Recent approach for preventing complications in upper gastrointestinal endoscopic submucosal dissection

Abstract

Although endoscopic submucosal dissection (ESD) is a minimally invasive treatment method for upper gastrointestinal (GI) tumors, patients undergoing upper GI ESD sometimes fall into a serious condition from complications. Thus, it is important to fully understand how to prevent complications when performing upper GI ESD. One of the major complications in esophageal and gastric ESD is intraoperative perforation. To prevent this complication, blind dissection should be avoided. Traction‐assisted ESD is a useful technique for maintaining good endoscopic view. This method was proven to reduce the incidence of intraoperative perforation, which would become a standard technique in esophageal and gastric ESD. In gastric ESD, delayed bleeding is the most common complication. Recently, a novel prediction model (BEST‐J score) consisting of 10 factors with four risk categories for delayed bleeding in gastric ESD was established, and a free mobile application is now available. For reducing delayed bleeding in gastric ESD, vonoprazan ≥20 mg/day is the sole reliable method in the current status. Duodenal ESD is still challenging with a much higher frequency of complications, such as perforation and delayed bleeding, than ESD in other organs. However, with the development of improved devices and techniques, the frequency of complications in duodenal ESD has been decreasing. To prevent intraoperative perforation, some ESD techniques, such as using the distal tips of the Clutch Cutter, were developed. An endoscopic mucosal defect closure technique would be mandatory for preventing delayed complications. However, several unresolved issues, including standardization of duodenal ESD, remain and further studies are demanded.

Deep Learning for the Diagnosis of Esophageal Cancer in Endoscopic Images: A Systematic Review and Meta-Analysis

“…The early detection of esophageal cancer offers a higher chance of survival [ 64 ]. Upper gastrointestinal endoscopy is still considered the standard method for the diagnosis of esophageal cancer [ 65 , 66 ]. Previous evidence shows that endoscopic techniques have made significant progress over the last decades [ 67 , 68 , 69 ].…”

Bleeding following Endoscopic Submucosal Dissection for Early Gastric Cancer in Surgically Altered Stomach

“…Despite the fact that many studies have investigated and discussed bleeding following gastric ESD in patients with whole stomach [ 10 , 11 , 12 , 32 ], few studies have evaluated the details of bleeding following gastric ESD in patients with surgically altered stomach, mainly due to the small numbers of cases in previous studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. Thus, the present study evaluated it using the data of a large-scale multicenter study.…”

“…Then, should P2Y12RA be interrupted before ESD? Although the bleeding rate in patients with P2Y12RA was lower in interruption than in replacement with aspirin/cilostazol or continuation, interruption may lead to thromboembolism [ 32 ]. Considering the more serious condition in thromboembolism [ 31 ], interruption of P2Y12RA may not be recommended in the current status; however, it is difficult to make a definite conclusion from this study and further studies are required.…”

Management of Superficial Esophageal Squamous Cell Carcinoma and Early Gastric Cancer following Non-Curative Endoscopic Resection

“…In addition, the introduction of the endoscopic submucosal dissection (ESD) technique has enabled en bloc resection of larger lesions and expanded the indications of ER for SESCC and EGC [ 9 , 10 ]. The use of ESD is prevalent in Eastern Asian countries [ 11 , 12 , 13 , 14 , 15 ], and this technique is now widely performed in Western countries [ 16 , 17 ]. However, when the lesion does not meet the curability criteria, which is referred to as non-curative resection (or eCuraC-2 in the Japanese guidelines for gastric cancer), using additional treatment because of the possibility of LNM is the standard protocol [ 18 , 19 , 20 , 21 , 22 , 23 ].…”