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Endoscopic submucosal dissection  [cached]
Carlos Robles-Medranda
Gastroenterology Insights , 2012, DOI: 10.4081/gi.2012.e10
Abstract: Endoscopic submucosal dissection (ESD) is a minimally invasive technique developed by Japanese endoscopists that allows one-piece endoscopic removal of early malignant lesions in the gastrointestinal tract. There is now a large and ever-increasing number of reports worldwide, and in the West use of this technique is on the increase. New materials and techniques have been developed to improve the technical aspects of ESD. Recent reports show successful clinical outcomes and improved overall 5-year survival rates for this technique. This review aims to offer an update of ESD based on the latest reports in the literature.
Endoscopic submucosal dissection for colorectal neoplasms  [cached]
Mitsuhiro Fujishiro
World Journal of Gastrointestinal Endoscopy , 2009,
Abstract: Although endoscopic submucosal dissection (ESD) gains acceptance as one of the standard treatments for esophageal and stomach neoplasms in Japan, it is still in the developing stage for colorectal neoplasms. In terms of indications, little likelihood of nodal metastasis and technical resectability are principally considered. Some of intramucosal neoplasms, carcinomas with minute submucosal invasion, and carcinoid tumors, which are technically unresectable by conventional endoscopic treatments, may become good candidates for ESD, considering substantial risks and obtained benefits. ESD as a staging measure to obtain histological information of the invasion depth and lymphovascular infiltration is acceptable because preoperative prediction is difficult in some cases. In terms of techniques, advantages of ESD in comparison with other endoscopic treatments are to be controllable in size and shape, and to be resectable even in large and fibrotic neoplasms. The disadvantages may be longer procedure time, heavier bleeding, and higher possibility of perforation. However, owing to refinement of the techniques, invention of devices, and the learning curve, acceptable technical safety has been achieved. Colorectal ESD is very promising and become one of the standard treatments for colorectal neoplasms in the near future.
Endoscopic submucosal dissection for gastrointestinal neoplasms  [cached]
Naomi Kakushima, Mitsuhiro Fujishiro
World Journal of Gastroenterology , 2008,
Abstract: 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 en-bloc 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.
The results and limitations of endoscopic submucosal dissection for colorectal tumors  [PDF]
Toyanaga T.,Man-I M.,Ivanov D.,Sanuki T.
Acta Chirurgica Iugoslavica , 2008, DOI: 10.2298/aci0803017t
Abstract: In the colorectal tumor, the lesions suitable for the endoscopic treatment are those with no lymph node metastasis such as adenomas, intramucosal cancers, and minimally invasive submucosal cancer (invasion depth 1000 m, well and moderately differentiated type, no lymphovascular invasion). The new endoscopic technique, endoscopic submucosal dissection (ESD) enables en-bloc resection of the lesions regardless of their size and location. In order to perform ESD more easily, safely, and efficiently, we invented water jet short needle knives (Flush knife). Emitting a jet of water from the tip of a sheath enables submucosal local injection with a knife itself without replacement of operative instruments, which leads to efficient treatment. Especially, Flush knife is very effective for the lesions located at lower rectum and anal canal where there are many vessels. We treated a total of 361 colorectal lesions by ESD between June 2002 and July 2007, and en-block complete resection rate was 98.3 %. In 12 cases, "muscle retracting sign" was recognized. This sign is an index of the discontinuation of ESD, but it is impossible to diagnose preoperatively. The postoperative bleeding occurred in 0.8 % (3 cases: no blood transfusion is needed). The intraoperative perforation occurred in 1.9 % (6 cases: 5 cases were treated conservatively, 1 case was treated surgically) and the postoperative perforation occurred in 1case (0.3%) treated surgically. ESD is the extremely effective treatment for the colorectal tumors and also is possible to be performed safely with the appropriate choice of the devices and strategy for dissection.
Management of the complications of endoscopic submucosal dissection  [cached]
Seong Hwan Kim,Jeong Seop Moon,Young Hoon Youn,Ki Myung Lee
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i31.3575
Abstract: Endoscopic submucosal dissection (ESD) is currently widely accepted as a standard treatment option for early gastrointestinal neoplasms in Korea. However, ESD has technical difficulties and a longer procedure time than conventional endoscopic resection. So it may have a higher risk of complications than conventional endoscopic resection techniques. We, the ESD study group of Korean Society of Gastrointestinal Endoscopy, have experienced many complications, mostly treated by endoscopic or conservative management. Here, we introduce and share our experiences for management of post ESD complications and review published papers on the topic.
Prevention and Management of Complications of and Training for Colorectal Endoscopic Submucosal Dissection  [PDF]
Naohisa Yoshida,Nobuaki Yagi,Yutaka Inada,Munehiro Kugai,Akio Yanagisawa,Yuji Naito
Gastroenterology Research and Practice , 2013, DOI: 10.1155/2013/287173
Abstract: Endoscopic submucosal dissection (ESD) is reported to be an efficient treatment with a high rate of en bloc resection for large colorectal tumors in Japan and some other Western and Asian countries. ESD is considered less invasive than laparoscopic colectomy. However, ESD carries a higher risk of perforation than endoscopic mucosal resection (EMR). Various devices and training methods for colorectal ESD have been developed to solve the difficulties. In this review, we describe the complications of colorectal ESD and prevention of those complications. On the other hand, colorectal ESD is difficult for less-experienced endoscopists. The unique step-by-step ESD training system is performed in Japan. Additionally, appropriate training, including animal model training, for colorectal ESD should be acquired before working on clinical cases. 1. Introduction Endoscopic submucosal dissection (ESD) is reported to be an efficient treatment with a high rate of en bloc resection for large colorectal tumors in Japan and some other Western and Asian countries. The rate of en bloc resection for large colorectal tumors by ESD was reported to be 80–98.9% [1–9]. ESD is considered less invasive than laparoscopic colectomy. However, ESD carries a higher risk of perforation than endoscopic mucosal resection (EMR) [7, 8] owing to its associated technical difficulties. First, the colon is winding in nature and has many folds. Moreover, the wall of the colon is thinner than the gastric wall. Various devices and training methods for colorectal ESD have been developed to solve the difficulties. In this review, we describe the complications of colorectal ESD, prevention of those complications, and training for the procedure. 2. Safe and Efficient Strategy and Our Therapeutic Results The following are the steps in our routine ESD procedure (Figure 1) [3, 7, 8]. First, injection for submucosal elevation is performed with a 25G needle (8B27A; TOP, Tokyo, Japan) after visualization of the border of the tumor, and mucosal incisions are made. A partial circumferential incision is made on the distal side of the tumor. If the tumor is >50?mm in size, the incision is performed at the proximal side of the tumor because in large tumors, it is sometimes difficult to resect the residual mucosa on the proximal side in the presence of a partially resected tumor. Mucosal incisions are performed with the endocut mode (endocut I, effect 2, duration 2, interval 1 in VIO300D; Erbe Elektromedizin Ltd., Tubingen, Germany). Then, simultaneously, an incision into the deep submucosa is made. After the
Application of Endoscopic Submucosal Dissection for Removal of Deep Invasive Submucosal Colon Carcinoma
Sergio A. Con,Yutaka Saito,Takahisa Matsuda,Hirokazu Taniguchi,Takeshi Nakajima
Case Reports in Medicine , 2009, DOI: 10.1155/2009/573981
Abstract: Endoscopic submucosal (sm) dissection (ESD) is a recently used technique that enables en-bloc resection of large colorectal tumors allowing a more precise histopathological analysis of the resected specimen. However, it has not been widely adopted even in Japan mainly due to its technical difficulty and increased risk of perforation. Herein, we present an ESD-treated lesion with deep sm invasion removed without complications, such as bleeding or perforation, from a patient at high-risk for surgical intervention. A successful ESD was achieved although the sm invasion was greater than 1000 μm from the muscularis mucosae, and the nonlifting sign was positive. It is our belief that this procedure should be performed at least in patients at high-risk for surgical intervention. At present, we have removed 16 lesions with deep sm invasion by ESD without complications, demonstrating that deep sm cancer can be successfully resected by this technique as a local resection. Herein, we report on one of these cases
Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications  [cached]
Naohisa Yoshida, Nobuaki Yagi, Yuji Naito, Toshikazu Yoshikawa
World Journal of Gastroenterology , 2010,
Abstract: Endoscopic submucosal dissection (ESD) is efficient for en bloc resection of large colorectal tumors. However, it has several technical difficulties, because the wall of the colon is thin and due to the winding nature of the colon. The main complications of ESD comprise postoperative perforation and hemorrhage, similar to endoscopic mucosal resection (EMR). In particular, the rate of perforation in ESD is higher than that in EMR. Perforation of the colon can cause fatal peritonitis. Endoscopic clipping is reported to be an efficient therapy for perforation. Most cases with perforation are treated conservatively without urgent surgical intervention. However, the rate of postoperative hemorrhage in ESD is similar to that in EMR. Endoscopic therapy including endoscopic clipping is performed and most of the cases are treated conservatively without blood transfusion. In blood examination, some degree of inflammation is detected after ESD. For the standardization of ESD, it is most important to decrease the rate of perforation. Adopting a safe strategy for ESD and a suitable choice of knife are both important ways of preventing perforation. Moreover, appropriate training and increasing experience can improve the endoscopic technique and can decrease the rate of perforation. In this review, we describe safe procedures in ESD to prevent complications, the complications of ESD and their management.
Balloon overtube-guided colorectal endoscopic submucosal dissection
Tomohiko Ohya, Ken Ohata, Kazuki Sumiyama, Yousuke Tsuji, Ikuro Koba, Nobuyuki Matsuhashi, Hisao Tajiri
World Journal of Gastroenterology , 2009,
Abstract: AIM: To evaluate the usefulness of a balloon overtube to assist colorectal endoscopic submucosal dissection (ESD) using a gastroscope.METHODS: The results of 45 consecutive patients who underwent colorectal ESD were analyzed in a single tertiary endoscopy center. In preoperative evaluation of access to the lesion, difficulties were experienced in the positioning and stabilization of a gastroscope in 15 patients who were thus assigned to the balloon-guided ESD group. A balloon overtube was placed with a gastroscope to provide an endoscopic channel to the lesion in cases with preoperatively identified difficulties related to accessibility. Colorectal ESD was performed following standard procedures. A submucosal fluid bleb was created with hyaluronic acid solution. A circumferential mucosal incision was made to marginate the lesion. The isolated lesion was finally excised from the deeper layers with repetitive electrosurgical dissections with needle knives. The success of colorectal ESD, procedural feasibility, and procedure-related complications were the main outcomes and measurements.RESULTS: The overall en bloc excision rate of colorectal ESD during this study at our institution was 95.6%. En bloc excision of the lesion was successfully achieved in 13 of the 15 patients (86.7%) in the balloon overtube-guided colorectal ESD group, which was comparable to the results of the standard ESD group with better accessibility to the lesion (30/30, 100%, not statistically significant).CONCLUSION: Use of a balloon overtube can improve access to the lesion and facilitate scope manipulation for colorectal ESD.
Endoscopic submucosal dissection for large laterally spreading tumors involving the ileocecal valve and terminal ileum  [cached]
Gustavo Kishimoto,Yutaka Saito,Hajime Takisawa,Haruhisa Suzuki
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i3.291
Abstract: Endoscopic submucosal dissection is a challenging technique that enables en-bloc resection for large colorectal tumors, as laterally spreading tumors, particularly difficult, if the ileocecal valve and terminal ileum is involved. Herein, we report on one of 4 cases. The procedures, using a bipolar needle knife (B-Knife) to reduce the perforation risk and carbon dioxide instead of conventional air insufflation for patient comfort, achieved curative resections without any complications.
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