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Xu M, Xu K, Peng W, Ge J, Wang N, Yu G, Wu Y, Zeng J. Hydrogels in Endoscopic Submucosal Dissection for Gastrointestinal Cancers. Acta Biomater 2025:S1742-7061(25)00368-X. [PMID: 40409509 DOI: 10.1016/j.actbio.2025.05.043] [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: 02/11/2025] [Revised: 04/23/2025] [Accepted: 05/20/2025] [Indexed: 05/25/2025]
Abstract
Endoscopic Submucosal Dissection (ESD) has emerged as a pivotal technique for the minimally invasive treatment of early gastrointestinal cancers, offering benefits such as reduced trauma, lower complication rates, and cost-effectiveness. Despite its advantages, the selection of optimal biomaterials for submucosal injection poses significant challenges. Current materials used in clinical settings often suffer from rapid diffusion, requiring multiple injections and potentially causing localized inflammation. These issues underscore the importance of identifying more effective submucosal injection materials to minimize postoperative complications and enhance patient outcomes. Recent advancements have highlighted the potential of hydrogels in this context, favored for their ability to maintain mucosal elevation longer and support wound healing. This review comprehensively examines the development and application of hydrogels in ESD, focusing on their physicochemical properties, biocompatibility, and the clinical implications of their use. These issues discuss various formulations of hydrogels, their mechanisms of action, and comparative analyses with traditional materials. Furthermore, the review explores ongoing innovations and future perspectives in hydrogel research, aiming to catalyze further advancements in ESD techniques. STATEMENT OF SIGNIFICANCE: This review critically examines hydrogel technologies in endoscopic submucosal dissection for gastrointestinal cancers, highlighting their role in improving procedural outcomes and patient recovery. It explores hydrogels' ability to enhance mucosal elevation, reduce complications, and accelerate healing, offering insights into their transformative potential in medical treatments. The findings emphasize the development of innovative materials that could significantly advance clinical practices in gastrointestinal cancer management.
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Affiliation(s)
- Mengdan Xu
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou, 215123, China.
| | - Keyang Xu
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou, 215123, China.
| | - Wei Peng
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Jianxian Ge
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou, 215123, China.
| | - Ning Wang
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou, 215123, China.
| | - Guangqiu Yu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Yongyou Wu
- Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.
| | - Jianfeng Zeng
- Center for Molecular Imaging and Nuclear Medicine, State Key Laboratory of Radiation Medicine and Protection, School for Radiological and Interdisciplinary Sciences (RAD-X), Soochow University, Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou, 215123, China; Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Zhou T, Liu Z, Xu L, Mao X, Jin H, Xiong Y, Chen G, Lv Y, Cen L, Wang C, Zhang Y, Ye K, Shen Q, Zhou J, Lv B, Dai J, Yu C, Shen Z. Konjac glucomannan/sodium alginate/ε-poly-l-lysine hydrogel promotes esophageal and colonic wound healing. Int J Biol Macromol 2025; 306:141146. [PMID: 39986528 DOI: 10.1016/j.ijbiomac.2025.141146] [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: 09/23/2024] [Revised: 02/14/2025] [Accepted: 02/14/2025] [Indexed: 02/24/2025]
Abstract
Endoscopic submucosal dissection (ESD) is widely used to treat gastrointestinal mucosal and submucosal lesions. However, it may cause bleeding, perforation, and stricture. Although these complications can be avoided by introducing materials such as polyglycolic acid and carboxymethyl cellulose sheets, such approaches are expensive and time-consuming. Herein, we report a hydrogel prepared by combining a colloidal solution composed of konjac glucomannan (KGM) and sodium alginate (SA) and a fixative solution containing ε-poly-l-lysine (ε-PLL) and calcium chloride. The two solutions were mixed on the wound surface to form the KGM/SA/ε-PLL hydrogel through hydrogen bonds, coordination bonds, and electrostatic attraction. The effectiveness and convenience of applying the KGM/SA/ε-PLL hydrogel to promote wound healing in the esophagus and colon were assessed in vitro and in vivo. We found that the hydrogel stimulated epithelial proliferation, reduced inflammation, promoted recapillarization, and inhibited fibrosis in the esophagus and colon. Therefore, the KGM/SA/ε-PLL hydrogel is an effective and convenient agent that can promote post-ESD wound healing and is recommended for ulcer bed protection in daily clinical practice.
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Affiliation(s)
- Tianyu Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Zhaoxue Liu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Lei Xu
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang, China
| | - Xinli Mao
- Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, Taizhou 318000, Zhejiang, China
| | - Haifeng Jin
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang, China
| | - Yangyang Xiong
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Guangwu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Yong Lv
- Department of Gastroenterology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350000, Fujian, China
| | - Li Cen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Chunren Wang
- National Institutes for Food and Drug Control, Beijing 100101, China
| | - Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang, China
| | - Kexin Ye
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Qien Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Jiaming Zhou
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China
| | - Bin Lv
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang, China
| | - Jianying Dai
- Department of Research and Development, Hangzhou Yingjian Bioscience and Technology Co., Ltd, Hangzhou 310000, Zhejiang, China
| | - Chaohui Yu
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China.
| | - Zhe Shen
- Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China.
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Kanazawa J, Ikehara H, Horii T, Kitahara G, Betto T, Yokoyama K, Kobayashi K, Kusano C. Effect of spray COAG mode on hemostasis in colorectal endoscopic submucosal dissection using inverse probability of treatment weight analysis. DEN OPEN 2025; 5:e70008. [PMID: 39290566 PMCID: PMC11405631 DOI: 10.1002/deo2.70008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/16/2024] [Accepted: 08/26/2024] [Indexed: 09/19/2024]
Abstract
Objective Swift and forced COAG with an electrosurgical knife are commonly used for intraoperative hemostasis in colorectal endoscopic submucosal dissection (ESD). If bleeding cannot be stopped using an electrosurgical knife, cauterization is attempted using hemostatic forceps. Since April 2022, our hospital has started using Spray COAG for intraoperative hemostasis for colorectal ESD. This study aimed to provide evidence of the efficacy of Spray COAG for intraoperative hemostasis. Methods Colorectal ESD was performed for 320 lesions at our hospital. Of these, 307 were included; 145 and 162 lesions were operated before and after the introduction of Spray COAG, respectively. Spray COAG was used after the change. The primary endpoint was the change in the frequency of use of hemostatic forceps after the introduction of Spray COAG; the secondary endpoint was the change in the prevalence of postoperative complications after the introduction of Spray COAG. It should be noted that the Spray COAG mode was employed solely for hemostasis and not for dissection, while the Swift COAG mode was utilized for dissection in the After Spray COAG group. Statistical analysis was conducted using IPTW analysis. Results The frequency of use of hemostatic forceps was significantly decreased after the introduction of Spray COAG (odds ratio = 0.12, 95% confidence interval [95%CI]: 0.06-0.23, p < 0.001). The prevalence of post-ESD electrocoagulation syndrome significantly decreased (odds ratio = 0.43, 95%CI: 0.22-0.88, p = 0.02). No significant differences were observed between the intraoperative and postoperative perforations or rate of postoperative bleeding. Conclusion Spray COAG reduced the frequency of hemostatic forceps use in colorectal ESD.
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Affiliation(s)
- Jun Kanazawa
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
| | - Hisatomo Ikehara
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
| | - Toshiki Horii
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
| | - Gen Kitahara
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
| | - Tomohiro Betto
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
| | - Kaoru Yokoyama
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
| | - Kiyonori Kobayashi
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
| | - Chika Kusano
- Department of Gastroenterology, Internal Medicine Kitasato University School of Medicine Kanagawa Japan
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Jo IH, Kim HG, Cho YS, Lee HJ, Kim ER, Lee YJ, Hwang SW, Kim KO, Lee J, Choi HS, Jung Y, Moon CM. Risk Factors for Perforation in Endoscopic Treatment for Early Colorectal Cancer: A Nationwide ENTER-K Study. Gut Liver 2025; 19:95-107. [PMID: 39628349 PMCID: PMC11736327 DOI: 10.5009/gnl240210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 01/16/2025] Open
Abstract
Background/Aims Early colorectal cancer (ECC) is commonly resected endoscopically. Perforation is a devastating complication of endoscopic resection. We aimed to identify the characteristics and predictive risk factors for perforation related to endoscopic resection of ECC. Methods This nationwide retrospective multicenter study included patients with ECC who underwent endoscopic resection. We investigated the demographics, endoscopic findings at the time of treatment, and histopathological characteristics of the resected specimens. Logistic regression analysis was used to investigate the clinical factors associated with procedure-related perforations. Survival analysis was conducted to assess the impact of perforation on the overall survival of patients with ECC. Results This study included 965 participants with a mean age of 63.4 years. The most common endoscopic treatment was conventional endoscopic mucosal resection (n=573, 59.4%), followed by conventional endoscopic submucosal dissection (n=259, 26.8%). Thirty-three patients (3.4%) experienced perforations, most of which were managed endoscopically (n=23/33, 69.7%). Patients who undergo endoscopic submucosal dissection-hybrid and precut endoscopic mucosal resection have a higher risk of perforation than those who undergo conventional endoscopic mucosal resection (odds ratio, 78.65 and 39.72, p<0.05). Procedure-related perforations were not associated with patient survival. Conclusions Perforation after endoscopic resection had no significant impact on the prognosis of ECC. The type of endoscopic resection was a crucial predictor of perforation. Large-scale prospective studies are needed to further investigate endoscopic resection of ECC.
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Affiliation(s)
- Ik Hyun Jo
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Gun Kim
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyeong-Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Lee
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Fang Z, Xu Y, Huang X. Impact of prophylactic wound closure in colorectal ESD on postoperative wound complications: A meta-analysis. Int Wound J 2024; 21:e14783. [PMID: 38472107 PMCID: PMC10932785 DOI: 10.1111/iwj.14783] [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: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
Endoscopic submucosa dissection (ESD) has been applied extensively in the treatment of large intestine tumours due to its high total excision ratio. Nevertheless, there is a high incidence of adverse reactions in colon ESD, and the efficacy of prophylactic ESD following ESD in prevention of postoperative haemorrhage is still disputed. The purpose of this meta-analysis is to evaluate the effectiveness of prophylaxis of wound closure in large intestine ESD after operation. For eligibility, we looked through three databases: PubMed, Embase and Cochrane Library. Heterogenity was measured by means of a chi-square method of Q-statistic and an I2 test. Fixed or random effects models were used for data processing. Based on the retrieval policy, we found a total of 1286 papers, and then we collected nine papers to extract the data. Regarding postoperative haemorrhage, there was a significant reduction in the risk of wound haemorrhage in the wound closure group than in the control group (OR, 0.29; 95% CI, 0.19-0.44 p < 0.0001). No statistical significance was found in the incidence of perforation in the wound closure and the control group (OR, 0.45; 95% CI, 0.19-1.03 p = 0.06). There was a significant reduction in the incidence of postoperation fever among those in the wound closure group than in the control group (OR, 0.37; 95% CI, 0.15-0.93 p = 0.04). Preventive endoscopic closure decreased the rate of ESD in colon disease, but did not significantly decrease the rate of postoperation perforation and postoperative fever. Future research will be required to clarify the risk factors and classify high-risk individuals in order to formulate a cost-effective prevention strategy.
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Affiliation(s)
- Zhengdong Fang
- Department of Critical Care MedicineSir Run Run Shaw Hospital, School of Medicine, Zhejiang UniversityHangzhouChina
| | - Yan Xu
- Department of Endoscopic CenterWenzhou Hospital of Intergrated Traditional Chinese Western MedicineWenzhouChina
| | - Xiaolin Huang
- Department of Endoscopic CenterWenzhou Hospital of Intergrated Traditional Chinese Western MedicineWenzhouChina
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In vitro analysis of exfoliated tumor cells in intraluminal lavage samples after colorectal endoscopic submucosal dissection. Int J Colorectal Dis 2022; 37:161-170. [PMID: 34599685 DOI: 10.1007/s00384-021-04037-y] [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] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Colorectal endoscopic submucosal dissection (ESD) produces exfoliated tumor cells that occasionally cause local recurrence. However, the biological characteristics of these tumor cells have not been clarified. The aim of this study was to clarify the genetic background and viability of exfoliated tumor cells in colorectal ESDs, as well as possible method for their elimination. METHODS Post-ESD intraluminal lavage samples from 19 patients who underwent colorectal ESDs were collected. In four patients with adenocarcinoma, gene mutations in the primary tumors and exfoliated cells in lavage samples were analyzed using a next-generation sequencer (NGS). In 15 patients with adenoma or adenocarcinoma, the viability of exfoliated cells and the cell-killing effect of povidone-iodine on exfoliated cells were evaluated. RESULTS The analysis using a NGS demonstrated that tumors targeted for ESD had already acquired mutations in many genes involved in cell proliferation, angiogenesis, and invasions. Furthermore, gene mutations between the exfoliated tumor cells and tumors resected by ESDs showed a 92 to 100% concordance. The median viable cell counts and the median viability of exfoliated cells in intraluminal lavage samples after ESDs were 4.9 × 105 cells/mL and 24%, respectively. The viability of the exfoliated cells did not decrease even 12 h after ESD. However, contact with 2.0% povidone-iodine solution reduced both viable cell counts and viability, significantly. CONCLUSION A large number of tumor cells exfoliated during colorectal ESDs had acquired survival-favorable gene mutations and could survive for some time. Therefore, a lavage using a solution of 2.0% povidone-iodine may be effective against such cells. TRIAL REGISTRATION The prospective study registered 1317, and the retrospective study registered 2729. The prospective study approved on June 20, 2016, and the retrospective study approved on October 6, 2020.
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Markarian E, Fung BM, Girotra M, Tabibian JH. Large polyps: Pearls for the referring and receiving endoscopist. World J Gastrointest Endosc 2021; 13:638-648. [PMID: 35070025 PMCID: PMC8716985 DOI: 10.4253/wjge.v13.i12.638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/04/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Polyps are precursors to colorectal cancer, the third most common cancer in the United States. Large polyps, i.e.,, those with a size ≥ 20 mm, are more likely to harbor cancer. Colonic polyps can be removed through various techniques, with the goal to completely resect and prevent colorectal cancer; however, the management of large polyps can be relatively complex and challenging. Such polyps are generally more difficult to remove en bloc with conventional methods, and depending on level of expertise, may consequently be resected piecemeal, leading to an increased rate of incomplete removal and thus polyp recurrence. To effectively manage large polyps, endoscopists should be able to: (1) Evaluate the polyp for characteristics which predict high difficulty of resection or incomplete removal; (2) Determine the optimal resection technique (e.g., snare polypectomy, endoscopic mucosal resection, endoscopic submucosal dissection, etc.); and (3) Recognize when to refer to colleagues with greater expertise. This review covers important considerations in this regard for referring and receiving endoscopists and methods to best manage large colonic polyps.
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Affiliation(s)
- Eric Markarian
- Academy of Science and Medicine, Crescenta Valley High School, Los Angeles, CA 91214, United States
| | - Brian M Fung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85006, United States
- Division of Gastroenterology, Banner - University Medical Center Phoenix, Phoenix, AZ 85006, United States
| | - Mohit Girotra
- Section of Gastroenterology and Therapeutic Endoscopy, Digestive Health Institute, Swedish Medical Center, Seattle, WA 98104, United States
| | - James H Tabibian
- Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA 91342, United States
- Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
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Park SK, Goong HJ, Ko BM, Kim H, Seok HS, Lee MS. Second-look endoscopy findings after endoscopic submucosal dissection for colorectal epithelial neoplasms. Korean J Intern Med 2021; 36:1063-1073. [PMID: 34098714 PMCID: PMC8435493 DOI: 10.3904/kjim.2020.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/10/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND/AIMS Although second-look endoscopy (SLE) is frequently performed after gastric endoscopic submucosal dissection (ESD) to prevent bleeding, no studies have reported SLE findings after colorectal ESD. This study aimed to investigate SLE findings and their role in preventing delayed bleeding after colorectal ESD. METHODS Post-ESD ulcer appearances were divided into coagulation (with or without remnant minor vessels) and clip closure groups. SLE findings were categorized according to the Forrest classification (high-risk ulcer stigma [type I and IIa] and low-risk ulcer stigma [type IIb, IIc, III, or clip closure]), and risk factors for high-risk ulcer stigma were analyzed. RESULTS Among the 375 cases investigated, SLEs were performed in 171 (45.6%) patients. The incidences of high-risk ulcer stigma and low-risk stigma were 5.3% (9/171) and 94.7% (162/171), respectively. During SLE, endoscopic hemostasis was performed more frequently in the high-risk ulcer stigma group than in the lowrisk ulcer stigma group (44.4% [4/9] vs. 1.9% [3/162], respectively; p < 0.001), but most of the endoscopic hemostasis in the high-risk ulcer stigma group (3/4, 75.0%) were prophylactic hemostasis. Post-ESD delayed bleeding occurred in three (0.8%) patients belonging to the SLE group, of which, one patient was from the high-risk stigma group and two were from the low-risk stigma group. CONCLUSION The incidence of high-risk ulcer stigma during SLE was low, and delayed bleeding occurred in, both, high-risk and low-risk groups of SLE. SLEs performed after colorectal ESD may not be effective in preventing delayed bleeding, and further prospective studies are needed to evaluate the efficacy of SLE in post-colorectal ESD.
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Affiliation(s)
- Soo-kyung Park
- Division of Gastroenterology, Department of Internal Medicine and Gastrointestinal Cancer Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Hyeon Jeong Goong
- Digestive Disease Center and Research Institute and Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon,
Korea
| | - Bong Min Ko
- Digestive Disease Center and Research Institute and Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon,
Korea
| | - Haewon Kim
- Digestive Disease Center and Research Institute and Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon,
Korea
| | - Hyo Sun Seok
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Moon Sung Lee
- Digestive Disease Center and Research Institute and Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon,
Korea
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Benites Goñi H, Palacios Salas F, Marin Calderón L, Bardalez Cruz P, Vásquez Quiroga J, Alva Alva E, Calixto Aguilar L, Alférez Andía J, Dávalos Moscol M. Closure of colonic deep mural injury and perforation with endoclips. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 112:772-777. [PMID: 32954773 DOI: 10.17235/reed.2020.6880/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION colorectal perforations are one of the most feared complications after performing an endoscopic resection. The use of endoclips is considered for the management of these complications. OBJECTIVES to evaluate the efficacy and safety of the use of endoclips in the management of perforations and deep mural injuries that occur after an endoscopic colorectal resection. METHODS a prospective cohort of consecutively included patients was used with a diagnosis of perforation or deep mural injury after an endoscopic colorectal resection treated with endoclips in our institution. The rates of perforation and deep mural injury were obtained. The factors associated with an unfavorable evolution after the placement of the endoclips were analyzed. RESULTS after 342 endoscopic mucosal resections (EMR) and 42 endoscopic submucosal dissections (ESD), there were 25 cases with perforation or deep mural injury. The deep mural injury rate was 3.22 % and 7.14 % in the case of EMR and ESD, respectively. The perforation rate was 1.46 % and 14.29 % in the case of EMR and ESD, respectively. Successful closure with endoclips was achieved in 24 cases (96 %). Only one patient presented an unfavorable evolution (10 %) after successful closure. The factors associated with an unfavorable evolution were the presence of diffuse peritoneal symptoms and a perforation size greater than or equal to 10 mm. CONCLUSION endoscopic closure with endoclips is effective to avoid surgery in cases of deep mural injury or perforation after an endoscopic resection.
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Affiliation(s)
| | | | | | | | | | - Edgar Alva Alva
- Gastroenterología, Hospital Nacional Edgardo Rebagliati Martins
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Ito S, Nishiguchi A, Sasaki F, Maeda H, Kabayama M, Ido A, Taguchi T. Robust closure of post-endoscopic submucosal dissection perforation by microparticle-based wound dressing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:111993. [PMID: 33812615 DOI: 10.1016/j.msec.2021.111993] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
Endoscopic submucosal dissection (ESD) has been used as a minimally invasive cancer treatment for early-stage gastrointestinal cancer. However, cancer dissection in thin tissues, such as the duodenum and large intestine, often cause post-ESD and delayed perforation, which elicit severe complications. In this study, we report a microparticle-based wound dressing with hydrophobically-modified gelatin that can close the perforation after ESD. Hydrophobized microparticles were prepared using a coacervation method in a water/ethanol mixed solvent. The optimized alkyl chain length and degree of substitution of hydrophobic groups improved the mechanical strength of the hydrogel formed by hydration and fusion of the microparticles. The hydrogels formed on tissue defects revealed higher burst strength in ex vitro perforation models using duodenum, large intestine, and stomach under wet conditions compared with hydrogels without hydrophobic modification. The particle fusion was determined to be a crucial step to yield a high burst strength. An in vivo degradability evaluation showed that microparticle hydrogels subcutaneously implanted in rats degraded within 14 days. The microparticle wound dressing is expected to be applicable to post-ESD perforation and prevent delayed perforation.
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Affiliation(s)
- Shima Ito
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Akihiro Nishiguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hidehito Maeda
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masayuki Kabayama
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Tetsushi Taguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
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Ismail MS, Bahdi F, Mercado MO, Habazi R, Alexander A, Prabhu S, John S, Kovvali C, Othman MO. ESD with double-balloon endoluminal intervention platform versus standard ESD for management of colon polyps. Endosc Int Open 2020; 8:E1273-E1279. [PMID: 33015328 PMCID: PMC7508668 DOI: 10.1055/a-1226-6372] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Endoscopic submucosal dissection (ESD) with the double-balloon endoluminal intervention platform (DEIP) is a novel technique for removal of complex colon polyps (> 2 cm) or those located in anatomically difficult positions. DEIP helps create a therapeutic zone with improved visualization and stability, facilitating polyp removal. We aimed to compare the outcomes of DEIP with the conventional cap-assisted ESD (standard ESD) technique for colon polyp resection, in particular, the ability to complete the ESD procedure without resorting to hybrid ESD or piecemeal resection. Patients and methods This was a retrospective cohort of all patients who underwent colon ESD in a single large tertiary referral center between September 2016 and October 2019. Information was collected on patient demographics and study outcomes including procedure time, rates of en bloc and curative resection, operative and postoperative complications. All patients were followed up for 1 month after the procedure. Results 111 patients were included in the study (DEIP 60, standard ESD 51). There was no statistically significant difference between mean procedures time (± SD) in the two groups, mean (81.9 ± 35.4 min standard vs. 96.4 ± 42.2 min in DEIP). Mean polyp size (± SD) was similar between the two groups (7.6 ± 6.0 cm 2 vs. 6.2 ± 5.5 cm 2 , P = .2). There were no significant differences in en bloc and curative resection rates or operative and postoperative complications between the two techniques. Conclusion Procedure time was similar using both techniques. However, DEIP enabled the entire procedure to be performed using the ESD technique without resorting to snare resection, which may affect the en bloc and curative resection rate. There were no significant differences in en bloc and curative resection rates between the two groups, probably due to the small sample size.
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Affiliation(s)
- Mohamed Saleh Ismail
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
- Department of Internal medicine, Gastroenterology & Hepatology, Ain Shams University, Cairo, Egypt
| | - Firas Bahdi
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Randa Habazi
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Angel Alexander
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Sahana Prabhu
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Sharon John
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Chandra Kovvali
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
| | - Mohamed O Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas
- Baylor St Luke's Medical Center, Houston, Texas
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12
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Nozawa H, Ishii H, Sonoda H, Emoto S, Murono K, Kaneko M, Sasaki K, Nishikawa T, Shuno Y, Tanaka T, Kawai K, Hata K, Ishihara S. Effects of preceding endoscopic treatment on laparoscopic surgery for early rectal cancer. Colorectal Dis 2020; 22:906-913. [PMID: 32072748 DOI: 10.1111/codi.14989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
Abstract
AIM Endoscopic treatment for rectal cancer, such as endoscopic mucosal resection and endoscopic submucosal dissection, causes inflammation, oedema and fibrosis in the surrounding tissue. However, little is known about the effect of these endoscopic therapies on salvage laparoscopic rectal surgery. The objective of this retrospective cohort study was to analyse the effect of preceding endoscopic treatment on the outcomes of laparoscopic surgery for rectal cancer. METHOD We analysed 53 patients who underwent laparoscopic surgery for rectal cancer with clinical Tis or T1 at our department between May 2011 and June 2019. Data from 30 patients who underwent laparoscopic surgery after preceding endoscopic treatment (Group E + S) were compared with those of 23 patients who underwent laparoscopic surgery alone (Group S). RESULTS There was no significant difference between the groups with respect to preoperative details. The mean operative time tended to be longer in Group E + S, and the volume of intra-operative blood loss was greater in Group E + S than in Group S (median 63 ml vs 10 ml, P = 0.049). There were no significant differences between the groups in other surgical parameters or oncological outcomes. CONCLUSION Laparoscopic surgery after endoscopic treatment for rectal cancer may be difficult due to an increased risk of intra-operative bleeding. Long-term prognosis after surgery was not affected by preceding endoscopic treatment in rectal cancer.
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Affiliation(s)
- H Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - H Ishii
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - H Sonoda
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - S Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - K Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - M Kaneko
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - K Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - T Nishikawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Y Shuno
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - T Tanaka
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - K Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - K Hata
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - S Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
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13
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Review on colorectal endoscopic submucosal dissection focusing on the technical aspect. Surg Endosc 2020; 34:3766-3787. [PMID: 32342217 DOI: 10.1007/s00464-020-07599-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) enables removal of broad-based colorectal polyps or lateral spreading tumors with a higher rate of en bloc resection and a lower risk of local recurrence. However, it is technically demanding. Over the past 20 years, various equipment and innovative techniques have been developed to reduce the difficulty of ESD. The information in the literature is scattered. Our aim is to provide a comprehensive review on the setup and technical aspects of colorectal ESD. METHODS We searched the PubMed database and systemically reviewed all original and review articles related to colorectal ESD. Further manual search according to reference lists of identified articles were done. The selected articles were categorized and reviewed. Original figures were created to help readers understand some of the ESD techniques. RESULTS A total of 216 articles were identified, in which 25 of them were review articles and 191 of them were original articles. They were categorized and reviewed. An in-depth appraisal of the setting, equipment, and technical aspects of colorectal ESD was performed. CONCLUSIONS Although ESD is a technically demanding procedure that requires expert endoscopic skills, it can be mastered. With good peri-procedural preparation, sufficient knowledge of the equipment, and thorough understanding of the useful endoscopic tricks and maneuvers, colorectal ESD can be performed smoothly and safely.
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14
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Safety and histologic outcomes of endoscopic submucosal dissection with a novel articulating knife for esophageal neoplasia. Gastrointest Endosc 2020; 91:797-805. [PMID: 31870824 DOI: 10.1016/j.gie.2019.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Treatment of large esophageal neoplasia is gradually evolving from piecemeal to en bloc resections. Endoscopic submucosal dissection (ESD) is known to achieve more complete resections than piecemeal EMR for large lesions, yet it remains underused in the West because of technical and safety concerns with traditional electrosurgical knives. We aimed to evaluate a novel endoscopic articulating knife used with ESD (ESD-AR) to determine its safety and efficacy for large esophageal neoplasms in comparison with EMR. METHODS We retrospectively studied clinically indicated cases of ESD-AR and EMR for esophageal lesions that were 15 mm or greater. All EMR cases had at least 3 simultaneous EMRs to adequately compare resection area. Rates of perforation, GI bleeding, technical performance, and pre- and postendoscopic resection diagnoses were evaluated. RESULTS Seventy-two ESD-AR and 72 widespread EMR cases were evaluated for Barrett's esophagus (56%), adenocarcinoma (36%), squamous nodularity (2%), and squamous cell carcinoma (6%). There were no statistical differences in age, sex, Barrett's esophagus length, and lesion or resection size between the 2 groups. No perforations occurred. Two adverse events were recorded with ESD-AR and none with EMR (3% vs 0%, P = .50); these were associated with anticoagulation use (P = .04) and greater resection area (P = .02). There were more upgraded diagnoses post-ESD versus EMR (27% vs 12%, P = .05). CONCLUSIONS ESD-AR by an experienced endoscopist has a comparable safety profile with widespread EMR for large esophageal neoplasia and may have advantages for diagnostic staging.
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15
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Kim SG, Hwang JH. How to decrease the risk of perforation in endoscopic submucosal dissection (ESD). TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Zhu Y, Xu JX, Cheng J, Zhang Z, Zhu BQ, Chen TY, Xu XY, Wang Y, Cai MY, Zhou PH. A novel injectable thermo-sensitive binary hydrogels system for facilitating endoscopic submucosal dissection procedure. United European Gastroenterol J 2019; 7:782-789. [PMID: 31316782 DOI: 10.1177/2050640619825968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/31/2018] [Indexed: 02/06/2023] Open
Abstract
Background and aims Making an optimal and lasting submucosal cushion is critical for endoscopic submucosal dissection. The thermo-sensitive binary hydrogels system composed of poloxamer 407 and poloxamer 188 might be an excellent submucosal injection solution considering the unique feature that it remains liquid at room temperature and becomes gelatinous after being injected in the submucosa of the digestive tract. The present study focuses on preparing the thermo-sensitive binary hydrogels system and testing its capacity in mucosal lifting and its role in the endoscopic submucosal dissection procedure. Methods Various concentrations of poloxamer 407 and poloxamer 188 were added to normal saline. The gelation temperature viscosity of the thermo-sensitive binary hydrogels system was measured to choose the best formula. The thermo-sensitive binary hydrogels system and normal saline were first compared in extracted porcine stomach. For in vivo study, the thermo-sensitive binary hydrogels system and normal saline were compared for facilitating the endoscopic submucosal dissection procedure. Results Among the 46 kinds of thermo-sensitive binary hydrogels system, gelation temperatures of the thermo-sensitive binary hydrogels system I (poloxamer 407/poloxamer 188, 17%/0.5%, w/w) and the thermo-sensitive binary hydrogels system II (poloxamer 407/poloxamer 188, 18%/2%, w/w) were among the ideal range of gelation temperature. The injecting pressure in vitro study of thermo-sensitive binary hydrogels system II was significantly higher than that of thermo-sensitive binary hydrogels system I and normal saline (p < 0.001). Sixteen gastric endoscopic submucosal dissection procedures were performed in a porcine model. The initial volume of normal saline injection (13.88 ± 3.91 ml vs 5.88 ± 3.44 ml, p = 0.001) was significantly larger than the thermo-sensitive binary hydrogels system group. The postoperative wound showed a significant difference in the two groups (p = 0.023) indicating that the thermo-sensitive binary hydrogels system can create a cleaner wound. Conclusions Considering the gelation temperature, viscosity, injection pressure, and the height of the mucosal elevation, the thermo-sensitive binary hydrogels system I was the better submucosal injection solution.
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Affiliation(s)
- Yan Zhu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Jia-Xin Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Jing Cheng
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Zhen Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Bo-Qun Zhu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Tian-Yin Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Xiao-Yue Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Yun Wang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Ming-Yan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
| | - Ping-Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Shanghai, China
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17
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Yamamoto K, Shimoda R, Ogata S, Hara M, Ito Y, Tominaga N, Nakayama A, Sakata Y, Tsuruoka N, Iwakiri R, Fujimoto K. Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan. Intern Med 2018; 57:2115-2122. [PMID: 29607956 PMCID: PMC6120842 DOI: 10.2169/internalmedicine.9186-17] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this study was to clarify the safety of colorectal endoscopic submucosal dissection (ESD) during the era of health insurance coverage starting from April 2012 in Japan. Methods Between April 2012 and May 2016, ESD was applied to 398 lesions in 373 patients. Risk factors for serious complications of colorectal ESD, perforation and post-ESD bleeding, were evaluated focusing on the resected specimen size, location, growth pattern, invasion depth, histopathology, postoperative clipping, and procedure time. In addition, the relationship between serious complications and patients' background characteristics was analyzed. Results Among 373 patients, perforation occurred in 12 patients and post-ESD bleeding in 19 patients. A univariate analysis showed that the risk factors for perforation were the lesion size, the resected specimen size, and a long operation time. A multivariate analysis showed that a long operation time was a risk factor for perforation during colorectal ESD. A univariate analysis indicated that significant risk factors for postoperative bleeding were a long operation time, rectal lesion, and cancer. All patients with serious complications were treated by an endoscopic procedure without blood transfusion or the need to convert to open surgery. Conclusion The present study suggests that colorectal ESD may be accepted with relative safety in Japan as a common therapeutic approach for early colorectal cancer.
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Affiliation(s)
- Koji Yamamoto
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Ryo Shimoda
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Shinichi Ogata
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Megumi Hara
- Departments of Preventive Medicine, Saga Medical School, Saga Medical School, Japan
| | - Yoichiro Ito
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Naoyuki Tominaga
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Atsushi Nakayama
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
- Department of Gastroenterology, Saga Prefectural Medical Center, Japan
| | - Yasuhisa Sakata
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Nanae Tsuruoka
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Ryuichi Iwakiri
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
| | - Kazuma Fujimoto
- Departments of Internal Medicine, Saga Medical School, Saga Medical School, Japan
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18
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Ogiyama H, Tsutsui S, Murayama Y, Maeda S, Satake S, Nasu A, Umeda D, Miura Y, Tominaga K, Horiki M, Sanomura T, Imanaka K, Iishi H. Prophylactic clip closure may reduce the risk of delayed bleeding after colorectal endoscopic submucosal dissection. Endosc Int Open 2018; 6:E582-E588. [PMID: 29756016 PMCID: PMC5943689 DOI: 10.1055/a-0581-8886] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/18/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large superficial colorectal tumors, but delayed bleeding remains one of the most common complications of colorectal ESD. The aim of the present study was to evaluate the clinical efficacy of prophylactic clip closure of mucosal defects for the prevention of delayed bleeding after colorectal ESD. PATIENTS AND METHODS We enrolled consecutive patients with colorectal lesions between January 2012 and May 2017 in this retrospective study. In the early part of this period, post-ESD mucosal defects were not closed (non-closure group); however, from January 2014, post-ESD mucosal defects were prophylactically closed with clips when possible (closure group). The main outcome measured was delayed bleeding. Variables were analyzed using the chi-squared test, Fisher's exact test, or Student's t-test. RESULTS Of 156 lesions analyzed, 61 were in the non-closure group and 95 in the closure group. Overall, delayed bleeding occurred in 5 cases (3.2 %). The delayed bleeding rate was 0 % (0/95) in the closure group and 8.2 % (5/61) in the non-closure group ( P = 0.008). The mean procedure time for closure was 10.4 ± 4.6 min (range 3 - 26 min). CONCLUSIONS We demonstrated that prophylactic clip closure of mucosal defects might reduce the risk of delayed bleeding after colorectal ESD.
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Affiliation(s)
- Hideharu Ogiyama
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan,Corresponding author Hideharu Ogiyama, MD, PhD Department of Gastroenterology and HepatologyItami City Hospital1-100, Koyaike, ItamiHyogo 664-8540, Japan+81-72-781-9888
| | - Shusaku Tsutsui
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Yoko Murayama
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Shingo Maeda
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Shin Satake
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Ayaka Nasu
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Daisuke Umeda
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Yoshio Miura
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Kouhei Tominaga
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Masashi Horiki
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Tamana Sanomura
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Kazuho Imanaka
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
| | - Hiroyasu Iishi
- Departments of Gastroenterology and Hepatology, Itami City Hospital, Itami, Hyogo, Japan
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Harada H, Suehiro S, Murakami D, Nakahara R, Ujihara T, Shimizu T, Miyama Y, Katsuyama Y, Hayasaka K, Tounou S. Clinical impact of prophylactic clip closure of mucosal defects after colorectal endoscopic submucosal dissection. Endosc Int Open 2017; 5:E1165-E1171. [PMID: 29201999 PMCID: PMC5698008 DOI: 10.1055/s-0043-118743] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/01/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) is useful for en bloc resection of superficial colorectal neoplasms to ensure accurate histologic diagnoses. However, colorectal ESD is associated with a high frequency of adverse events (AEs). We aimed to investigate the effectiveness of prophylactic clip closure (PCC) of mucosal defects for AEs after colorectal ESD. PATIENTS AND METHODS This study included 197 patients with 211 lesions who underwent colorectal ESD between June 2010 and August 2016. Patients who had delayed perforation, delayed bleeding, abdominal pain, or fever were defined as AEs after colorectal ESD. Complete PCC was defined as completely sutured mucosal defect using endoclips following colorectal ESD, whereas incomplete PCC was defined as the mucosal defects that did not enable PCC or were partially sutured. Clinical records were retrospectively reviewed and clinical outcomes evaluated. RESULTS AEs occurred in 29 lesions (13.7 %), including 12 with delayed bleeding, 12 with fever, 2 with abdominal pain, 2 with fever and abdominal pain, and 1 with delayed bleeding and fever. Delayed perforation was not observed in any patient. The frequency of AEs was significantly lower in the group with complete PCC than in the group with incomplete PCC (7.3 % [9/123] vs. 22.7 % [20/88]; P < 0.001). Multivariate analysis revealed that AEs after colorectal ESD were significantly associated with tumor size and submucosal fibrosis. Subgroup analysis among the resected specimen size of < 40 mm revealed that there was no significant difference in AEs between the 2 groups (5.6 % [6/107] vs. 17.8 % [8/45]; P = 0.069). However, the frequency of fever with complete PCC was significantly lower than that with incomplete PCC (2.8 % [3/107] vs. 13.3 % [6/45]; P = 0.020). CONCLUSIONS Tumor size and submucosal fibrosis were independent risk factors for AEs after colorectal ESD. PCC may be effective in minimizing AEs after colorectal ESD, especially the frequency of fever.
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Affiliation(s)
- Hideaki Harada
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan,Corresponding author Hideaki Harada, MD Department of GastroenterologyNew Tokyo Hospital1271 WanagayaMatsudo Chiba 270-2232Japan+81-47-392-8718
| | - Satoshi Suehiro
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Daisuke Murakami
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Ryotaro Nakahara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Tetsuro Ujihara
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Takanori Shimizu
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Yasunaga Miyama
- Department of Health Service Center, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Kenji Hayasaka
- Department of Gastroenterology, New Tokyo Hospital, Chiba, Japan
| | - Shigetaka Tounou
- Second Division of Internal Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
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20
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Gromski MA, Cohen J, Saito K, Gonzalez JM, Sawhney M, Kang C, Moore A, Matthes K. Learning colorectal endoscopic submucosal dissection: a prospective learning curve study using a novel ex vivo simulator. Surg Endosc 2017; 31:4231-4237. [PMID: 28281126 DOI: 10.1007/s00464-017-5484-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 02/16/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is increasingly being used in Asia as a minimally invasive therapy to eradicate large laterally spreading superficial tumors in the colon. To date, the learning curve and effectiveness of ex vivo simulators in colonic ESD training remain unclear. The aim of the study is to determine the learning curve of colonic ESD in an ex vivo simulator. METHODS We conducted a prospective study of colon ESD in ex vivo porcine colons in a prototype simulator. Three endoscopists with prior experience in gastric ESD but with no experience in colonic ESD each performed 30 ESD resections on standardized lesions in the rectosigmoid and left colon of the porcine simulator. Procedure time, en bloc resection status, and perforation were recorded. RESULTS All 90 lesions were resected using the ESD technique. The mean time of procedure was 49.6 min (standard deviation 29.6 min). The aggregate rate of perforation was 14.4% and the aggregate rate of non-en bloc resection was 5.6%. Using a composite quality score integrating complications and procedural time, it was found that there was a significant difference between two local polynomial regression lines when using a cut-point at the 9th procedure (p = 0.04), reflecting the point at which most of the learning curve is traversed. CONCLUSIONS In this study, there were significant improvements realized in colonic ESD performance after 9 colon ESD procedures in ex vivo specimens. Although training will depend on endoscopist skill and expertise, we suggest at least 9 ex vivo procedures prior to moving to live animal or proctored training in colonic ESD.
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Affiliation(s)
- Mark A Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA.
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Jonah Cohen
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kayoko Saito
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Gastroenterology, Medical Topia Soka Hospital, Soka, Japan
| | - Jean-Michel Gonzalez
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Gastroenterology, Aix-Marseille University, APHM, Hôpital Nord, Marseille, France
| | - Mandeep Sawhney
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Changdon Kang
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea
| | - Andrew Moore
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Kai Matthes
- Department of Anesthesia, Critical Care and Pain Medicine, Children's Hospital, Harvard Medical School, Boston, MA, USA
- T.A.M.G.I., Maui, HI, USA
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Chiba H, Tachikawa J, Kurihara D, Ashikari K, Goto T, Takahashi A, Sakai E, Ohata K, Nakajima A. Safety and efficacy of simultaneous colorectal ESD for large synchronous colorectal lesions. Endosc Int Open 2017; 5:E595-E602. [PMID: 28670616 PMCID: PMC5482740 DOI: 10.1055/s-0043-110567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/20/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Multiple large colorectal lesions are sometimes diagnosed during colonoscopy. However, there have been no investigations of the feasibility of simultaneous endoscopic submucosal dissection (ESD) for multiple lesions. This study aims to reveal the strategy of simultaneous ESD for multiple large colorectal lesions. PATIENTS AND METHODS 246 patients who underwent ESD for 274 colorectal lesions were retrospectively evaluated in this study. Fifty-one large colorectal lesions among 23 patients were treated by ESD simultaneously (simultaneous group), and 223 patients were treated with ESD for a single lesion (single group). RESULTS En-bloc resection and curative resection rates did not differ. Compared with the single group, each procedure time was faster (31.8 ± 23.6 min vs. 45.8 ± 44.8, P = 0.002), but total procedure time was significantly longer in the simultaneous group (70.6 ± 33.4 vs. 45.8 ± 44.8 min, P = 0.01). Rates of adverse events including bleeding and perforation were not higher in the simultaneous group but the mean blood pressure, incidence of bradycardia and the amount of sedative drug used during ESD were significantly higher in the simultaneous group. Multiple logistic regression analysis identified non-experienced physician, lesion size ≥ 40 mm and submucosal fibrosis as an independent risk factor for procedure duration (≥ 90 min) (Odds ratio 11.852, 18.280, and 3.672; P < 0.05, respectively). CONCLUSIONS Simultaneous ESD for multiple synchronous colorectal lesions is safe and feasible compared with single ESD and can reduce the burden to patients, length of hospital stay and medical expense. These results need to be elucidated by further studies.
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Affiliation(s)
- Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Daisuke Kurihara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Keiichi Ashikari
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Toru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Akihiro Takahashi
- Department of Gastroenterology, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Eiji Sakai
- Department of Gastroenterology, Tokyo, Japan
| | - Ken Ohata
- Department of Gastroenterology, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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22
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Kang DU, Choi Y, Lee HS, Lee HJ, Park SH, Yang DH, Yoon SM, Kim KJ, Ye BD, Myung SJ, Yang SK, Kim JH, Byeon JS. Endoscopic and Clinical Factors Affecting the Prognosis of Colorectal Endoscopic Submucosal Dissection-Related Perforation. Gut Liver 2017; 10:420-8. [PMID: 26780090 PMCID: PMC4849696 DOI: 10.5009/gnl15252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Although colorectal endoscopic submucosal dissection (ESD)-related perforation is not uncommon, the factors affecting clinical outcomes after perforation have not been investigated. This study was designed to investigate the factors influencing the clinical course of ESD-related colon perforation. Methods Forty-three patients with colorectal ESD-related perforation were evaluated. The perforations were classified as endoscopic or radiologic perforations. The patients’ medical records and endoscopic pictures were analyzed. Results The clinical outcomes were assessed by the duration of nil per os, intravenous antibiotics administration, and hospital stays, which were 2.7±1.5, 4.9±2.3, and 5.1±2.3 days, respectively. Multivariate analyses revealed that a larger tumor size, ESD failure, specific endoscopists, and abdominal pain were independently related to a poorer outcome. The time between perforation and clipping was 15.8±25.4 minutes in the endoscopic perforation group. The multivariate analysis of this group indicated that delayed clipping, specific endoscopists, and abdominal pain were independently associated with poorer outcomes. Conclusions Tumor size, ESD failure, abdominal pain, and the endoscopist were factors that affected the clinical outcomes of patients with colorectal ESD-related perforation. The time between the perforation and clipping was an additional factor influencing the clinical course of endoscopic perforation. Decreasing this time period may improve outcomes.
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Affiliation(s)
- Dong-Uk Kang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yunsik Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Su Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jeong Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Man Yoon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ho Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Mavrogenis G, Hochberger J, Deprez P, Shafazand M, Coumaros D, Yamamoto K. Technological review on endoscopic submucosal dissection: available equipment, recent developments and emerging techniques. Scand J Gastroenterol 2017; 52:486-498. [PMID: 28050913 DOI: 10.1080/00365521.2016.1271996] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic submucosal dissection (ESD) is widely practiced in Japan and the Eastern World and is rapidly expanding in western countries for the management of early malignancies of the upper and lower gastrointestinal tube. In addition, novel therapeutic applications deriving from ESD have emerged including the treatment of achalasia, of submucosal tumors, of diverticula, of strictures and of reflux disease. An ESD procedure necessitates not only skills and specific training, but also familiarization with a vast spectrum of devices (endoscopes, high-frequency generators and their settings, endoknives, hoods, irrigation devices) and techniques (such as countertraction, artificial ulcer closure), that render the procedure faster, more efficient and safer. This technological article gives an overview on current and novel equipment for an ESD and associated techniques.
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Affiliation(s)
- Georgios Mavrogenis
- a Department of Endoscopy , Mediterraneo Hospital , Glyfada , Athens , Greece
| | - Juergen Hochberger
- b Department of Gastroenterology , Vivantes-Friedrichshain Hospital , Berlin , Germany
| | - Pierre Deprez
- c Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc , Université Catholique de Louvain , Brussels , Belgium
| | - Morteza Shafazand
- d Department of Endoscopy , Internal Medicin Clinic, Sahlgrenska University Hospital/East Hospital , Gothenburg , Sweden
| | - Dimitri Coumaros
- e Department of Gastroenterology , Clinique Saint Barbe , Strasbourg , France
| | - Katsumi Yamamoto
- f Department of Gastroenterology , Japan Community Healthcare Organization Osaka Hospital , Fukushima , Osaka , Japan
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24
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Yoshida N, Naito Y, Murakami T, Hirose R, Ogiso K, Inada Y, Dohi O, Okayama T, Kamada K, Uchiyama K, Ishikawa T, Handa O, Konishi H, Siah KTH, Yagi N, Itoh Y. Safety and Efficacy of a Same-Day Low-Volume 1 L PEG Bowel Preparation in Colonoscopy for the Elderly People and People with Renal Dysfunction. Dig Dis Sci 2016; 61:3229-3235. [PMID: 27487795 DOI: 10.1007/s10620-016-4262-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/20/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION A same-day low-volume 1 L polyethylene glycol (PEG) for bowel preparation before colonoscopy was developed to improve patients' compliance. We aimed to evaluate the efficacy and safety of this regimen especially for the elderly and patients with renal dysfunction. METHODS All consecutive patients who underwent colonoscopy in our center from November 2014 to September 2015 were included. Patients undertook a low-residue diet with 10 mL sodium picosulfate 1 day before colonoscopy. Subsequently, they had 1 L low-volume PEG (MoviPrep) and 0.5 L water 4 h before the examination. Clinical outcomes, including cleansing level using the Boston bowel preparation score (BBPS), in the elderly and special-elderly (65-79 and ≥80 years old) were analyzed and compared with the non-elderly (18-64 years old). Additionally, patients with renal dysfunction were analyzed with respect to both complications and changes in blood parameters. RESULTS A total of 5427 patients (mean age: 64.5 ± 13.8) were analyzed. The rate of BBPS ≥ 6 in the elderly (2761 patients), special-elderly (565 patients), and non-elderly (2101 patients) was 94.1, 91.8, and 94.6 %, respectively. In the special-elderly, the rate of renal dysfunction was 14.8 %, and no severe complications were detected after colonoscopy. Additionally, there were no severe complications in 86 patients with renal dysfunction, though elevation of hematocrit was shown after intake of 1 L PEG (before, 36.7 ± 6.1 vs. after, 39.0 ± 5.7, P = 0.006). CONCLUSIONS Our study shows the safety and efficacy of same-day low-volume 1 L PEG bowel preparation in colonoscopy for the elderly and patients with renal dysfunction.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takaaki Murakami
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tetsuya Okayama
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore
| | - Nobuaki Yagi
- Department of Gastroenterology, Murakami Memorial Hospital, Gifu, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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25
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Hong SN, Byeon JS, Lee BI, Yang DH, Kim J, Cho KB, Cho JW, Jang HJ, Jeon SW, Jung SA, Chang DK. Prediction model and risk score for perforation in patients undergoing colorectal endoscopic submucosal dissection. Gastrointest Endosc 2016; 84:98-108. [PMID: 26708921 DOI: 10.1016/j.gie.2015.12.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 12/04/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Perforation is the adverse event of greatest concern during colorectal endoscopic submucosal dissection (ESD). Accurate risk prediction of perforation may enable prevention strategies and selection of the most efficient therapeutic option. This study aimed to develop and validate a risk prediction model for ESD-induced perforation. METHODS A multicenter cross-sectional study was performed on 2046 patients who underwent colorectal ESD at 9 Korean ESD Study Group-affiliated hospitals. The enrolled patients were randomly divided into either a derivation set or a validation set. In the derivation set, a prediction score was constructed to assess the risk of perforation using preoperative and procedural-related predictors selected via logistic regression. Discrimination and calibration of the prediction model was assessed using the validation set. RESULTS An ESD-induced perforation occurred in 135 patients (6.6%). In the derivation set, multivariate logistic regression identified endoscopist experience (≥50 ESDs: odds ratio [OR] = 0.59; 95% confidence interval [CI], 0.35-1.00), tumor size (+1-cm increments: OR = 1.39; 95% CI, 1.19-1.62), colonic location (OR = 2.20; 95% CI, 1.24-3.89), and submucosal fibrosis (OR = 2.00; 95% CI, 1.04-3.87) as predictive factors (C-statistic = 0.678; 95% CI, 0.617-0.739). In the validation set, the model showed good discrimination (C-statistic = 0.675; 95% CI, 0.615-0.735) and calibration (P = .635). When a simplified weighted scoring system based on the OR was used, risk of perforation ranged from 4.1% (95% CI, 2.8%-5.9%) in the low-risk group (score ≤4) to 11.6% (95% CI, 8.5%-15.6%) in the high-risk group (score >4). CONCLUSIONS This study developed and internally validated a score consisting of simple clinical factors to estimate the risk of colorectal ESD-induced perforation. This score can be used to identify patients at high risk before colorectal ESD.
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Affiliation(s)
- Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Sik Byeon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bo-In Lee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jinsu Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jin Woong Cho
- Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Hyun Joo Jang
- Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Hwasung, Korea
| | - Seong Woo Jeon
- Department of Internal Medicine, Kyungpook National University Medical Center, Daegu, Korea
| | - Sung Ae Jung
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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26
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Yamamoto K, Michida T, Nishida T, Hayashi S, Naito M, Ito T. Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful procedures. World J Gastrointest Endosc 2015; 7:1114-1128. [PMID: 26468335 PMCID: PMC4600177 DOI: 10.4253/wjge.v7.i14.1114] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is very useful in en bloc resection of large superficial colorectal tumors but is a technically difficult procedure because the colonic wall is thin and endoscopic maneuverability is poor because of colonic flexure and extensibility. A high risk of perforation has been reported in colorectal ESD. To prevent complications such as perforation and unexpected bleeding, it is crucial to ensure good visualization of the submucosal layer by creating a mucosal flap, which is an exfoliated mucosa for inserting the tip of the endoscope under it. The creation of a mucosal flap is often technically difficult; however, various types of equipment, appropriate strategy, and novel procedures including our clip-flap method, appear to facilitate mucosal flap creation, improving the safety and success rate of ESD. Favorable treatment outcomes with colorectal ESD have already been reported in many advanced institutions, and appropriate understanding of techniques and development of training systems are required for world-wide standardization of colorectal ESD. Here, we describe recent technical advances for safe and successful colorectal ESD.
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Hirasawa K, Sato C, Makazu M, Kaneko H, Kobayashi R, Kokawa A, Maeda S. Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments. World J Gastrointest Endosc 2015; 7:1055-1061. [PMID: 26380051 PMCID: PMC4564832 DOI: 10.4253/wjge.v7.i12.1055] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/18/2015] [Accepted: 08/31/2015] [Indexed: 02/05/2023] Open
Abstract
Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients.
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Yoshida N, Hisabe T, Hirose R, Ogiso K, Inada Y, Konishi H, Yagi N, Naito Y, Aomi Y, Ninomiya K, Ikezono G, Terasawa M, Yao K, Matsui T, Yanagisawa A, Itoh Y. Improvement in the visibility of colorectal polyps by using blue laser imaging (with video). Gastrointest Endosc 2015; 82:542-549. [PMID: 25851158 DOI: 10.1016/j.gie.2015.01.030] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/12/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fujifilm developed blue laser imaging (BLI) via a laser light source with a narrow-band light observation function. It has a brighter BLI bright mode for tumor detection. OBJECTIVE To investigate whether the BLI bright mode can improve the visibility of colorectal polyps compared with white light (WL). DESIGN We studied 100 colorectal polyps (protruding, 42; flat, 58; size, 2-20 mm) and recorded videos of the polyps by using the BLI bright mode and WL at Kyoto Prefectural University of Medicine and Fukuoka Chikushi University Hospital. The videos were evaluated by 4 expert endoscopists and 4 nonexperts. Each endoscopist evaluated the videos in a randomized order. Each polyp was assigned a visibility score from 4 (excellent visibility) to 1 (poor visibility). SETTING Japanese academic units. MAIN OUTCOME MEASUREMENTS The visibility scores in each mode and their relationship to the clinical characteristics were analyzed. RESULTS The mean visibility scores of the BLI bright mode were significantly higher than those of WL for both experts and nonexperts (experts, 3.10 ± 0.95 vs 2.90 ± 1.09; P = .00013; nonexperts, 3.04 ± 0.94 vs 2.78 ± 1.03; P < .0001). For all nonexperts, the visibility scores of the BLI bright mode were significantly higher than those of WL; however, these scores were significantly higher in only 2 experts. For experts, the mean visibility scores of the BLI bright mode was significantly higher than those of WL for flat polyps, neoplastic polyps, and polyps located on the left side of the colon and the rectum. LIMITATIONS Small sample size and review of videos. CONCLUSIONS Our study showed that polyps were more easily visible with the BLI bright mode compared with WL. ( CLINICAL TRIAL REGISTRATION NUMBER UMIN000013770.).
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Nobuaki Yagi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshiaki Aomi
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kazeo Ninomiya
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Go Ikezono
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masaaki Terasawa
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Kenshi Yao
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiyuki Matsui
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akio Yanagisawa
- Department of Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Manta R, Tremolaterra F, Arezzo A, Verra M, Galloro G, Dioscoridi L, Pugliese F, Zullo A, Mutignani M, Bassotti G. Complications during colonoscopy: prevention, diagnosis, and management. Tech Coloproctol 2015; 19:505-513. [PMID: 26162284 DOI: 10.1007/s10151-015-1344-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/07/2015] [Indexed: 02/08/2023]
Abstract
Colonoscopy is largely performed in daily clinical practice for both diagnostic and therapeutic purposes. Although infrequent, different complications may occur during the examination, mostly related to the operative procedures. These complications range from asymptomatic and self-limiting to serious, requiring a prompt medical, endoscopic or surgical intervention. In this review, the complications that may occur during colonoscopy are discussed, with a particular focus on prevention, diagnosis, and therapeutic approaches.
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Affiliation(s)
- R Manta
- Diagnostic and Interventional Digestive Endoscopy Unit, Niguarda Cà-Granda Hospital, Milano, Italy,
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30
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Pissas D, Ypsilantis E, Papagrigoriadis S, Hayee B, Haji A. Endoscopic management of iatrogenic perforations during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for colorectal polyps: a case series. Therap Adv Gastroenterol 2015; 8:176-81. [PMID: 26136835 PMCID: PMC4480568 DOI: 10.1177/1756283x15576844] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Iatrogenic perforation during therapeutic colonoscopy, reported in up to 1% of endoscopic mucosal resections (EMRs) and up to 14% of endoscopic submucosal dissections (ESDs), has conventionally been an indication for surgery. AIMS We present a case series of successful endoscopic management of iatrogenic colorectal perforation during EMR and ESD, demonstrating the feasibility and safety of the method. METHODS Retrospective analysis of a database of patients undergoing EMR and ESD for colorectal polyps in a tertiary referral centre in the United Kingdom. RESULTS Four cases of perforation were identified (two EMRs and two ESDs) in a series of 218 procedures (1.8%), all detected at the time of endoscopy and managed with endoscopic clips. Patients were observed in hospital and treated with antibiotics. Their median length of stay was 3 days (range 2-6 days), with no mortality or need for surgery. CONCLUSION Surgery is no longer the first choice in the management of iatrogenic perforations during EMR and ESD for colorectal polyps; in selected patients with small perforations and minimal extraluminal contamination, conservative management with application of endoscopic clips, antibiotics and close patient monitoring constitute a safe and effective treatment option, avoiding the morbidity of major surgery.
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Affiliation(s)
- Dimitrios Pissas
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Efthymios Ypsilantis
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Savvas Papagrigoriadis
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Bu’Hussain Hayee
- Department of Colorectal Surgery and Endoscopy, King’s College Hospital, Denmark Hill, London, UK
| | - Amyn Haji
- Department of Colorectal Surgery, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
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Yoshida N, Naito Y, Hirose R, Ogiso K, Siah KTH, Inada Y, Dohi O, Kamada K, Katada K, Uchiyama K, Handa O, Takagi T, Konishi H, Yagi N, Itoh Y. Risk of lens cloudiness during colorectal endoscopic submucosal dissection and ability of a novel lens cleaner to maintain and restore endoscopic view. Dig Endosc 2015; 27:609-617. [PMID: 25613857 DOI: 10.1111/den.12442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/19/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Generally, colorectal endoscopic submucosal dissection (ESD) cannot be carried out with severe lens cloudiness. We examined the occurrence of lens cloudiness during ESD as well as the efficacy of a novel cleaner for it. METHODS This study was a prospective study compared to historical control. First, we analyzed 103 ESD cases using standard cleaner at the Kyoto Prefectural University of Medicine in 2012. Relationship between lens cloudiness and clinical characteristics of lesions was analyzed. Lens cloudiness was recorded as grade 0 (clear) to grade 2 (very unclear). Then, we recruited 92 consecutive patients who underwent colorectal ESD using the novel cleaner from August 2013 to July 2014. The cleaner was applied on top of the lens before procedure and ability to prevent lens cloudiness was tested. Additionally, the novel cleaner was injected from endoscopic channel into a space created by endoscopic hood and colonic wall in seven cases with grade 1 or 2 of lens cloudiness and the ability to clean lens cloudiness inside the colon was tested. RESULTS Rate of severe lens cloudiness was 8.7%. Multivariate analysis showed that severe lens cloudiness was related with severe submucosal fatty tissue (P < 0.001). The novel cleaner had significantly less cloudiness cases compared to the standard cleaner (14.1% vs 33.0%, P = 0.002). Additionally, the novel cleaner enabled us to clean lens cloudiness in all seven cases. CONCLUSION Lens cloudiness during ESD was associated with submucosal fatty tissue. Effective lens cleaner should be used to prevent and clean lens cloudiness.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Naito
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kewin Tien Ho Siah
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Inada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiro Kamada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiro Katada
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Handa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobuaki Yagi
- Department of Gastroenterology, Asahi University Murakami Memorial Hospital, Gifu, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yoshinaga T, Shigemitsu T, Nishimata H, Kitazono M, Hori E, Tomiyoshi A, Takei T, Yoshida M. Angiopoietin-like protein 2 as a potential biomarker for colorectal cancer. Mol Clin Oncol 2015; 3:1080-1084. [PMID: 26623054 DOI: 10.3892/mco.2015.577] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/15/2015] [Indexed: 11/06/2022] Open
Abstract
Colorectal cancer (CRC) is the third most common malignancy worldwide. Disease progression leads to its spread to other organs, such as the liver, and is associated with higher mortality rates. Early CRC detection is therefore crucial for maximizing the chances of complete cure. The measurement of serum-based tumor biomarkers has shown great potential for the detection of CRC. In this study, we investigated the feasibility of using angiopoietin-like protein 2 (ANGPTL2) as a candidate biomarker for CRC. We first investigated ANGPTL2 expression in 7 CRC cell lines, among which Colo320, NCC-CoCK-115P, Caco-2 and Colo205 exhibited comparatively high ANGPTL2 expression. The serum levels of ANGPTL2 in CRC patients (3.45±1.30 ng/ml) were higher compared with those in healthy controls (2.74±0.64 ng/ml) (P<0.05). A receiver operating characteristic analysis demonstrated that the diagnostic performance of ANGPTL2 was marginally lower compared with that of the established biomarker C-reactive protein, but higher compared with that of carbohydrate antigen 19-9. These results suggested that the simultaneous measurement of ANGPTL2, along with previously established serum biomarkers, may increase the likelihood of early detection of CRC.
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Affiliation(s)
- Takuma Yoshinaga
- Division of Clinical Application, Nanpuh Hospital, Kagoshima 891-8512, Japan ; Department of Chemical Engineering, Graduate School of Science and Engineering, Kagoshima University, Kagoshima 890-0065, Japan
| | - Takamasa Shigemitsu
- Department of Chemical Engineering, Graduate School of Science and Engineering, Kagoshima University, Kagoshima 890-0065, Japan
| | - Hiroto Nishimata
- Department of Gastroenterology, Nanpuh Hospital, Kagoshima 891-8512, Japan
| | - Masaki Kitazono
- Department of Gastrointestinal Surgery, Nanpuh Hospital, Kagoshima 891-8512, Japan
| | - Emiko Hori
- Division of Clinical Application, Nanpuh Hospital, Kagoshima 891-8512, Japan
| | - Ayako Tomiyoshi
- Division of Clinical Application, Nanpuh Hospital, Kagoshima 891-8512, Japan
| | - Takayuki Takei
- Department of Chemical Engineering, Graduate School of Science and Engineering, Kagoshima University, Kagoshima 890-0065, Japan
| | - Masahiro Yoshida
- Department of Chemical Engineering, Graduate School of Science and Engineering, Kagoshima University, Kagoshima 890-0065, Japan
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The effectiveness of endoscopic submucosal resection with a ligation device for small rectal carcinoid tumors: focused on previously biopsied tumors. Surg Laparosc Endosc Percutan Tech 2015; 24:264-9. [PMID: 24710234 DOI: 10.1097/sle.0b013e3182901176] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of endoscopic submucosal resection with a ligation device (ESMR-L) on histologic complete resection for the treatment of small rectal carcinoid tumors in comparison with the treatment with endoscopic mucosal resection (EMR) alone. METHODS Thirty-five patients with small rectal carcinoid tumors were enrolled prospectively for ESMR-L, and we retrospectively reviewed 74 carcinoid tumor patients who underwent EMR. The comparison between ESMR-L and EMR groups was analyzed including endoscopic and histologic complete resection and complications after resection. We also evaluated the associations of histologic complete resection with clinical and procedure-related factors. RESULTS The histologic complete resection rate was significantly higher in ESMR-L than in EMR (94.3% vs. 75.7%, P=0.019). In addition, the resection time was significantly shorter in ESMR-L than in EMR (4.16±1.48 min vs. 5.11±2.47 min, respectively, P=0.014). Moreover, previously biopsied rectal carcinoid tumors were significantly associated with histologic incomplete resection, especially in patients who underwent EMR (odds ratio, 6.28; 95% confidence interval, 1.92-20.58; P=0.002). CONCLUSIONS Compared with EMR, ESMR-L is a safe and effective method for histologic complete resection of small rectal carcinoid tumors, especially in patients with previously biopsied carcinoid tumors.
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Castro-Poças F, Dinis-Ribeiro M, Araújo T, Pedroto I. Echoendoscopic characterization of the human colon. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2015; 107:469-75. [DOI: 10.17235/reed.2015.3721/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yoshida N, Saito Y, Hirose R, Ogiso K, Inada Y, Yagi N, Naito Y, Otake Y, Nakajima T, Matsuda T, Yanagisawa A, Itoh Y. Endoscopic mucosal resection for middle and large colorectal polyps with a double-loop snare. Digestion 2014; 90:232-239. [PMID: 25532080 DOI: 10.1159/000368044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/02/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS This study aimed to analyze the endoscopic mucosal resection (EMR) with a novel uniquely shaped, double-loop snare (Dualoop, Medico's Hirata Inc., Tokyo, Japan) for colorectal polyps. METHODS This was a clinical trial conducted in two referral centers, Kyoto Prefectural University of Medicine and National Cancer Center Hospital in Japan. First, the firmness of various snares including 'Dualoop' was experimentally analyzed with a pressure gauge. Five hundred and eighty nine consecutive polyps that underwent EMR with 'Dualoop' were compared to 339 polyps with the standard round snare. Lesion characteristics, en bloc resection, and complications were analyzed. RESULTS 'Dualoop' had the most firmness among the various snares. The average tumor size was 9.3 mm (5-30), and en bloc resection was achieved in 95.4%. The rate of en bloc resection for middle polyps 15-19 mm in diameter was significantly higher with the 'Dualoop' than that with the round snare (97.9 vs. 80.0%, p < 0.05). The rate of en bloc resection was 64.7% for large polyps ≥20 mm in diameter using 'Dualoop'. Higher age, larger tumor size, and superficial polyps were associated with the failure of en bloc resection. CONCLUSION EMR with 'Dualoop' was effective for resecting both middle and large polyps en-bloc.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Agapov M, Dvoinikova E. Factors predicting clinical outcomes of endoscopic submucosal dissection in the rectum and sigmoid colon during the learning curve. Endosc Int Open 2014; 2:E235-40. [PMID: 26135099 PMCID: PMC4424868 DOI: 10.1055/s-0034-1377613] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/23/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Colorectal endoscopic submucosal dissection (ESD) is associated with significant technical difficulty, long procedure time, and increased risk of complications, especially perforation. This study aimed to determine the factors associated with clinical results of ESD during the learning curve. PATIENTS AND METHODS In total, 44 patients with sessile and flat rectal and sigmoid colon lesions underwent ESD from November 2009 to September 2013. The procedure time, resection method, tumor size, location, gross morphology, presence of fibrosis, histologic findings, rates of en bloc and piecemeal resections and perforation were analyzed. The ESD procedure was classified as technically difficult in the case of procedure time > 120 minutes and/or piecemeal resection. The whole study time was divided into two periods: first period: resections 1 - 22, second period: resections 23 - 44. RESULTS En bloc and R0 resection have been achieved in 84.1 % of lesions. The mean procedure time was 119.95 ± 11.22 minutes (range 25 - 360 minutes). Perforation was seen in five cases (11.4 %). A larger tumor size was a risk factor for difficult ESD (P = 0.0001). A finding of fibrosis was a risk factor for piecemeal ESD (P = 0.0074), and perforation (P = 0.0012). There was a high direct positive correlation between tumor size and operation time (r = 0.83, P < 0.0001, 0.95 and 0.99 confidence interval for rho 0.71 - 0.904). There was no significant difference between the first and second period in terms of mean procedure time, en bloc resection or complication rate. CONCLUSION A larger tumor size was associated with technically difficult ESD. Severe submucosal fibrosis was a risk factor for both piecemeal resection and perforation.
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Affiliation(s)
- Mikhail Agapov
- Vladivostok Clinical Railway Hospital – Endoscopy, Vladivostok, Russian Federation,Corresponding author Mikhail Agapov Vladivostok Clinical Railway Hospital – EndoscopyVerhneportovaya, 25Vladivostok 690003Russian Federation+7-4232-248227
| | - Ekaterina Dvoinikova
- Vladivostok Clinical Railway Hospital – Endoscopy, Vladivostok, Russian Federation
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Arantes V, Toyonaga T, Piñeros EAF. Polyethylene glycol submucosal irrigation: a novel approach to improve visibility during endoscopic submucosal dissection. Endosc Int Open 2014; 2:E193-5. [PMID: 26134968 PMCID: PMC4423321 DOI: 10.1055/s-0034-1377444] [Citation(s) in RCA: 2] [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: 04/21/2014] [Accepted: 06/03/2014] [Indexed: 11/30/2022] Open
Abstract
In order to expand the availability of endoscopic submucosal dissection (ESD), measures to facilitate the procedure are necessary. When bleeding occurs, the examiner's field of vision is critically impaired, and ESD becomes less efficient and more hazardous because of the presence of submucosal hematoma and covered blood clot. We propose the use of polyethylene glycol (PEG) irrigation as a simple and effective measure to improve visibility during submucosal dissection, particularly when bleeding occurs. PEG irrigation facilitates further dissection by allowing a better recognition of the submucosal fibers and muscularis propria layer.
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Affiliation(s)
- Vitor Arantes
- Faculdade de Medicina da Universidade Federal de Minas Gerais - Alfa
Institute of Gastroenterology, Belo Horizonte, Brazill
| | - Takashi Toyonaga
- Kobe University Hospital – Endoscopy, Kobe, Japan,Corresponding author T. Toyonaga, M.D. Department
of EndoscopyKobe University
Hospital7-5-1
Kusunoki-choChuo-kuKobe5500-0017
–
Japan+81-78-3826309
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Hirota M, Miyazaki Y, Takahashi T, Yamasaki M, Takiguchi S, Mori M, Doki Y, Nakajima K. Dynamic article: steady pressure CO2 colonoscopy; its feasibility and underlying mechanism. Dis Colon Rectum 2014; 57:1120-8. [PMID: 25101609 DOI: 10.1097/dcr.0000000000000190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Steady pressure automatically controlled endoscopy is a new insufflation concept, achieving a laparoscopy-like steady environment in the upper GI tract, recently reported in the esophagus. OBJECTIVE The purpose of this work was to validate the feasibility and safety of steady pressure automatically controlled endoscopy in the lower GI tract and to identify major factors that enable it. DESIGN This was a nonsurvival animal study using canine models. SETTINGS The study was conducted in an academic center. PATIENTS Canine models were used in this study. INTERVENTIONS In experiment 1, steady pressure automatically controlled endoscopy was attempted in the cecum with insufflation pressures of 4, 8, and 12 mm Hg. We assessed performance by video review and continuous intracecal pressure monitoring. Next, steady pressure automatically controlled endoscopy was performed for 20 minutes under optimal pressure, 8 mm Hg (n = 10). In experiment 2, steady pressure automatically controlled endoscopy was attempted in the rectum with or without artificial colonic flexure and with either low (8 mm Hg) or high (16 mm Hg) insufflation pressure to assess the effects of anatomic flexure and insufflation pressure on the establishment of steady pressure automatically controlled endoscopy (n = 6). MAIN OUTCOME MEASURES We measured multipoint intraluminal pressure monitoring in the upstream bowel, as well as cardiopulmonary parameters. RESULTS For experiment 1, steady pressure automatically controlled endoscopy in cecum was successful at all of the tested insufflation pressures; 8 mm Hg provided the optimal result. Steady pressure automatically controlled endoscopy was safely performed for 20 minutes at 8 mm Hg without any cardiopulmonary parameter changes or intraluminal pressure elevation in the upstream bowel. For experiment 2, confinement of the steady pressure environment to the rectum was achieved only with the assistance of colonic flexure and at 8 mm Hg insufflation pressure. In other conditions, the insufflated gas extended throughout the entire colon. LIMITATIONS This study was limited by being an animal study. CONCLUSIONS Steady pressure automatically controlled endoscopy is feasible and safe in the lower GI tract under the optimized insufflation pressure and in the presence of anatomical flexure (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A150).
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Affiliation(s)
- Masashi Hirota
- 1Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan 2Division of Collaborative Research for Next Generation Endoscopic Intervention, Center for Advanced Medical Engineering and Informatics, Osaka University, Osaka, Japan
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Yoshida N, Fernandopulle N, Inada Y, Naito Y, Itoh Y. Training methods and models for colonoscopic insertion, endoscopic mucosal resection, and endoscopic submucosal dissection. Dig Dis Sci 2014; 59:2081-2090. [PMID: 25102984 DOI: 10.1007/s10620-014-3308-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/17/2014] [Indexed: 12/17/2022]
Abstract
Colonoscopic examination is considered an effective examination for the detection of colorectal cancers. Additionally, early colorectal cancers can be resected using endoscopic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection. However, those examinations and treatments need special techniques. Various training methods are practiced to acquire such endoscopic techniques throughout the world. In clinical cases, magnetic positioning devices help endoscopic insertion by less experienced endoscopists. There is a physical model made by polyvinyl chloride and a virtual simulator for training of colonoscopic insertion. Various techniques including a method to apply pressure to the abdomen and consideration for patient's pain can be trained using these models. In view of extensive training of endoscopic mucosal resection and endoscopic submucosal dissection, animal models are useful and actually used. Live animal models of minipig, which entails blood flow, are ideal and used frequently, but are cumbersome to prepare. On the other hand, ex vivo animal models using intestine of porcine and bovine are convenient for preparation and less expensive. Unique ex vivo animal models with blood flow have been developed recently and techniques for hemostasis can be practiced. With respect to a method of training for colorectal endoscopic submucosal dissection, a stepwise system has been adopted throughout the world. Thus, first they observe the expert's technique, then practice training of animal models, and finally, they perform clinical rectal cases. The system is useful for a safe and definite procedure. In this review, we reveal various training methods for colonoscopic examinations and treatments.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan,
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Hsu WH, Sun MS, Lo HW, Tsai CY, Tsai YJ, Chen PH. Clinical experience of large colorectal laterally spreading tumor in a regional hospital: 2-year results. ADVANCES IN DIGESTIVE MEDICINE 2014. [DOI: 10.1016/j.aidm.2013.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc 2014; 28:2959-65. [DOI: 10.1007/s00464-014-3558-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/17/2014] [Indexed: 12/28/2022]
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Sato K, Ito S, Kitagawa T, Kato M, Tominaga K, Suzuki T, Maetani I. Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc 2014. [PMID: 24853849 DOI: 10.1016/j.gie.2014.02.988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) for colorectal tumors is technically difficult due to the anatomy of the large intestine, with its narrow lumen, thin walls, and redundancy. Here, we assessed factors associated with incomplete resection and difficult colorectal ESD. METHODS Between November 2009 and April 2013, we performed ESD on 151 consecutive colorectal tumors in 147 patients. We evaluated the clinical outcomes of all cases and conducted multiple logistic regression analysis of the following factors related to incomplete resection and difficult procedure: age, gender, location (right colon, left colon or rectum), tumor size (diameter ≥40 or <40 mm), operation time, morphology [granular-type laterally spreading tumor (LST-G), non-granular-type laterally spreading tumor (LST-NG), or protruded type], fibrosis, and paradoxical movement during the procedure. A procedure that required more than 120 min was defined as a difficult colorectal ESD. RESULTS Average tumor size was 32.1 ± 10.7 mm, and the average procedure length was 71.8 ± 49.5 min. The rate of en bloc resection was 94.7%, while that of en bloc curative resection was 86.8%. Perforation occurred in 1.3% of the ESD procedures. Multivariate logistic regression analysis revealed that only severe fibrosis [odds ratio (OR) 4.51; 95% confidence interval (CI) 1.36-14.91, p = 0.014] contributed to incomplete resection and that a tumor size exceeding 40 mm (OR 5.73 [95% CI 1.66-19.74], p = 0.006), severe fibrosis (OR 23.31 [95% CI 6.59-82.54], p < 0.001), and paradoxical movement (OR 4.26 [95% CI 1.11-16.44], p = 0.035) were independent factors exacerbating the difficulty of colorectal ESD. CONCLUSIONS Severe fibrosis contributed to both incomplete resection and difficult colorectal ESD. Larger tumor size and paradoxical movement during the procedure were independent factors contributing to the difficulty of colorectal ESD. These factors might enable endoscopists to develop strategies for treating colorectal ESD.
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Affiliation(s)
- Koichiro Sato
- Division of Gastroenterology and Hepatology , Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan,
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Yoshida N, Naito Y, Hirose R, Ogiso K, Inada Y, Fernandopulle N, Kamada K, Katada K, Uchiyama K, Handa O, Takagi T, Konishi H, Yagi N, Wakabayashi N, Yanagisawa A, Itoh Y. Prevention of colonic spasm using L-menthol in colonoscopic examination. Int J Colorectal Dis 2014; 29:579-583. [PMID: 24584277 DOI: 10.1007/s00384-014-1844-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The detailed efficacy of intraluminal L-menthol for preventing colonic spasm is not known. The aim of this study was to evaluate the effectiveness of L-menthol in preventing colonic spasm during colonoscopy. METHODS We analyzed 65 patients (mean age: 71.7 years; 49 men and 16 women) who were administered 0.8% L-menthol (MINCLEA, Nihon Seiyaku, Tokyo, Japan) intraluminally for severe colonic spasm during colonoscopic examination at Kyoto Prefectural University of Medicine between February 2012 and May 2013. The efficacy of L-menthol was defined as the absence of colonic spasm during a period of 30 s, and its effect was evaluated at 30 s, 1 min, and 5 min after administration. Additionally, various characteristics of these patients were analyzed. Twenty-seven patients with severe colonic spasm were administered intraluminal water and assessed as controls. RESULTS L-Menthol was effective in preventing colonic spasms in 60.0%, 70.8%, and 46.5% of patients at 30 s, 1 min, and 5 min, respectively. In contrast, water was effective in 22.2%, 29.6%, and 48.1% of patients at 30 s, 1 min, and 5 min, respectively. There was a significant difference about the efficacy at 30 s and 1 min between L-menthol and water (P = 0.0009, P = 0.0006). CONCLUSIONS L-Menthol (0.8%) was effective in preventing colonic spasm during colonoscopic examination.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan,
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Current innovations in endoscopic therapy for the management of colorectal cancer: from endoscopic submucosal dissection to endoscopic full-thickness resection. BIOMED RESEARCH INTERNATIONAL 2014; 2014:925058. [PMID: 24877148 PMCID: PMC4022075 DOI: 10.1155/2014/925058] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/11/2014] [Accepted: 04/14/2014] [Indexed: 12/11/2022]
Abstract
Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for colorectal cancer. However, due to technical difficulties and an increased rate of complications, ESD is not widely used in the colorectum. In some cases, endoscopic treatment alone is insufficient for disease control, and laparoscopic surgery is required. The combination of laparoscopic surgery and endoscopic resection represents a new frontier in cancer treatment. Recent developments in advanced polypectomy and minimally invasive surgical techniques will enable surgeons and endoscopists to challenge current practice in colorectal cancer treatment. Endoscopic full-thickness resection (EFTR) of the colon offers the potential to decrease the postoperative morbidity and mortality associated with segmental colectomy while enhancing the diagnostic yield compared to current endoscopic techniques. However, closure is necessary after EFTR and natural transluminal endoscopic surgery (NOTES). Innovative methods and new devices for EFTR and suturing are being developed and may potentially change traditional paradigms to achieve minimally invasive surgery for colorectal cancer. The present paper aims to discuss the complementary role of ESD and the future development of EFTR. We focus on the possibility of achieving EFTR using the ESD method and closing devices.
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Modified laparoscopic intragastric surgery and endoscopic full-thickness resection for gastric stromal tumor originating from the muscularis propria. Surg Endosc 2014; 28:1447-53. [PMID: 24671350 DOI: 10.1007/s00464-013-3375-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 12/09/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the feasibility and security of the modified laparoscopic intragastric surgery (MLIGS) and the endoscopic full-thickness resection (EFR) for the treatment of gastric stromal tumors (GSTs) originating from the muscularis propria. METHODS The study population was 18 patients with GSTs of the intraluminal muscularis propria layer. Eight were treated by MLIGS performed according to the following procedures: (1) gastroscopy was used to expose and confirm the location of the tumor; (2) a laparoscope light was placed in the cavity using the trocar at the navel, with the remaining two trocars penetrating both the abdominal and stomach walls; (3) the operation was performed in the gastric lumen using laparoscopic instruments with gastroscope monitoring, and the tumor was resected; (4) the tumor tissue was removed orally using a grasping forceps; (5) and the puncture holes and perforation in the stomach were sutured using titanium clips. The remaining 10 patients were treated by EFR, which involved (1) injection of normal saline into the submucosa and precutting of the mucosal and submucosal layer around the lesion, (2) a circumferential incision as deep as the muscularis propria around the lesion, (3) an incision into the serosal layer around the lesion, (4) completion of full-thickness incision to the tumor, (5) closure of the gastric wall defect with clips. RESULTS The GSTs all were resected completely. The two groups did not differ significantly in terms of tumor size, hospital stay, or abdominal pain time. But in the MLIGS group, the operation time and blood loss were significantly decreased compared with the EFR group. No postoperative complications occurred in the MLIGS group, whereas one peritoneal abscess occurred in the EFR group. The pathology of all the resected specimens showed GST. No case of implantation or metastasis was found. CONCLUSIONS Both MLIGS and EFR are feasible and effective treatments for GSTs from the muscularis propria. Moreover, both are minimally invasive.
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Yoshida N, Yagi N, Inada Y, Kugai M, Okayama T, Kamada K, Katada K, Uchiyama K, Ishikawa T, Handa O, Takagi T, Konishi H, Kokura S, Yanagisawa A, Naito Y. Ability of a novel blue laser imaging system for the diagnosis of colorectal polyps. Dig Endosc 2014; 26:250-258. [PMID: 23731034 DOI: 10.1111/den.12127] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/12/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND A new endoscope system with a laser light source, blue laser imaging (BLI), has been developed by Fujifilm that allows for narrow-band light observation. The aim of the present study was to evaluate the utility of BLI for the diagnosis of colorectal polyps. METHODS We retrospectively analyzed 314 colorectal polyps that were examined with BLI observation at Kyoto Prefectural University of Medicine between September 2011 and January 2013. The surface and vascular patterns of polyps detected by published narrow-band imaging magnification: Hiroshima classification were used. Correlations were determined between the classifications and the histopathological diagnoses. Additionally, the ability of BLI without magnification to differentiate between neoplastic or non-neoplastic polyps was analyzed. RESULTS A total of 41 hyperplastic polyps, 168 adenomas, 80 intramucosal cancer, 11 shallowly invaded submucosal cancer, and 14 deeply invaded submucosal cancer were analyzed.Hyperplastic polyp was observed in 100% of Type A lesions (39 lesions), adenoma was observed in 89.3% of Type B lesions (159 lesions), intramucosal cancer and shallowly invaded submucosal cancer was observed in 69.6% of Type C1 (92 lesions) and in 84.6% of Type C2 (13 lesions), and deeply invaded submucosal cancer was observed in 81.8% of Type C3 lesions (11 lesions). The overall diagnostic accuracy of BLI with magnification was 84.3%. Additionally, the diagnostic accuracy of BLI without magnification for differentiating between neoplastic and non-neoplastic polyps <10 mm in diameter was 95.2%, which was greater than that of white light (83.2%). CONCLUSION BLI was useful for the diagnosis of colorectal polyps.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Yoshida N, Hisabe T, Inada Y, Kugai M, Yagi N, Hirai F, Yao K, Matsui T, Iwashita A, Kato M, Yanagisawa A, Naito Y. The ability of a novel blue laser imaging system for the diagnosis of invasion depth of colorectal neoplasms. J Gastroenterol 2014; 49:73-80. [PMID: 23494646 DOI: 10.1007/s00535-013-0772-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/06/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Fujifilm has developed a novel endoscope system with two kinds of lasers that enables us to allow narrow-band light observation with blue laser imaging (BLI). The aim of this study was to evaluate BLI magnification in comparison with narrow-band imaging (NBI) magnification for the diagnosis of colorectal neoplasms. METHODS This was a multicenter open study. A total of 104 colorectal neoplasms were examined with BLI and NBI magnifications in Kyoto Prefectural University of Medicine and Fukuoka University Chikushi Hospital. Vascular and surface patterns of tumors under BLI magnification were compared with those under NBI magnification, using a published NBI classification. The main outcome was the correlation between the NBI classification diagnosed by BLI or NBI magnification and the histopathological analyses. RESULTS Sixty-two cases of adenoma, 34 cases of intramucosal cancer and shallowly invaded submucosal cancer, and eight cases of deeply invaded submucosal cancer were diagnosed. The diagnostic accuracy of BLI magnification in the NBI classification was 74.0 % (77/104), similar to that of NBI magnification (77.8 %). The consistency rate between BLI and NBI magnification in the NBI classification was 74.0 %. Concerning image evaluation, the interobserver variability of two expert endoscopists (N.Y. and T.H.) in BLI magnification was κ = 0.863. On the other hand, the intraobserver variability of the two endoscopists was κ = 0.893 (N.Y.) and 0.851 (T.H.). CONCLUSIONS BLI magnification by laser source could predict histopathological diagnosis and invasion depth of colorectal neoplasms. The diagnostic effectiveness of this method was similar to that of NBI magnification.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan,
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Techniques of endoscopic submucosal dissection: application for the Western endoscopist? Gastrointest Endosc 2013; 78:677-88. [PMID: 24021491 DOI: 10.1016/j.gie.2013.07.033] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/18/2013] [Indexed: 12/13/2022]
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Rolanda C, Caetano AC, Dinis-Ribeiro M. Emergencies after endoscopic procedures. Best Pract Res Clin Gastroenterol 2013; 27:783-98. [PMID: 24160934 DOI: 10.1016/j.bpg.2013.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 02/08/2023]
Abstract
Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.
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Affiliation(s)
- Carla Rolanda
- Department of Gastroenterology, Hospital Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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Yoshida N, Yagi N, Inada Y, Kugai M, Naito Y. Preventing Complications at Endoscopic Submucosal Dissection for Colorectal Neoplasia. VIDEO JOURNAL AND ENCYCLOPEDIA OF GI ENDOSCOPY 2013; 1:397-398. [DOI: 10.1016/s2212-0971(13)70176-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
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