A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate

Yamamoto, Hironori; Hirobumi, Koiwal; Tomizo, Yube; Isoda, Norio; Sato, Yukihiro; Sugita, Y.; Higashizawa, Toshihiko; Utsunomiya, Kenji; Ido, Kenichi; Sugano, Kentaro

doi:10.1016/s0016-5107(99)80026-1

Cited by 100 publications

(65 citation statements)

References 9 publications

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“…As from an oncological standpoint, resections of benign lesions are indisputably unnecessary; currently a certain number of laminar adenomas still remain which are removed by open surgery, because their endoscopic removal appears to be too risky or impossible [15] . In the past few years, different groups have focused on finding new substances for submucosal injection instead of saline solutions, in the expectation that these new substances would produce a longer elevation time of the submucosal cushions and/or facilitate the transsection of the submucosa (hyaluronic acid) [16,17] . Other innovations have concentrated on the resection instruments [17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

Selective Fluid Cushion in the Submucosal Layer by Water Jet: Advantage for Endoscopic Mucosal Resection

et al. 2007

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Background/Aim: Numerous new techniques have recently been reported and described for the endoscopic mucosal resection of large superficial lesions of the gastrointestinal tract. We present here for the first time the application of a water jet dissector for mucosa elevation. Materials and Methods: In an ex vivo study, the effectiveness of a water jet dissector (Helix Hydro-Jet®) placed directly on the stomach walls of 8 pigs was examined to create a mucosal elevation. After having determined optimal pressures, angle of application, and application times, 13 submucosal fluid cushions were produced in different areas of the stomach walls of 8 pigs in vivo, and the sizes of the resulting submucosal cushions were measured. Results: Using pressures between 30 and 70 bar, it was routinely possible to create submucosal fluid cushions in the stomach wall ex vivo as well as in vivo. Histological examination showed a selective edema in the submucosa without damage to the deeper mucosal layers of the gastric wall. Conclusions: The capacity of a targeted high-pressure water jet to penetrate the mucosa and selectively create a fluid cushion in the submucosa facilitates endoscopic resection of the mucosa. This new method could contribute to ameliorate the endoscopic treatment of mucosal tumors which previously could not be resected endoscopically due to their size, extent, or location.

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Section: Discussionmentioning

confidence: 99%

Selective Fluid Cushion in the Submucosal Layer by Water Jet: Advantage for Endoscopic Mucosal Resection

et al. 2007

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“…In ESD, hyaluronate sodium [12][13][14] is an important component of the injection solution as it facilitates good submucosal elevation. In routine practice, it is diluted four-to sixfold with glycerol, and small amounts of indigo carmine and epinephrine hydrochloride (Bosmin) are added to the solution.…”

Section: Injection Solutionmentioning

confidence: 99%

Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection

2008

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Endoscopic submucosal dissection (ESD) allows en bloc resection of a lesion, irrespective of the size of the lesion. ESD has been established as a standard method for the endoscopic ablation of malignant tumors in the upper gastrointestinal (GI) tract in Japan. Although the use of ESD for colorectal lesions has been studied via clinical research, ESD is not yet established as a standard therapeutic method for colorectal lesions because colorectal carcinoma has unique pathological, organ specific characteristics that differ radically from those of the esophagus and stomach, and scope handling and control is more difficult in the colorectum than in the upper GI tract. Depending on the efficacy of endoscopic mucosal resection (EMR) and the clinicopathological characteristics of the colorectal tumor, the proposed indications for colorectal ESD are as follows: (1) lesions difficult to remove en bloc with a snare EMR, such as nongranular laterally spreading tumors (particularly the pseudo depressed type), lesions showing a type VI: pit pattern, and large lesions of the protruded type suspected to be carcinoma; (2) lesions with fibrosis due to biopsy or peristasis; (3) sporadic localized lesions in chronic inflammation such as ulcerative colitis; and (4) local residual carcinoma after EMR. Colorectal ESD is currently in the development stage, and a standard protocol will be available in the near future. We hope that colorectal tumors will be efficiently treated by a treatment method appropriately selected from among EMR, ESD, and surgical resection after precise preoperative diagnosis based on techniques such as magnifying colonoscopy.

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“…Hypertonic saline and adrenaline are used to retain the fluid at the site for a longer period but the saline bleb lasts no longer than 10-15 min. A viscous mucinous solution of 0.5% sodium hyaluronate has been used to elevate large flat polyps for EMR [13]. The solution is isotonic and lasts longer than normal saline or diluted adrenaline.…”

Section: Polypectomy Methodsmentioning

confidence: 99%

Endoscopic polypectomy: techniques, complications and follow-up

Repici

Tricerri

2004

Tech Coloproctol

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Colorectal cancer is one of the most common cancers in developed countries. Increasing numbers of early stage colorectal cancers and precancerous adenomatous lesions, polypoidal type lesions, and flat and depressed type lesions can be visualised and treated endoscopically thanks to endoscopic ultrasonography, high magnification chromoendoscopy and other technical advances. Polypectomy is generally considered for protuberant lesions, with both sessile and pedunculate morphology, and endoscopic mucosal resection (EMR) is indicated for superficial, flat or depressed types of lesions. Endoscopic therapy for colonic adenoma with dysplasia and early colorectal cancer is more advantageous than the conventional operative treatment, in that it is a relatively non-invasive and less costly method. However, endoscopic therapy is completely ineffective in lesions with lymph node or distant metastasis. Therefore, it is becoming more and more important to understand the correct indications and limitations of endoscopic polypectomy/mucosectomy as well as complication rates and the correct follow-up schedule.

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A successful single-step endoscopic resection of a 40 millimeter flat-elevated tumor in the rectum: endoscopic mucosal resection using sodium hyaluronate

Cited by 100 publications

References 9 publications

Selective Fluid Cushion in the Submucosal Layer by Water Jet: Advantage for Endoscopic Mucosal Resection

Selective Fluid Cushion in the Submucosal Layer by Water Jet: Advantage for Endoscopic Mucosal Resection

Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection

Endoscopic polypectomy: techniques, complications and follow-up

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