Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer

Ono, Hiroyuki; Hasuike, Noriaki; Inui, Tomoyuki; Takizawa, Kohei; Ikehara, Hisatomo; Yamaguchi, Yoshihiro; Otake, Yosuke; Matsubayashi, Hiroyuki

doi:10.1007/s10120-008-0452-0

Cited by 152 publications

(129 citation statements)

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“…Then, the submucosal layer was dissected using the IT Knife, and the lesion was finally removed. An IT Knife was used to perform ESD until the end of March 2007, and an IT Knife2 (Olympus Medical Systems) was then used from April 2007 onward [12]. If resection was incomplete, additional treatment was performed, mainly by thermocoagulation therapy (laser, heater probe, or argon plasma coagulation).…”

Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

et al. 2013

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Background Few studies have compared the outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in patients with early gastric cancer. Methods We studied 780 lesions for which endoscopic treatment was indicated according to the Japanese Gastric Cancer Association (JGCA) criteria or the Results The median follow-up was 73 months in the EAM group and 65 months in the ESD group. Overall, the local recurrence rate was significantly lower in the ESD group (0.2 %, 1/421) than in the EAM group (4.2 %, 15/359) (p \ 0.05). For lesions meeting the JGCA criteria, the local recurrence rate was 2.9 % in the EAM group and 0 % in the ESD group (p \ 0.05). For lesions meeting the NCC criteria, the local recurrence rate was 12.5 % in the EAM group and 0.6 % in the ESD group (p \ 0.05). There was no significant difference between the groups in overall survival. Conclusions On long-term follow-up, ESD was associated with a lower rate of local recurrence than EAM for lesions that met the JGCA or the NCC criteria. From the point of view of radical curability, ESD can be recommended for the management of lesions that meet either set of criteria.

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Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

et al. 2013

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“…Endoscopic submucosal dissection (ESD) allows en-bloc resection of large superficial lesions and is a widely applied treatment for early gastric cancer (EGC) with little risk of lymph node (LN) metastasis [1][2][3]. Pathologically, gastric cancer can be broadly divided into two types according to the presence or absence of tubular structures: differentiated and undifferentiated types [4].…”

Section: Introductionmentioning

confidence: 99%

Risk of lymph node metastases from intramucosal gastric cancer in relation to histological types: how to manage the mixed histological type for endoscopic submucosal dissection

et al. 2012

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Background The behavior of early gastric cancer (EGC) with mixed-type histology (differentiated and undifferentiated) is incompletely understood. This study aimed to clarify the clinicopathological features of EGC with mixedtype histology in relation to lymph node (LN) metastasis. Methods Clinicopathological data from 410 patients who underwent surgical resection for intramucosal EGC were reviewed. Lesions were classified into four types according to the proportion of differentiated and undifferentiated components at histopathology: pure differentiated (PD) type, mixed predominantly differentiated (MD) type, mixed predominantly undifferentiated (MU) type, and pure undifferentiated (PU) type. We examined the clinicopathological differences between PD and MD, and between PU and MU, and the rate of LN metastasis according to tumor size and ulceration.Results Moderately differentiated adenocarcinoma was the primary component in MD relative to PD (90.7 vs. 46.1 %). Signet ring cell carcinoma was the main component in PU relative to MU (81.5 vs. 33.3 %). LN metastasis was more common in MU than PU (19.0 vs. 6.0 %). For intramucosal tumors larger than 20 mm without lymphovascular invasion and without ulceration, the rate of LN metastasis was 0 % for MD and 24 % for MU. For intramucosal lesions less than 30 mm with ulceration but without lymphovascular invasion, the rate of LN metastasis was 0 % for MD and 20 % for MU. Conclusions Histologically mixed-type EGC with a predominantly undifferentiated component should be managed as an undifferentiated-type tumor. Further investigation is required to determine whether mixed-type EGC with a predominantly differentiated component could be managed the same way as a differentiated-type EGC.

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“…This fact reflects the null presence of ESD in our country, and is in contrast with the extended experience in Asiatic countries (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). It would be desirable to have at least one training program on ESD in our country to provide initial skills for ESD performance.…”

Section: Discussionmentioning

confidence: 92%

“…Learning to perform EMR is relatively easy, and for this reason it has become widely available in recent years (2,17). In contrast, the ESD technique is more complicated and difficult to learn, and to date has only been implemented in Asiatic countries (due to the need to endoscopically diagnose and treat a high number of superficial gastrointestinal tumors occurring in those countries) (8)(9)(10)(11)(12)(13)(14)(15)(16)(18)(19)(20). The major advantage of this type of therapy versus EMR is that it may allow resecting lesions > 1.5 cm in size in a single fragment, which may facilitate sample orientation and therefore a more complete pathological exam (2).…”

Section: Discussionmentioning

confidence: 99%

Training model for teaching endoscopic submucosal dissection of gastric tumors

Vázquez-Sequeiros¹,

Miquel²,

Olcina³

et al. 2009

Rev. esp. enferm. dig.

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Introduction: the elevated risk of complications and technical complexity of endoscopic submucosal dissection (ESD) has limited its implementation in our medical system.Objective: to design and evaluate a training program for learning the ESD technique.Methods: four endoscopists with no experience with ESD underwent a 4-step training program: 1) review of the existing literature, didactic material, and theoretical aspects of ESD; 2) ESD training in an ex-vivo animal model; 3) ESD training in an in-vivo animal model (supervised by ESD expert); and 4) ESD performance in a patient. A standard gastroscope and an ESD knife (IT, Flex or Hook-knife Olympus ® ) were employed. The classical ESD technique was performed: rising of the lesion, circumferential incision, and submucosal dissection.Results: ex-vivo animal model: 6 x swine stomach/esophagus -cost < 100 euro; 6 x ESD: antrum (n = 2), body (n = 3) and fundus/cardia (n = 1)-; size of resected specimen: 4-10 cm; ESD duration: 105-240 minutes; therapeutic success: 100%; complications: perforation (1/6: 16%) sealed with clips. In-vivo animal model: 6 ESD (antrum/body of stomach: 4; esophagus: 2); size: 2-5 cm; duration: 40-165 minutes; success: 100%; complications: 0%. Patient: ESD of a gastric lesion located in the antrum/body; size: 3 cm; duration 210 minutes; a complete resection was achieved; no complications.Conclusions: the results of the present study support the usefulness of this model for learning ESD in our system. Key words: Endoscopic submucosal dissection. ESD. Submucosal resection. Large endoscopic resection. INTRODUCTIONEndoscopic mucosal resection (EMR) consists of resecting a superficial tumor of the gastrointestinal tract (esophagus, stomach, colon or rectum) by endoscopic means with curative intention (R0 resection) (1-5). An EMR-resected lesion may be submitted for pathological examination. One of the advantages of EMR compared with surgical resection is its lower morbidity/mortality and cost. At present EMR has become widely available in clinical practice in both Asian and Western countries (1-5). However, EMR presents a number of limitations: a) technical difficulty; b) risk for complications: bleeding (2-29%), perforation (0.36%) and stenosis (mainly in the esophagus); and c) restricted to superficial lesions with no lymphatic spread and size < 1-1.5 cm (1-8). Lesions with a diameter > 1.5 cm cannot be completely resected with a single EMR procedure, and repeated mucosectomies (several fragments) or endoscopic submucosal dissection (ESD) (allowing to resect the entire lesion in a single piece) will be required (2). It is generally assumed that it is better to resect tumoral lesions in single pieces, as we can be sure the tumor has been completely resected, and it also facilitates sample orientation at the time of the pathology study (8)(9)(10)(11)(12)(13)(14)(15). Furthermore, ESD allows to perfom wider and deeper resections versus EMR (2). However, the learning curve for ESD (high technical difficulty) is longer (compared with EMR), and compli...

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Usefulness of a novel electrosurgical knife, the insulation-tipped diathermic knife-2, for endoscopic submucosal dissection of early gastric cancer

Cited by 152 publications

References 7 publications

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center

Risk of lymph node metastases from intramucosal gastric cancer in relation to histological types: how to manage the mixed histological type for endoscopic submucosal dissection

Training model for teaching endoscopic submucosal dissection of gastric tumors

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