New Endoscopic Treatment for Intramucosal Gastric Tumors Using an Insulated-Tip Diathermic Knife

Ohkuwa, Masana; Hosokawa, Koichi; Boku, Narikazu; Ohtu, A.; Tajiri, Hisao; Yoshida, Shigeto

doi:10.1055/s-2001-12805

Cited by 385 publications

(278 citation statements)

References 3 publications

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“…Although the IT-ESD technique is complicated, it might be worth trying as the first therapy for mucosal gastric carcinoma because of its high one-piece resection rate (1,2). The introduction of our treatment protocol did not affect the operation time of IT-ESD.…”

Section: Discussionmentioning

confidence: 91%

“…The reported incidence of bleeding in IT-ESD was higher than in EMR using conventional methods. Ohkuwa et al (1) reported that the incidence of bleeding in IT-ESD was as high as 22%. In our study, the bleeding frequency was higher than Ohkuwa et al (1) reported.…”

Section: Discussionmentioning

confidence: 99%

“…Generally speaking, the Clinical Pathway and standardizing the treatment protocol for gastric carcinoma treated with endoscopic submucosal dissection using an insulated-tip diathermic knife (IT-ESD) is thought to be difficult to adopt because this disease shows various clinical patterns according to the size of tumor (1). The appearance of complications such as bleeding or perforation may further complicate the course of the disease (2), which will result in a longer hospital stay and high hospital costs in some cases.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Clinical Pathway for the Management of Mucosal Gastric Carcinoma Treated with Endoscopic Submucosal Dissection Using an Insulated-tip Diathermic Knife

et al. 2004

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Objective Recently, the cases of early gastric carcinomas which can be treated by endoscopic submucosal dissection (ESD) method have been increasing in our institute. Simple and precise guidelines for treating mucosal gastric carcinoma are necessary for improving the treatment outcome of this disease. In our institute, ESD using an insulated-tip diathermic knife (IT-ESD) was introduced for the treatment of mucosal gastric carcinoma in 1996. The purpose of this study was to evaluate the impact of a clinical pathway and standardize the treatment for mucosal gastric carcinoma treated with IT-ESD.Materials and Methods The Clinical Pathway and standardized of treatment for mucosal gastric carcinoma treated with IT-ESD were introduced at our institute in January 2002. We compared the length of hospitalization, total costs, hospital costs, operation time and bleeding rate during the 18 months before and after January 2002.Results There was no significant difference in the clinical characteristics of the 20 patients in the control group and the 23 patients in the pathway group. There were 9 and 13 bleeding cases in the respective groups. The mean length of hospitalization, total costs and hospital costs were significantly less for patients in the pathway group. There was no significant difference in the operation time or bleeding rate among the two groups.Conclusion Our clinical pathway and the standardization of treatment for mucosal gastric carcinoma treated with IT-ESD proved effective for treating patients with mucosal gastric carcinoma and for minimizing the length of hospitalization without compromising patient care.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of Clinical Pathway for the Management of Mucosal Gastric Carcinoma Treated with Endoscopic Submucosal Dissection Using an Insulated-tip Diathermic Knife

et al. 2004

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“…Despite this limitation, our study provides information and identifies the potential complications associated with ESD. Compared to Hosokawa's original description [11], our ESD procedure involves several slight modifications that, in our opinion, make it easier to perform. We considered a complete resection of GIST to have occurred when severe histological criteria were respected (en bloc resection; entire capsule preserved and normal tissue visible at the deepest margin of the lesion).…”

Section: Discussionmentioning

confidence: 99%

“…ESD according to Hosokawa et al [11] was performed as follows: SMTs with a degree of elevation [50 % and with an acute angle with respect to the underlying mucosa were endoscopically treated through a hemicircumferential incision around the lesion. For tumors of low elevation and at an obtuse angle with respect to the underlying mucosa, a complete circumferential incision was performed to make easier the spontaneous spillage of the lesions from the deeper layer of the gastric wall (Fig.…”

Section: Endoscopic Proceduresmentioning

confidence: 99%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

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Background A submucosal tumor (SMT) of the stomach, which is an occasional finding during routine upper gastrointestinal endoscopy, may pose diagnostic and therapeutic challenges. Methods To assess whether endoscopic submucosal dissection (ESD) is a feasible approach to definitively cure SMTs, the authors performed a retrospective cohort study with two endoscopic italian centers.Results The study consisted of 20 patients with SMTs who underwent ESD. The patients underwent ESD and were followed up by endoscopy. We analyzed complete resection rate, frequency of complications, and survival. The overall rate of R0 resection was 90 % (18/20), with two endoscopic failures, one for a submucosal tumor and one for a neoplasm deeply infiltrating the proper muscle layer. The median procedure time was 119.1 min (range 40-240 min). The median size of the resected specimens was 29 mm (range 15-60 mm). Perforation occurred in 3 patients; all were treated conservatively. There were no cases of severe bleeding. Based on histopathological findings, 6 cases of ectopic pancreas, 1 of ectopic spleen, 3 of leiomyoma, and 10 of gastrointestinal stromal tumor (GIST) were diagnosed. Complete resection was obtained in all GIST cases. Among the 10 GIST cases treated by ESD, no death occurred: the 5-year disease-specific survival rate was 100 %. Conclusions The high success rate of 90 % and the low incidence of complications should indicate ESD is the correct diagnostic and definitive treatment in selected patients.

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Endoscopic Submucosal Dissection

Messmann¹

2008

Endoscopic Mucosal Resection

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New Endoscopic Treatment for Intramucosal Gastric Tumors Using an Insulated-Tip Diathermic Knife

Abstract: Compared with conventional EMR, this new method may have significant benefits, particularly regarding one-piece resection of lesions between 11 and 20 mm in size, and may also have a lower recurrence rate.

Cited by 385 publications

References 3 publications

Efficacy of Clinical Pathway for the Management of Mucosal Gastric Carcinoma Treated with Endoscopic Submucosal Dissection Using an Insulated-tip Diathermic Knife

Efficacy of Clinical Pathway for the Management of Mucosal Gastric Carcinoma Treated with Endoscopic Submucosal Dissection Using an Insulated-tip Diathermic Knife

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Endoscopic Submucosal Dissection

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