Safety and curative ability of endoscopic submucosal dissection for superficial esophageal cancers at least 50 mm in diameter

Yamashina, Takeshi; Ishihara, Ryu; Uedo, Noriya; Nagai, Kengo; Matsui, Futoshi; Kawada, Natsuko; Oota, Takashi; Kanzaki, Hiromitsu; Hanafusa, Masao; Yamamoto, Sachiko; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji

doi:10.1111/j.1443-1661.2011.01215.x

Cited by 39 publications

(40 citation statements)

References 29 publications

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“…In recent years, ESD has been increasingly performed even for large lesions because of technical and device im- LNM, lymph node metastasis; EP-LPM, intraepithelial carcinoma to tumor invading lamina propria; MM-SM1, tumor in contact with or invading the muscularis mucosa to tumor invading the most superficial 1/3 of the submucosa; SM2-3, tumor invading deeper than the SM1 level. DOI: 10.1159/000499017 provements, and its efficacy has been reported [14,15]. The risk of LNM in patients with the spreading-type tumors has not been reported previously, and in this study, we found that ER is an acceptable therapeutic option in patients with EP-SM1 lesions of the spreading type.…”

Section: Discussionsupporting

confidence: 57%

Risk of Lymph Node Metastasis in Patients with the Superficial Spreading Type of Esophageal Squamous Cell Carcinoma

et al. 2019

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Background: Little is known about the clinicopathological characteristics of superficial spreading-type esophageal carcinoma extending ≥5 cm along the long axis of the esophagus. This study was aimed at investigating the frequency of lymph node metastasis (LNM) in patients with superficial spreading-type esophageal carcinoma. Methods: We reviewed the data of 320 patients with superficial esophageal squamous cell carcinoma who had undergone esophagectomy with lymph node dissection at our hospital between 1986 and 2010. The incidence of LNM was compared between the spreading (≥5 cm) and nonspreading (< 5 cm) types. Results: The multivariate analysis revealed significant differences in the likelihood of LNM depending on the lymphovascular invasion, the infiltrative growth pattern (INF)-c, and the depth. There was no difference in the LNM frequency between nonspreading and spreading type in the patients with epithelium (EP)-lamina propria, muscularis mucosa (MM)-submucosa (SM)1 and SM2/3 lesions. The frequencies of LNMs (nonspreading-type vs. spreading-type tumors) in the patients with MM-SM1 lesions were 7/47 (14.9%) versus 4/25 (16%) and those in the patients with SM2/3 lesions were 22/58 (37.9%) versus 4/14 (28.9%), when the lesions did not have lymphovascular invasion and INF-c. Conclusions: Endoscopic resection can be selected for EP-SM1 lesions, regardless of whether the lesions are of the spreading type or nonspreading type.

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Section: Discussionsupporting

confidence: 57%

Risk of Lymph Node Metastasis in Patients with the Superficial Spreading Type of Esophageal Squamous Cell Carcinoma

et al. 2019

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“…Risk of esophageal stricture is increased in a tumor >59% of circumferential extent or in a resection wound >75% of circumferential extent after ESD . Yamashina et al . reported that strictures occurred in 36% of cases with lesions ≥50 mm that were <2/3 of circumferential extent.…”

Section: Management Of Adverse Events Related To Esophageal Esdmentioning

confidence: 99%

“…6,7 Risk of esophageal stricture is increased in a tumor >59% of circumferential extent or in a resection wound >75% of circumferential extent after ESD. [6][7][8][9] Yamashina et al 10 reported that strictures occurred in 36% of cases with lesions ≥50 mm that were <2/3 of circumferential extent. Shi et al 9 described that stricture did not occur in most cases with <1/2 circumferential mucosal defect, whereas cases with 1/2-3/4 circumferential mucosal defect developed stricture in 28% and cases with >3/4 circumferential mucosal defect had stricture in 94%.…”

Section: Management Of Adverse Events Related To Esophageal Esdmentioning

confidence: 99%

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Yamamoto

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

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Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2–3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self‐expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post‐ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high‐risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over‐the‐scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three‐quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.

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“…Although the safety and efficacy of ESD in the esophagus have already been reported[2,6,22], intraoperative perforation, muscle layer damage, and bleeding may occur because of the anatomically thin wall and narrow working space. Moreover, postoperative esophageal stricture is one of the main complications associated with large esophageal ESD[23,24].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection

Ohara

Toyonaga

Hoshi

et al. 2017

WJG

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AIMTo investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical practice.METHODSIn order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed.RESULTSFunctional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065).CONCLUSIONOur results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and reinsertion.

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Safety and curative ability of endoscopic submucosal dissection for superficial esophageal cancers at least 50 mm in diameter

Cited by 39 publications

References 29 publications

Risk of Lymph Node Metastasis in Patients with the Superficial Spreading Type of Esophageal Squamous Cell Carcinoma

Risk of Lymph Node Metastasis in Patients with the Superficial Spreading Type of Esophageal Squamous Cell Carcinoma

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection

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