Endoscopic submucosal dissection using a traction method for gastric tube cancer

Canadian Journal of Gastroenterology and Hepatology

et al. 2022

The incidence of gastric tube carcinoma (GTC) after esophagectomy for esophageal carcinoma has increased in recent years. Surgical removal of the reconstructed gastric tube is associated with high mortality, and endoscopic submucosal dissection (ESD) is a promising alternative. There are limited reports of ESD for GTC. This study investigated the efficacy and safety of ESD in GTC. This single-center retrospective study examined patients who underwent ESD for GTC after esophagectomy at our institution between 2003 and 2018. The curability of GTC with ESD was evaluated histologically according to the Japanese Gastric Cancer Treatment Guidelines. Patient characteristics and procedural and long-term outcomes were analyzed. Overall, 31 patients (29 men and 2 women; median age, 73 years) with 45 GTC lesions underwent ESD. The mean period between primary esophagectomy and the diagnosis of GTC was 10.6 years. Bleeding during ESD was noted in two patients (6.5%). No other adverse or fatal events such as perforation were noted. Complete resection and curative resection were documented in 80.6% and 48.4% of cases, respectively. The 3-year and 5-year overall survival rates were 67.6% and 47.7%, respectively. The 3-year and 5-year disease-specific survival rates were 100% and 92.9%, respectively. One patient died of GTC, and fourteen patients died of other diseases, including primary carcinoma in five cases. ESD was safe and provided good long-term outcomes in patients with GTC. Regular long-term gastroscopy is required for the early detection of GTC. Patients with GTC after esophagectomy for esophageal carcinoma have a high risk of other primary carcinomas or comorbidities after ESD.

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Gastric Tube Carcinoma after Esophagectomy Contributes to Long-Term Outcomes

Canadian Journal of Gastroenterology and Hepatology

et al. 2022

“…Therefore, ESD for GTC should be performed by fully trained endoscopists. When there is a lesion on the suture line, severe brosis of the submucosal layer, and remaining surgical staples, attaching the ST hood short-type and traction methods, such as clipping with the line method, are effective for obtaining good endoscopic visualization [14] [20] [21]. When a lesion is submerged in uid or blood, we should consider positioning the patient in the opposite direction.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Gastric Tube Carcinoma After Esophagectomy Contributes to Long-Term Outcomes: A Retrospective Case Series

et al. 2020

Preprint

Background: Gastric tube carcinoma (GTC) after esophagectomy has been observed increasingly in recent years after advanced treatment of esophageal carcinoma. Surgical removal of the reconstructed gastric tube is not usually preferred; however, endoscopic submucosal dissection (ESD) is greatly anticipated to be a promising option. This study investigated the efficacy and safety of ESD for GTC. Methods: This study was designed based on a retrospective survey performed at our single center between 2003 and 2018. Patients with GTC were treated with ESD and followed-up according to the policy of our institution. The curability of ESD was evaluated histologically according to the Japanese gastric cancer treatment guidelines. Patient characteristics, outcomes of ESD procedures, and long-term outcomes were analyzed. Results: A total of 31 patients (2 females; median age, 73 years) with 45 GTC cases were treated with ESD. The mean period from esophagectomy to the diagnosis of GTC was 10.6 years. The only adverse event due to ESD was bleeding (2 patients: 4.4%). No fatal events, such as perforation, occurred. The rates of complete resections and curative resections were 86.7% and 60.0%, respectively. The 3-year and 5-year overall survival rates were 67.6% and 47.7%, respectively. The 3-year and 5-year disease-specific survival rates were 100% and 92.9%, respectively. One patient died of GTC and 14 patients died of other diseases, including five primary carcinomas. Conclusions: ESD for GTC can be a safe treatment and contribute to positive long-term outcomes. Long-term regular gastroscopy is required for early detection. Screening should be performed before ESD and follow-up should be performed after ESD to prolong overall survival.

“…Therefore, ESD for GTC should be performed by fully trained endoscopists. When there is a lesion on the suture line, severe brosis of the submucosal layer, and remaining surgical staples, attaching the ST hood short-type and traction methods, such as clipping with the line method, are effective for obtaining good endoscopic visualization [12] [17] [18]. When a lesion is submerged in uid or blood, we should consider positioning the patient in the opposite direction.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic submucosal dissection for gastric tube carcinoma after esophagectomy contributes to long-term outcomes: a retrospective case series

et al. 2020

Preprint

Background: Gastric tube carcinoma (GTC) after esophagectomy has been observed increasingly in recent years after advanced treatment of esophageal carcinoma. Surgical removal of the reconstructed gastric tube is not usually preferred; however, endoscopic submucosal dissection (ESD) is greatly anticipated to be a promising option. This study investigated the efficacy and safety of ESD for GTC. Methods: This study was designed based on a retrospective survey performed at our single center between 2003 and 2018. Patients with GTC were treated with ESD and followed-up according to the policy of our institution. The curability of ESD was evaluated histologically according to the Japanese gastric cancer treatment guidelines. Patient characteristics, outcomes of ESD procedures, and long-term outcomes were analyzed. Results: A total of 31 patients (2 females; median age, 73 years) with 45 GTC cases were treated with ESD. The mean period from esophagectomy to the diagnosis of GTC was 10.6 years. The only adverse event due to ESD was bleeding (2 patients: 6.5%). No fatal events, such as perforation, occurred. The rates of complete resections and curative resections were 80.6% and 48.4%, respectively. The 3-year and 5-year overall survival rates were 67.6% and 47.7%, respectively. The 3-year and 5-year disease-specific survival rates were 100% and 92.9%, respectively. One patient died of GTC and 14 patients died of other diseases, including five primary carcinomas. Conclusions: ESD for GTC can be a safe treatment and contribute to positive long-term outcomes. Long-term regular gastroscopy is required for early detection. Moreover, additional care should be given to GTC patients who are at high risk for other primary carcinomas or comorbidities.