Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection

Mizutani, Hiroya; Ono, Satoshi; Ohki, Daisuke; Takeuchi, Chihiro; Yakabi, Seiichi; Kataoka, Yasufumi; Saito, Itaru; Sakaguchi, Yoshiki; Minatsuki, Chihiro; Tsuji, Yosuke; Niimi, Keiko; Kodashima, Shinya; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Koike, Kazuhiko

doi:10.5946/ce.2017.108

Cited by 17 publications

(14 citation statements)

References 29 publications

(37 reference statements)

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Section: Introductionmentioning

confidence: 99%

“…Endoscopic submucosal dissection (ESD) has gradually emerged as a feasible treatment option for colorectal tumors with the development of improved techniques and specialized devices. [1][2][3] Although colorectal ESD is recognized as a standard technique for colorectal tumors, difficult cases are often encountered. Factors creating difficulties for ESD include fibrosis of the submucosal layer, fold convergence, lesion type, colon location, and poor endoscopic maneuverability.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and suitable indication of colorectal endoscopic submucosal dissection using a balloon‐assisted endoscope

et al. 2019

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Background and Aim Cases of colorectal endoscopic submucosal dissection (ESD) with poor maneuverability are often encountered. We aimed to evaluate the efficacy of balloon‐assisted endoscopy (BAE) for such cases. Methods We confirmed maneuverability preoperatively in 400 consecutive cases of colorectal ESD performed at a single center from April 2011 to April 2018. A total of 83 deep colon cases judged as having poor maneuverability were retrospectively reviewed; 54 cases underwent BAE with a single balloon endoscope (group B), and 29 cases underwent conventional procedures without BAE (group C). Tumor size, procedure duration, dissection speed, en bloc resection rate, histology, and associated complications were compared between groups. Results The mean tumor size, tumor invasiveness, fibrosis, and complications did not differ between groups. Although the en bloc resection rate did not differ (both 98%), the groups significantly differed with regard to the R0 resection rate (B: 96%; C: 83%; P = 0.048). Overall, the procedure duration (B: 51 min; C: 70 min; P = 0.17) and dissection speed (B: 19.4 mm2/min; C: 17.4 mm2/min; P = 0.13) were not significantly different between groups. However, the dissection speed for lesions in the cecum/ascending colon was significantly faster in group B than in group C (B: 22.3 mm2/min; C: 11.3 mm2/min; P = 0.037). Conclusions In cases of colorectal ESD with poor maneuverability, the use of BAE contributed to an improvement in the R0 resection rate. In addition, BAE contributed to a quicker dissection speed for lesions located in the cecum/ascending colon.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and suitable indication of colorectal endoscopic submucosal dissection using a balloon‐assisted endoscope

et al. 2019

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“…Secondly, the long procedure time should be considered because it may have an increased risk of anesthesia-related AEs such as aspiration pneumonia. The use of traction devices for submucosal dissection may shorten the procedure time [25]. Thirdly, the median follow-up of 8 months might be too short to detect tumor recurrence in cases with low-grade adenoma.…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique of Endoscopic Papillectomy with Hybrid Endoscopic Submucosal Dissection for Ampullary Tumors: A Proof-of-Concept Study (with Video)

Takahara

Tsuji

Nakai

et al. 2020

JCM

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Background: Endoscopic papillectomy (EP) carries a potential risk of procedure-related adverse events and incomplete resection. Since hybrid endoscopic submucosal dissection (ESD) had been established as an alternative option for relatively large and difficult gastrointestinal tumors, we evaluated a novel EP with hybrid ESD (hybrid ESD-EP) for curative safe margin in this proof-of-concept study. Methods: A total of eight cases who underwent hybrid ESD-EP between 2018 and 2020 were identified from our prospectively maintained database. Hybrid ESD-EP involved a (sub)circumferential incision with partial submucosal dissection, and subsequent snare resection of ampullary tumors, which was performed by two endoscopists with expertise in ESD or endoscopic retrograde cholangiopancreatography. Demographic data and clinicopathological outcomes were retrospectively evaluated. Results: En bloc resection was achieved by hybrid ESD-EP in all eight cases, with the median procedure time of 112 (range: 65–170) minutes. The median diameters of the resected specimens and tumors were 18 and 12 mm, respectively. All lateral margins were clear, whereas vertical margin was uncertain in three (38%), resulting in the complete resection rate of 63%. Postoperative bleeding and pancreatitis developed in each one (13%). No tumor recurrence was observed even in those cases with uncertain vertical margin, after a median follow-up of 244 (range, 97–678) days. Conclusions: Hybrid ESD-EP seems to be feasible and promising in ensuring the lateral resection margin. However, further investigations, especially to secure the vertical margin and to shorten the procedure time, should be required.

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“…Minimally invasive ESD is a promising technique for treatment of digestive tract diseases, especially polyps, adenoma, and early stage carcinoma [7]. Most well-trained gastrointestinal endoscopic physicians can correctly perform ESD operations [8].…”

Section: Discussionmentioning

confidence: 99%

Cost Analysis of Endoscopic Submucosal Dissection for the Treatment of Colorectal Lesions in China

Cui

Zhang

2019

BioMed Research International

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Aim. The aim of the study was to evaluate costs associated with colonic endoscopic submucosal dissection (ESD) for treatment of colorectal cancer. Methods. The study is a retrospective analysis of data on 395 patients treated by colonic ESD. Results. The operation, consumable items, and medication accounted for 71% of the total costs for colonic ESD treatment. Medication and consumable items’ costs were higher if lesions occurred in the transverse colon and right hemicolon compared to the left hemicolon. Medication, consumable items, and total costs were higher for larger lesions. Lesion numbers and carcinoma were associated with higher medication, consumable items, operation, and total costs. Positive surgical margins and complications of hemorrhage or perforation were positively correlated with higher costs for medication, consumable items, and total costs. Conclusion. Labor costs for doctors and nurses remain low in China. Costs for medication and consumable items were higher for treatment involving the transverse colon or right hemicolon (vs. the left hemicolon), larger lesions, carcinoma, and a positive surgical margin. A benchmark cost estimate for ESD treatment including 4 days of postoperative hospitalization was determined to be approximately 5400 USD.

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Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection

Cited by 17 publications

References 29 publications

Efficacy and suitable indication of colorectal endoscopic submucosal dissection using a balloon‐assisted endoscope

Efficacy and suitable indication of colorectal endoscopic submucosal dissection using a balloon‐assisted endoscope

A Novel Technique of Endoscopic Papillectomy with Hybrid Endoscopic Submucosal Dissection for Ampullary Tumors: A Proof-of-Concept Study (with Video)

Cost Analysis of Endoscopic Submucosal Dissection for the Treatment of Colorectal Lesions in China

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