Pocket Creation Method of Endoscopic Submucosal Dissection to Ensure Curative Resection of Rectal Neuroendocrine Tumors

Kobori, Ikuhiro; Katayama, Yasumi; Kitagawa, Tomoyuki; Fujimoto, Yasuyuki; Oura, Ryosuke; Toyoda, Koji; Kusano, Yuumi; Ban, Shinichi; Tamano, Masaya

doi:10.1159/000491559

Cited by 8 publications

(5 citation statements)

References 16 publications

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“…Therefore, when perform- ing endoscopic treatment, it is necessary to leave as much submucosa as possible on the side of the resected specimen. The PCM method reported by Hayashi et al in 2014 can be easily applied to traction and countertraction (8)(9)(10). Because the muscular layer is easily recognized in PCM, incisions can be made just above the muscular layer, facilitating dissection of the submucosal layer and reducing the rate of positive deep-seated margins compared to conventional ESD.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment for Submucosal Heterotopic Gastric Gland in a Case Observed over Nine Years from Development to Enlargement

et al. 2023

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A 70-year-old Japanese man with a submucosal gastric mass that continued to increase in size underwent endoscopic submucosal dissection using the pocket creation method. Histologically, some epithelial cell nuclei were enlarged, but there was little atypia overall and no sign of malignancy, suggesting a diagnosis of submucosal heterotopic gastric gland (SHGG). SHGG that enlarges over time has been associated with gastric cancer, but a preoperative diagnosis is difficult. This case was very valuable, as it enabled us to follow the course of SHGG over a period of about nine years, from the onset to enlargement.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Treatment for Submucosal Heterotopic Gastric Gland in a Case Observed over Nine Years from Development to Enlargement

et al. 2023

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“…A multicentered study with several endoscopists, higher sample and follow-up time is recommended to achieve more significant and generalizable results and outcomes. Variants of ESD with tunneling and pocket-creation methods might also be studied [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center

Mendes¹,

Barreiro²,

Mascarenhas³

et al. 2023

GE Port J Gastroenterol

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Background: Endoscopic submucosal dissection (ESD) is a minimally invasive technique for en bloc resection of superficial neoplastic lesions, independent of their size. However, for giant gastrointestinal superficial neoplasia, the risk of invasive cancer is higher, and ESD is typically challenging. Despite the increasing literature on giant resections, data on their efficacy and safety are still lacking. Objective: The aim of this study was to describe ESD outcomes from a Portuguese center, compare them with other international studies, and analyze the possible risk factors influencing outcomes. Methods: We conducted a retrospective single-center review using a prospectively collected database, including patients with rectal ESD resections larger than 10 cm, between January 2016 and December 2021. Clinical, procedural, and pathological data were collected and analyzed. Revision of the literature for comparison with international results was done through PubMed. Data were analyzed and statistical analysis performed, using Microsoft Excel and SPSS, to identify significant risk factors. Results: The study included 15 rectal resections, with a mean diameter of 140.9 mm (range 105–270), corresponding to lesions of 125.9 mm (87–238). The overall en bloc resection rate was 100% (n = 15). According to ESGE criteria, procedure was considered curative in 53.3% (n = 8), non-curative with high risk in 13.3% (n = 2), and local-risk recurrence in 33.3% (n = 5). Adverse events occurred in 26.7% (n = 4): 1 minor perforation and 3 stenosis, most endoscopically managed. For non-curative resections with local-risk recurrence, surveillance without adjuvant therapy was performed in all cases. For high-risk non-curative resections, surgery was performed in 1 patient and adjuvant chemoradiation therapy in another. Follow-up (mean 16 months) demonstrated a recurrence rate of 0%. Statistical analysis revealed resection size ≥20 cm as a risk factor for perforation (p value 0.067), and involvement of ≥90% of the circumference and procedural time ≥4 h as risk factors for stenosis (p value 0.029 and 0.009, respectively). Conclusions: Although challenging, ESD for giant lesions seems effective and safe, with a still relevant rate of complications, which were mostly endoscopically treated. Rigorous characterization of lesions is crucial to predict and avoid complications or the need for therapy escalation.

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“…PCM-ESD was first introduced by Yamamoto, et al [7][8][9]. In recent years, several studies reported the usefulness of PCM-ESD for colorectal neoplastic lesions with giant size, difficult location, different tumor types or postsurgery conditions [7,8,10,11,[18][19][20][21][22][23][24][25]. According to the experience of endoscopists, this new ESD strategy has several advantages over C-ESD.…”

Section: Discussionmentioning

confidence: 99%

Pocket-creation method improves efficacy of colorectal endoscopic submucosal dissection: a system review and meta-analysis

Gong

Chen²,

Tan³

et al. 2020

European Journal of Gastroenterology &Amp; Hepatology

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The pocket-creation method (PCM) is a new strategy for endoscopic submucosal dissection (ESD). The aim of this system review is to evaluate the clinical efficacy and safety of PCM-ESD compared to conventional ESD (C-ESD) for colorectal neoplasm lesions. We performed literature search using MEDLINE, EMBASE and CENTRAL database from inception to 15 February 2020. Studies provided comparison between PCM-ESD and C-ESD for colorectal neoplasm lesions were included. En bloc resection rate, R0 resection rate, occurrence rate of adverse events and operation speed/time were extracted from included studies. Pooled risk difference with 95% confidence intervals (CIs) was calculated in meta-analysis. Three cohort studies and one randomized control trial (RCT) were included, which contained 432 colorectal lesions removed by PCM-ESD and 959 lesions resected by C-ESD. PCM-ESD achieved significantly higher en bloc/R0 resection rate than C-ESD in cohort studies with pooled risk differences of 0.05 (CI, 0.03–0.07, I 2 = 34%) and 0.14 (CI, 0.04–0.24, I 2 = 83%). However, comparison of en bloc/R0 resection rate between two surgery strategies could not be estimated in RCT. Pooled results in cohort studies and data from RCT revealed comparable occurrence rate of adverse events between PCM-ESD and C-ESD. Measurements and outcomes of operation time/speed varied between the included studies and no consistent conclusion could be achieved in this aspect. The results indicate that PCM-ESD is an effective and well-tolerated treatment for colorectal neoplasm lesions and may be a superior treatment to C-ESD in en bloc/R0 resection rate.

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Pocket Creation Method of Endoscopic Submucosal Dissection to Ensure Curative Resection of Rectal Neuroendocrine Tumors

Cited by 8 publications

References 16 publications

Endoscopic Treatment for Submucosal Heterotopic Gastric Gland in a Case Observed over Nine Years from Development to Enlargement

Endoscopic Treatment for Submucosal Heterotopic Gastric Gland in a Case Observed over Nine Years from Development to Enlargement

Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center

Pocket-creation method improves efficacy of colorectal endoscopic submucosal dissection: a system review and meta-analysis

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