy was completed in all patients, and the incidence of grade ≥ 3 nonhematologic adverse events was 6%. The 2-year overall survival rates were 100%, and locoregional control was achieved in all patients in the CRT group, and the 2-year DFS rates were 88 and 100% for the CRT and esophagectomy groups, respectively, without significant differences. Conclusions Our data confirmed our new approach as being safe and effective for locoregional control and may provide a nonsurgical treatment option for patients with clinical stage T1b tumors.
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Affiliation(s)
- Gen Suzuki
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Norihiro Aibe
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naomi Sasaki
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Daisuke Shimizu
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takuya Kimoto
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Atsushi Shiozaki
- Department of Digestive Surgery, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Gastroenterology and Hepatology, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hitoshi Fujiwara
- Department of Digestive Surgery, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Ishikawa
- Department of Gastroenterology and Hepatology, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hirotaka Konishi
- Department of Digestive Surgery, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuji Naito
- Department of Gastroenterology and Hepatology, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Eigo Otsuji
- Department of Digestive Surgery, Kyoto prefectural university Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Hazama H, Tanaka M, Kakushima N, Yabuuchi Y, Yoshida M, Kawata N, Takizawa K, Ito S, Imai K, Hotta K, Ishiwatari H, Matsubayashi H, Mori K, Ono H. Predictors of technical difficulty during endoscopic submucosal dissection of superficial esophageal cancer. Surg Endosc 2018; 33:2909-2915. [DOI: 10.1007/s00464-018-6591-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 11/13/2018] [Indexed: 12/13/2022]
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Cho JY, Cheung DY, Kim TJ, Kim JK. A Case of Esophageal Squamous Cell Carcinoma in situ Arising from Esophageal Squamous Papilloma. Clin Endosc 2018; 52:72-75. [PMID: 30021250 PMCID: PMC6370924 DOI: 10.5946/ce.2018.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/14/2018] [Indexed: 12/20/2022] Open
Abstract
Squamous papilloma is a common benign tumor of the esophagus. Patients with papilloma are usually asymptomatic, and they are diagnosed incidentally during esophagogastroduodenoscopy. Most papillomas are small and easily removed by forceps biopsy. Recurrence of papilloma after removal is rare. Human papilloma virus infection is supposed to play a role in the development of esophageal papilloma; however, malignant transformation of papilloma is extremely unusual. Here, we report a case of malignant transformation of esophageal squamous papilloma at the gastroesophageal junction into squamous cell carcinoma in situ, which was treated by endoscopic submucosal dissection.
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Affiliation(s)
- Jae Yeong Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dae Young Cheung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Tae Jung Kim
- Department of Hospital Pathology, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Kwang Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Song BG, Min YW, Cha RR, Lee H, Min BH, Lee JH, Rhee PL, Kim JJ. Endoscopic submucosal dissection under general anesthesia for superficial esophageal squamous cell carcinoma is associated with better clinical outcomes. BMC Gastroenterol 2018; 18:80. [PMID: 29879909 PMCID: PMC5992637 DOI: 10.1186/s12876-018-0813-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/31/2018] [Indexed: 02/06/2023] Open
Abstract
Background Endoscopic submucosal dissection (ESD) has been widely accepted for treating superficial esophageal squamous cell carcinoma (SESCC). The aim of this study was to evaluate the efficacy and safety of ESD for SESCC and the effect of different sedation methods on their clinical outcomes. Methods We retrospectively analyzed a total of 169 patients (175 lesions) who underwent ESD for SESCC at Samsung Medical Center, Seoul, South Korea. Short-term and long-term clinical outcomes were evaluated and compared according to the sedation method (conscious sedation [CS] vs general anesthesia [GA]). Results En bloc resection, complete resection, and curative resection (CuR) were achieved in 93.7, 74.9, and 58.9% of cancers, respectively. Perforation and stricture occurred in 8.0 and 12.0% of lesions, respectively. During a mean follow-up period of 33.7 months for survival, 3 (3.0%) patients died without evidence of recurrence after achieving CuR. During a mean follow-up period of 32.5 months for recurrence, 1 (1.0%) patient experienced lymph node metastasis. Synchronous and metachronous cancer were found in 1.0% and in 3.0% of patients, respectively. Multivariate analysis revealed that GA was associated with a higher complete resection rate and a lower perforation rate as compared to CS (odds ratio 3.401, 95% confidence interval 1.317–8.785, P = 0.011 and odds ratio 0.067, 95% confidence interval 0.006–0.775, P = 0.030, respectively). Conclusions ESD is an oncologically effective treatment modality for SESCC, particularly when CuR is achieved. Applying GA for esophageal ESD could improve the clinical outcomes of ESD in patients with SESCC.
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Affiliation(s)
- Byeong Geun Song
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Ra Ri Cha
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
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Wang WP, Ni PZ, Yang JL, Wu JC, Yang YS, Chen LQ. Esophagectomy after endoscopic submucosal dissection for esophageal carcinoma. J Thorac Dis 2018; 10:3253-3261. [PMID: 30069321 DOI: 10.21037/jtd.2018.05.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Endoscopic submucosal dissection (ESD) has been used to treat early stage esophageal cancer, but reports about additional esophagectomy after ESD and postoperative outcomes are lacking. Complete removal of cancer tissue together with lymph nodes was the advantage of esophagectomy; however, invasiveness, organ loss, postoperative complications, and worse postoperative quality of life were serious disadvantages. The purpose of this study was to find the clear indication of additional esophagectomy after ESD, and help the other patients avoid excessive surgery. Methods We reviewed the clinicopathologic data and outcomes consecutive patients who had esophageal cancer confirmed by endoscopic biopsy and who were treated with ESD and subsequent esophagectomy between October 2011 and December 2016 in our department. The esophagectomy necessity following ESD was defined and the groups with necessity (+) vs. (-) were compared retrospectively. The esophagectomy necessity outcomes were retrospectively analyzed to judge whether the surgery option was correct. Results Total 214 patients with esophageal and esophagogastric cancer have undergone ESD treatment in our center, of which 32 patients (23 men and 9 women; mean age, 60±8 years) ultimately required esophagectomy after ESD. All patients had complete resection (R0) from esophagectomy. Postoperative TNM staging included TisN0M0 (6 patients), T1aN0M0 (6 patients), T1bN0M0 (18 patients), T1bN1M0 (1 patient), and T2N3M0 (1 patient). Necessity of esophagectomy after ESD was associated with residual margin status. There was a significant difference in ESD specimen margin status between the esophagectomy necessity (+) vs. (-) groups (positive/negative margin: 8/3 vs. 2/9 patients; P=0.03). Esophagectomy should be delayed at least 30 days after ESD to enable resolution of esophageal edema (P=0.017) (206±68 vs. 163±56 mL, P=0.057). Median follow-up was 16.8 months (range, 11.2-54.5 months); 3 patients were lost to follow-up (9%) and 1 patient died of metastasis after esophagectomy. All other patients were alive with excellent postoperative disease-free survival. Conclusions Indications for esophagectomy after ESD include ESD failure, cancer recurrence, esophageal rupture, esophageal stricture refractory to endoscopic dilation, and residual tumor at the ESD specimen margin. Stage T1b alone is not an indication for esophagectomy. According to our study, we recommend that esophagectomy should be delayed ≥30 dafter ESD unless urgent esophagectomy is indicated.
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Affiliation(s)
- Wen-Ping Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Peng-Zhi Ni
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin-Lin Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jun-Chao Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
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26
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Lee JW, Cho CJ, Kim DH, Ahn JY, Lee JH, Choi KD, Song HJ, Park SR, Lee HJ, Kim YH, Lee GH, Jung HY, Kim SB, Kim JH, Park SI. Long-Term Survival and Tumor Recurrence in Patients with Superficial Esophageal Cancer after Complete Non-Curative Endoscopic Resection: A Single-Center Case Series. Clin Endosc 2018; 51:470-477. [PMID: 29860747 PMCID: PMC6182292 DOI: 10.5946/ce.2018.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/25/2018] [Indexed: 01/11/2023] Open
Abstract
Background/Aims To report the long-term survival and tumor recurrence outcomes in patients with superficial esophageal cancer (SEC) after complete non-curative endoscopic resection (ER).
Methods We retrieved ER data for 24 patients with non-curatively resected SEC. Non-curative resection was defined as the presence of submucosal and/or lymphovascular invasion on ER pathology. Relevant clinical and tumor-specific parameters were reviewed.
Results The mean age of the 24 study patients was 66.3±8.3 years. Ten patients were closely followed up without treatment, while 14 received additional treatment. During a mean follow-up of 59.0±33.2 months, the 3- and 5-year survival rates of all cases were 90.7% and 77.6%, respectively. The 5-year overall survival rates were 72.9% in the close observation group and 82.1% in the additional treatment group (p=0.958). The 5-year cumulative incidences of all cases of recurrence (25.0% vs. 43.3%, p=0.388), primary EC recurrence (10.0% vs. 16.4%, p=0.558), and metachronous EC recurrence (16.7% vs. 26.7%, p=0.667) were similar between the two groups.
Conclusions Patients with non-curatively resected SEC showed good long-term survival outcomes. Given the similar oncologic outcomes, close observation may be an option with appropriate caution taken for patients who are medically unfit to receive additional therapy.
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Affiliation(s)
- Ji Wan Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Charles J Cho
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sook Ryun Park
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Joo Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yong Hee Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Bae Kim
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Hoon Kim
- Department of Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Min YW. [Endoscopic Treatment for Esophageal Cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:116-123. [PMID: 29566472 DOI: 10.4166/kjg.2018.71.3.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Esophageal cancer incidence rate per 100,000 is 4.7 in 2013, which accounts for 1.1% of the total cancer incidence in Korea. Superficial esophageal squamous cell carcinoma is frequently detected in persons undergoing upper endoscopy for gastrointestinal symptoms or for gastric cancer screening. Esophagectomy with lymph node dissection is the standard treatment for esophageal cancer. However, given the considerable morbidity and mortality of esophagectomy, endoscopic resection has become the standard of care for most cases of superficial esophageal squamous cell carcinoma without metastasis. In addition, endoscopic submucosal dissection has increased the cure rate, even when the tumor is large, compared to endoscopic mucosal resection. Thus, endoscopic submucosal dissection is the treatment of choice for superficial esophageal squamous cell carcinoma with a negligible risk of lymph node metastasis. Endoscopic resection is usually associated with a low risk of morbidity and no mortality, and has also shown favorable long-term outcomes. However, the long-term risk of metastasis remains after endoscopic resection, which varies according to the characteristics of tumor. This review describes the indication and outcomes of endoscopic resection, complications of endoscopic resection, and management after treatment.
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Affiliation(s)
- Yang Won Min
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ma DW, Youn YH, Jung DH, Park JJ, Kim JH, Park H. Risk factors of electrocoagulation syndrome after esophageal endoscopic submucosal dissection. World J Gastroenterol 2018; 24:1144-1151. [PMID: 29563758 PMCID: PMC5850133 DOI: 10.3748/wjg.v24.i10.1144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate post endoscopic submucosal dissection electrocoagulation syndrome (PEECS) of the esophagus. METHODS We analyzed 55 consecutive cases with esophageal endoscopic submucosal dissection for superficial esophageal squamous neoplasms at a tertiary referral hospital in South Korea. Esophageal PEECS was defined as "mild" meeting one of the following criteria without any obvious perforation: fever (≥ 37.8 °C), leukocytosis (> 10800 cells/μL), or regional chest pain more than 5/10 points as rated on a numeric pain intensity scale. The grade of PEECS was determined as "severe" when meet two or more of above criteria. RESULTS We included 51 cases without obvious complications in the analysis. The incidence of mild and severe esophageal PEECS was 47.1% and 17.6%, respectively. Risk factor analysis revealed that resected area, procedure time, and muscle layer exposure were significantly associated with PEECS. In multivariate analysis, a resected area larger than 6.0 cm2 (OR = 4.995, 95%CI: 1.110-22.489, P = 0.036) and muscle layer exposure (OR = 5.661, 95%CI: 1.422-22.534, P = 0.014) were independent predictors of esophageal PEECS. All patients with PEECS had favorable outcomes with conservative management approaches, such as intravenous hydration or antibiotics. CONCLUSION Clinicians should consider the possibility of esophageal PEECS when the resected area exceeds 6.0 cm2 or when the muscle layer exposure is noted.
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Affiliation(s)
- Dae Won Ma
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Young Hoon Youn
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Jae Jun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
| | - Hyojin Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
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Wang S, Huang Y, Xie J, Zhuge L, Shao L, Xiang J, Zhang Y, Sun Y, Hu H, Chen S, Lerut T, Luketich JD, Zhang J, Chen H. Does delayed esophagectomy after endoscopic resection affect outcomes in patients with stage T1 esophageal cancer? A propensity score-based analysis. Surg Endosc 2018; 32:1441-1448. [PMID: 28916920 DOI: 10.1007/s00464-017-5830-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 08/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although endoscopic resection (ER) may be sufficient treatment for early-stage esophageal cancer, additional treatment is recommended when there is a high risk of cancer recurrence. It is unclear whether delaying esophagectomy by performing and assessing the success of ER affects outcomes as compared with immediate esophagectomy without ER. Additionally, long-term survival after sequential ER and esophagectomy required further investigation. METHODS Between 2011 and 2015, 48 patients with stage T1 esophageal cancer underwent esophagectomy after ER with curative intent at our institution. Two-to-one propensity score methods were used to identify 96 matched-control patients who were treated with esophagectomy only using baseline patient, tumor characteristics and surgical approach. Time from initial evaluation to esophagectomy, relapse-free survival, overall survival, and postoperative complications were compared between the propensity-matched groups. RESULTS In the ER + esophagectomy group, the time from initial evaluation to esophagectomy was significantly longer than in the esophagectomy only group (114 vs. 8 days, p < 0.001). The incidence of dense adhesion (p = 0.347), operative time (p = 0.867), postoperative surgical complications (p = 0.966), and postoperative length of hospital stay (p = 0.125) were not significantly different between the groups. Moreover, recurrence-free survival and overall survival were also similar between the two groups (p = 0.411 and p = 0.817, respectively). CONCLUSIONS Treatment of stage T1 esophageal cancer with ER prior to esophagectomy did not increase the difficulty of performing esophagectomy or the incidence of postoperative complications and did not affect survival after esophagectomy. These results suggest that ER can be recommended for patients with stage T1 cancer even if esophagectomy is warranted eventually.
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Affiliation(s)
- Shengfei Wang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yangle Huang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Juntao Xie
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lingdun Zhuge
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Longlong Shao
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yawei Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sufeng Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Louvain, Belgium
| | - James D Luketich
- Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jie Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China.
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Tao Z, Yan C, Zhao H, Tsauo J, Zhang X, Qiu B, Zhao Y, Li X. Comparison of endoscopic ultrasonography and magnifying endoscopy for assessment of the invasion depth of shallow gastrointestinal neoplasms: a systematic review and meta-analysis. Surg Endosc 2017; 31:4923-4933. [PMID: 28547665 DOI: 10.1007/s00464-017-5596-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/11/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To conduct a meta-analysis to provide accurate evidence regarding the preferred diagnostic method, magnifying endoscopy (ME) or endoscopic ultrasonography (EUS), for assessment of the depth of invasion of the gastrointestinal neoplasms. METHODS PubMed, EMBASE, Ovid Medline, and the Cochrane Library databases were searched for studies published between January 1946 and October 2016, regarding the use of EUS and ME to assess the invasion depth of gastrointestinal cancers. The quality of diagnostic studies was evaluated using the QUADAS2 instrument. The Meta-DiSc software (version 1.4) was used for meta-analysis of the pooled data regarding the diagnostic accuracy of EUS and ME of the invasion depth of gastrointestinal neoplasms. RESULTS Our meta-analysis included the data of 754 patients with gastrointestinal cancers contributed by seven prospective studies. All studies were of high quality (QUADAS2). The receiver operating characteristic (ROC) planes were not observed in shoulder and arm forms for either EUS or ME, with Spearman's correlation coefficients of -0.821 and 0.234 for EUS and ME, respectively. The p values of the diagnostic odds ratio for EUS and ME were 0.0038 and 0.0131, respectively. The sensitivity and specificity of EUS for the diagnosis of the depth of invasion of gastrointestinal cancers were 0.75 (95% CI 0.69-0.81) and 0.84 (95% CI 0.79-0.88), respectively. In comparison, the sensitivity and specificity for ME were 0.74 (95% CI 0.67-0.69) and 0.85 (95% CI 0.80-0.89), respectively. The values of area under the summary ROC (SROC) curves for EUS and ME were 0.8499 and 0.8757, respectively, with a non-significant Z value between EUS and MR (0.296 < 1.96). CONCLUSIONS Both EUS and ME provide a comparable performance for judging the depth of invasion of gastrointestinal neoplasms. However, there is heterogeneity between studies contributed by non-threshold effects.
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Affiliation(s)
- Zhang Tao
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
- Department of Gastroenterology, Jing Men No.2 People's Hospital, Jingchu Center Hospital Affiliated to Institute of Technology, Jing Men City, 448000, Hubei, China
| | - Chen Yan
- Department of Gastroenterology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 637000, Sichuan, China
| | - He Zhao
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Jiawei Tsauo
- Department of Radiology and Interventional Therapy, West China Hospital, Sichuan University, Chengdu, 637000, Sichuan, China
| | - Xiaowu Zhang
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Bing Qiu
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Yanqing Zhao
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100021, China.
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Shimamura Y, Ikeya T, Marcon N, Mosko JD. Endoscopic diagnosis and treatment of early esophageal squamous neoplasia. World J Gastrointest Endosc 2017; 9:438-447. [PMID: 28979708 PMCID: PMC5605343 DOI: 10.4253/wjge.v9.i9.438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/14/2017] [Accepted: 08/17/2017] [Indexed: 02/06/2023] Open
Abstract
Esophageal cancer is one of the leading causes of cancer-related death and is associated with high morbidity and mortality. It carries a poor prognosis as more than half of patients present with advanced and unresectable disease. One contributing factor is the increased risk of lymph node metastases at early stages of disease. As such, it is essential to detect squamous cell neoplasia (SCN) at an early stage. In order to risk stratify lesions, endoscopists must be able to perform image enhanced endoscopy including magnification and Lugol’s chromoendoscopy. The assessment of both the horizontal extent and depth of any lesion is also of utmost importance prior to treatment. Endoscopic mucosal resection and submucosal dissection remain the standard of care with literature supportive their respective use. Radiofrequency ablation and other endoscopic treatments are currently available although should not be considered first line at this time. Our objective is to review the current options for the endoscopic diagnosis and treatment of esophageal SCN.
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Affiliation(s)
- Yuto Shimamura
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B1W8, Canada
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke’s International Hospital, Tokyo 104-8560, Japan
| | - Norman Marcon
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B1W8, Canada
| | - Jeffrey D Mosko
- Division of Gastroenterology, St. Michael’s Hospital, University of Toronto, Toronto, ON M5B1W8, Canada
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Song BG, Min YW, Lee JH, Lee H, Min BH, Rhee PL, Kim JJ. Efficacy and safety of endoscopic submucosal dissection in elderly patients with esophageal squamous cell carcinoma. Surg Endosc 2017; 31:3905-3911. [DOI: 10.1007/s00464-017-5421-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/20/2017] [Indexed: 12/16/2022]
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Gong EJ, Jung HY. Endoscopic Submucosal Dissection for Superficial Esophageal Neoplasm: A Growing Body of Evidence. Clin Endosc 2016; 49:101-3. [PMID: 26983549 PMCID: PMC4821517 DOI: 10.5946/ce.2016.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 03/05/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Eun Jeong Gong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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