Tissue damage of different submucosal injection solutions for EMR

Fujishiro, Mitsuhiro; Yahagi, Naohisa; Kashimura, Koji; Matsuura, Toyokazu; Nakamura, Masanori; Kakushima, Naomi; Kodashima, Shinya; Ono, Satoshi; Kobayashi, Katsuya; Hashimoto, Takuhei; Yamamichi, Nobutake; Tateishi, Ayako; Shimizu, Yasuhito; Oka, Masashi; Ichinose, Masakazu; Omata, Masao

doi:10.1016/j.gie.2005.07.052

Cited by 148 publications

(119 citation statements)

References 16 publications

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“…Recently, in an attempt to minimize the chance of gastric perforation, polyethylene glycol or sodium hyaluronate has been used as the injection agent; this has been reported to help make ESD easier and safer, as these agents stay longer in the submucosa and produce clearer dissection planes [70,71]. Considering the tissue damage that can occur after injection of the solution during endoscopic resection, an effi cient one should be used [72].…”

Section: Endoscopic Submucosal Dissection (Esd)mentioning

confidence: 99%

Endoscopic resection of early gastric cancer

2007

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The purpose of this review is to examine recent advances in the techniques and technologies of endoscopic resection of early gastric cancer (EGC). Endoscopic mucosal resection (EMR) of EGC, with negligible risk of lymph node metastasis, is a standard technique in Japan and is increasingly becoming accepted and regularly used in Western countries. EMR is a minimally invasive technique which is safe, convenient, and effi cacious; however, it is insuffi cient when treating larger lesions. The evidence suggests that diffi culties with the correct assessment of depth of tumor invasion lead to an increase in local recurrence with standard EMR when lesions are larger than 15 mm. A major factor contributing to this increase in local recurrence relates to lesions being excised piecemeal due to the technical limitations of standard EMR. A new development in endoscopic techniques is to dissect directly along the submucosal layer -a procedure called endoscopic submucosal dissection (ESD). This allows the en-bloc resection of larger lesions. ESD is not necessarily limited by lesion size and it is predicted to replace conventional surgery in dealing with certain stages of ECG. However, it still has a higher complication rate when compared to standard EMR, and it requires high levels of endoscopic skill and experience. Endoscopic techniques, indications, pathological assessment, and methods of endoscopic resection of EGC need to be established for carrying out appropriate treatment and for the collation of long-term outcome data.

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Section: Endoscopic Submucosal Dissection (Esd)mentioning

confidence: 99%

Endoscopic resection of early gastric cancer

2007

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“…As another approach to successful www.wjgnet.com ESD, investigations of submucosal injection solutions have been actively done. It was reported that a hyaluronic acid solution makes a better long-lasting submucosal cushion without tissue damage than other available solutions [7,[20][21][22][23] . As a further improvement of hyaluronic acid solution, usefulness of a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar has also been reported [24,25] .…”

Section: Development Of Esdmentioning

confidence: 99%

Endoscopic submucosal dissection for gastrointestinal neoplasms

Kakushima¹,

Fujishiro²

2008

WJG

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159

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Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it: injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of enbloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator's skill, and (3) organ characteristics.

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“…As another approach to successful ESD, investigations of submucosal injection solutions have been actively done. It was reported that a hyaluronic acid solution makes a better long-lasting submucosal cushion without tissue damage than other available solutions [29][30][31][32][33] . As a further improvement of hyaluronic acid solution, usefulness of a mixture of high-molecularweight hyaluronic acid, glycerin, and sugar has also been reported [34,35] .…”

Section: Cosal Dissectionmentioning

confidence: 99%

Endoscopic submucosal dissection for stomach neoplasms

Fujishiro¹

2006

WJG

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Recent advances in techniques of therapeutic endoscopy for stomach neoplasms are rapidly achieved. One of the major topics in this field is endoscopic submucosal dissection (ESD). ESD is a new endoscopic technique using cutting devices to remove the tumor by the following three steps: injecting fluid into the submucosa to elevate the tumor from the muscle layer, pre-cutting the surrounding mucosa of the tumor, and dissecting the connective tissue of the submucosa beneath the tumor. So the tumors are resectable in an en bloc fashion, regardless of the size, shape, coexisting ulcer, and location. Indication for ESD is strictly confined by two aspects: the possibility of nodal metastases and technical difficulty, which depends on the operators. Although long-term outcome data are still lacking, short-term outcomes of ESD are extremely favourable and laparotomy with gastrectomy is replaced with ESD in some parts of therapeutic strategy for early gastric cancer.

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Tissue damage of different submucosal injection solutions for EMR

Cited by 148 publications

References 16 publications

Endoscopic resection of early gastric cancer

Endoscopic resection of early gastric cancer

Endoscopic submucosal dissection for gastrointestinal neoplasms

Endoscopic submucosal dissection for stomach neoplasms

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