BackgroundEndoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal neoplasms; however, most ESD articles report small series, with short-term outcomes performed by multiple operators on single organ. We assessed short- and long-term treatment outcomes following ESD for early neoplasms throughout the gastrointestinal tract.MethodsWe performed a longitudinal cohort study in single tertiary care referral center. A total of 1,635 early gastrointestinal neoplasms (stomach 1,136; esophagus 138; colorectum 361) were treated by ESD by single operator. Outcomes were complication rates, en bloc R0 resection rates, and long-term overall and disease-specific survival rates at 3 and 5 years for both guideline and expanded criteria for ESD.ResultsEn bloc R0 resection rates were: stomach: 97.1 %; esophagus: 95.7 %; colorectum: 98.3 %. Postoperative bleeding and perforation rates respectively were: stomach: 3.6 and 1.8 %; esophagus: 0 and 0 %; colorectum: 1.7 and 1.9 %. Intra criteria resection rates were: stomach: 84.9 %; esophagus: 81.2 %; colorectum: 88.6 %. Three-year survival rates for lesions meeting Japanese ESD guideline/expanded criteria were for all organ-combined: 93.4/92.7 %. Five-year rates were: stomach: 88.1/84.6 %; esophagus: 81.6/57.3 %; colorectum: 94.3/100 %. Median follow-up period was 53.4 (range, 0.07–98.6) months. Follow-up rate was 94 % (1,020/1,085). There was no recurrence or disease-related death.ConclusionsIn this large series by single operator, ESD was associated with high curative resection rates and low complication rates across the gastrointestinal tract. Disease-specific and overall long-term prognosis for patients with lesions within intra criteria after curative resection appeared to be excellent.
Background:The emergence of endoscopic submucosal dissection (ESD) has enabled en bloc resection of lesions, which were conventionally difficult. However, ESD has problems of technical difficulty and high incidence of complications. In order to improve the procedure of marking and submucosal dissection in the esophagus, we modified and adjusted the standard needle knife to a short needle knife having a tip portion with a projection length of 1.5 mm. Methods: We treated 20 esophageal lesions with ESD using the short needle knife. We marked around the lesion with the short needle knife and performed mucosal incision of the entire circumference with a needle knife and an IT knife, then dissected the submucosal layer with the short needle knife. A Hook knife was also used in situations where muscular layers were located in the front-view Results: Complete en bloc resection was performed in all 20 cases. The diameter of lesions ranged from 3 to 65 mm (median, 20 mm), and that of resected specimens ranged from 28 to 90 mm (median, 47 mm). Submucosal dissection was completed with the short needle knife alone in 13 cases in 20 (65%), and in seven cases (35%), in combination with socalled Hook knife. The procedure was complicated in one patient with mediastinal emphysema. Conclusions: The short needle knife proved to be useful and safe in clear marking and submucosal dissection of esophageal lesions. It allows greater flexibility in the angle of insertion, and enables more effective and safer procedures because its full length can be inserted into the submucosa and fixed.
In this study, a pn homojunction was intentionally fabricated in the Cu(InGa)Se2 (CIGS) layer by Zn doping. For Zn doping of the CIGS layer, Zn was evaporated after CIGS formation, and a potential improvement in cell performance was confirmed by this technique. Furthermore, Zn diffusion into the CIGS film was investigated by secondary ion mass spectroscopy (SIMS). A conductivity-type conversion from p-type to n-type was studied by the measurement of the cross-sectional electron beam-induced current (junction EBIC: JEBIC) and the spectral response of solar cells. A conversion efficiency of 11.5% has been achieved using the Zn-doped CIGS layer without a buffer layer and by the formation of a pn homojunction in the CIGS absorber.
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