Endoscopic submucosal dissection for stomach neoplasms

Fujishiro, Mitsuhiro

doi:10.3748/wjg.12.5108

Cited by 16 publications

(17 citation statements)

References 6 publications

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“…Tissue biopsies were taken in cases prior to ESD where indicated. ESD was performed in a standard manner [14]. All patients had sedation, which was administered by an anaesthetist.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic Submucosal Dissection Outcomes for Gastroesophageal Tumors in Low Volume Units: A Multicenter Survey

Azmi

Khor

et al. 2016

Diagnostic and Therapeutic Endoscopy

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Background and Aims. Endoscopic submucosal dissection (ESD) outcomes have traditionally been reported from high volume centers in East Asia. Data from low volume centers in other parts of Asia remain sparse. Methods. A retrospective survey with a structured questionnaire of 5 tertiary centers in 3 countries in South East Asia was conducted. Details of training and clinical outcomes of ESD cases, with follow-up data from these centers, were analyzed. Results. Seven endoscopists from the 5 centers performed a total of 35 cases of ESD in the upper gastrointestinal tract (UGIT) over a 6-year duration. Details of the lesions excised were as follows: median size was 20 mm, morphologically 20 (68.6%) were flat/depressed and 6 (17.1%) were submucosal, and histologically 27 (77.1%) were neoplastic. The median duration of ESD procedures was 105 minutes, with an en-bloc resection rate of 91.4%. There was 1 (2.9%) case of delayed bleeding, but no perforation nor mortality in any of the cases. The recurrence rate after ESD was 5.7%. A prolonged ESD duration was influenced by a larger size of lesion (25 mm, p = 0.02) but not by factors related to the training experience of endoscopists. Conclusions. ESD in the UGIT is feasible and safe in low volume centers in Asia.

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“…Tissue biopsies were taken in cases prior to ESD where indicated. ESD was performed in a standard manner [14]. All patients had sedation, which was administered by an anaesthetist.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic Submucosal Dissection Outcomes for Gastroesophageal Tumors in Low Volume Units: A Multicenter Survey

Azmi

Khor

et al. 2016

Diagnostic and Therapeutic Endoscopy

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“…Endoscopic submucosal dissection (ESD), an endoscopic procedure that originated from Japan and Korea in the late 1990s and has since spread rapidly to other nations, is now commonly used to treat gastric cancer and adenoma [1]. ESD is performed using electrosurgical knives to make gastrointestinal mucosal incisions and submucosal dissections [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Proton Pump Inhibitor Therapy before and after Endoscopic Submucosal Dissection: A Review

Sugimoto

Jang

Yoshizawa

et al. 2012

Diagnostic and Therapeutic Endoscopy

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Endoscopic submucosal dissection (ESD) is a novel endoscopic procedure first developed in the 1990s which enables en bloc resection of gastric neoplastic lesions that are difficult to resect via conventional endoscopic mucosal resection. However, given that ESD increases the risk of intra- and post-ESD delayed bleeding and that platelet aggregation and coagulation in artificial ulcers after ESD strongly depend on intragastric pH, faster and stronger acid inhibition via proton pump inhibitors (PPIs) and histamine 2-receptor antagonists (H2RAs) as well as endoscopic hemostasis by thermocoagulation during ESD have been used to prevent ESD-related bleeding. Because PPIs more potently inhibit acid secretion than H2RAs, they are often the first-line drugs employed in ESD treatment. However, acid inhibition after the initial infusion of a PPI is weaker in the early phase than that achievable with H2RAs; further, PPI effectiveness can vary depending on genetic differences in CYP2C19. Therefore, optimal acid inhibition may require tailored treatment based on CYP2C19 genotype when ESD is performed, with a concomitant infusion of PPI and H2RA possibly most effective for patients with the rapid metabolizer CYP2C19 genotype, while PPI alone may be sufficient for those with the intermediate or poor metabolizer genotypes.

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“…ESD is, therefore, considered the treatment of choice to achieve en bloc resection of lesions > 2.0 cm and correct histological evaluation minimizing recurrence risk [18-20]. …”

Section: Discussionmentioning

confidence: 99%

Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

et al. 2010

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BackgroundEndoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy alternative to endoscopic mucosal resection (EMR) for superficial gastrointestinal neoplasms >2 cm. ESD allows for the direct dissection of the submucosa and large lesions can be resected en bloc. ESD is not limited by resection size, increases histologically complete resection rates and may reduce the local recurrence.Nevertheless, the technique is time-consuming, technically demanding and associated with a high complication rate. To reduce the risk of complications, different devices and technical advances have been proposed with conflicting results and, still, ESD en bloc resections of huge lesions are associated with increased complications.Case PresentationWe successfully used a combined ESD/EMR technique for huge rectal laterally spreading tumors (LSTs). ESD was used for circumferential resection of 2/3 of the lesion followed by piecemeal resection (2-3 pieces) of the central part of the tumour.In all three patients we obtained the complete dissection of the polyp and the complete histological evaluation in absence of complications and recurrence at 6 months' follow up.ConclusionsIn the treatment of rectal LSTs, the combined treatment - ESD/EMR resection may be considered a suitable therapeutic option, indicated in selected cases as an alternative to surgery, in which the two techniques are neither reliable nor safe separately. However, to confirm our results, larger trials with longer follow up are required together with improvement of the technique and of the technical devices.

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Endoscopic submucosal dissection for stomach neoplasms

Cited by 16 publications

References 6 publications

Endoscopic Submucosal Dissection Outcomes for Gastroesophageal Tumors in Low Volume Units: A Multicenter Survey

Endoscopic Submucosal Dissection Outcomes for Gastroesophageal Tumors in Low Volume Units: A Multicenter Survey

Proton Pump Inhibitor Therapy before and after Endoscopic Submucosal Dissection: A Review

Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

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