Long-term outcomes of endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection

BACKGROUND Endoscopic submucosal dissection(ESD)for over 2 cm in size undifferentiated type(UD type)early gastric cancer(EGC)confined to the mucosa is not only challenging,but also long-term outcomes are not well known.AIM To evaluate the long-term outcomes of ESD done for UD type EGCs confined to the mucosa over 2 cm in size and compare the results with those where the lesions were less than 2 cm.METHODS 143 patients with UD type EGC confirmed on histology after ESD at a tertiary hospital were reviewed.Cases with synchronous and metachronous lesions and a case with emergency surgery after ESD were excluded.A total of 137 cases were enrolled.79 cases who underwent R0 resection were divided into 2 cm or less(group A)and over 2 cm(group B)in size.RESULTS Among 79 patients who underwent R0 resection,the number in group A and B were 51 and 28,respectively.The mean follow-up period(SD)was 79.71±45.42 months.There was a local recurrence in group A(1/51,2%)and group B(1/28,3.6%)respectively.This patient in group A underwent surgery while the patient in group B underwent repeated ESD with no further recurrences in both patients.There was no regional lymph node metastasis,distant metastasis,and deaths in both groups.With R0 resection strategy for ESD on lesions over 2 cm,20.4%(28/137)of patients were able to avoid surgery compared with expanded indication.CONCLUSION If R0 resection is achieved by ESD,UD type EGCs over 2 cm also showed good and similar clinical outcomes as compared to lesions less than 2 cm when followed for over 5 years.With R0 resection strategy,several patients can avoid surgery.

Large colonic lipoma with a laterally spreading tumor treated by endoscopic submucosal dissection:A case report

BACKGROUND Since fat does not transmit electrical energy well,delayed perforation and postpolypectomy syndrome due to electrical thermal injury are concerns in the endoscopic removal of colonic lipoma.The endoscopic submucosal dissection(ESD)technique concentrates electrical energy conducts to the submucosa,not the adipose tissue.This helps to minimize electrical thermal injury,especially in the case of large colonic lipomas.In rare cases,such as colonic lipomas accompanied by mucosal lesions,it is difficult for endoscopists to decide how to safely remove them.CASE SUMMARY A 78-year-old man underwent colonoscopy for colorectal cancer screening.During colonoscopy,a yellowish submucosal tumor with positive cushion sign was observed in the ascending colon measuring about 4.5 cm.A nodular mucosal lesion of about 2.5 cm was observed on the mucosal surface of the lipoma.The lipoma was so large that it occupied much of the inside of the colon,making it difficult to see the entire laterally spreading tumor(LST)at once.The LST was confined to the surface of the lipoma,which had a semipedunculated shape with a wide neck.The margin of the LST was not observed at the neck of the lipoma.ESD was performed and the colonic lipoma with the LST was successfully removed without complications.After 3 d of hospitalization,the patient was discharged without any symptoms.The final pathology report showed that the lesion consisted of submucosal lipoma and tubulovillous adenoma with lowgrade dysplasia.CONCLUSION ESD is effective and safe for treating a large colonic lipoma with an LST by minimizing electrical thermal injury.

Small sphincterotomy combined with endoscopic papillary large balloon dilation versus sphincterotomy

AIM:To compare small sphincterotomy combined with endoscopic papillary large balloon dilation(SES+ ELBD)and endoscopic sphincterotomy(EST)for large bile duct stones. METHODS:We compared prospectively SES+ELBD (group A,n=27)with conventional EST(group B, n=28)for the treatment of large bile duct stones(≥ 15 mm).When the stone could not be removed with a normal basket,mechanical lithotripsy was performed. We compared the rates of complete stone removal with one session and application of mechanical lithotripsy. RESULTS:No significant differences were observed in the mean largest stone size(A:20.8 mm,B:21.3 mm), bile duct diameter(A:21.4 mm,B:20.5 mm),number of stones(A:2.2,B:2.3),or procedure time(A:18 min, B:19 min)between the two groups.The rates of complete stone removal with one session was 85%in group A and 86%in group B(P=0.473).Mechanical lithotripsy was required for stone removal in nine of 27 patients(33%)in group A and nine of 28 patients (32%,P=0.527)in group B.CONCLUSION:SES+ELBD did not show significant benefits compared to conventional EST,especially for the removal of large(≥15 mm)bile duct stones.

A novel device for endoscopic submucosal dissection,the Fork knife

瞄准：用一台新奇设备介绍并且评估功效和内视镜的粘膜下层解剖(ESD ) 的技术方面，叉刀。方法：从 2004 年 3 月到 2008 年 4 月， ESD 在一个单个第三级的工作分派中心用 Flexknife (组 B ) 在使用一把叉刀(Endo FSregister )( 组 A ) 的 265 胃的损害上并且在 72 胃的损害上被执行。我们回顾地比较了 resected 标本的肿瘤，病理检查所见，和尺寸的内视镜的特征。我们也比较了在二个组之间的整块切除术率，完全的切除术率，复杂并发症，和过程时间。结果：resected 标本的吝啬的尺寸是 4.27 +/- 在组 A 和 4.29 +/- 的 1.26 厘米在组 B 的 1.48 厘米。整块切除术率是 95.8%(254/265 损害) 在组 A 并且 93.1%(67/72 ) 在组 B。没有 resected 边缘的肿瘤房间侵略的完全的 ESD 在 81.1% 被获得(215/265 ) 组 A 并且在 73.6%(53/72 ) 组 B。穿孔率是 0.8%(2/265 ) 在组 A 并且 1.4%(1/72 ) 在组 B。吝啬的过程时间是 59.63 +/- 在组 A 和 76.65 +/- 的 56.12 min 在组 B 的 70.75 min (P 【 0.05 ) 。结论：叉刀(Endo FSregister ) 为临床的实践是有用的并且有的优点减少过程时间。

Short health scale: A valid measure of health-related quality of life in Korean-speaking patients with inflammatory bowel disease

AIM To evaluate the short health scale(SHS),a new,simple,four-part visual analogue scale questionnaire that is designed to assess the impact of inflammatory bowel disease(IBD)on health-related quality of life(HRQOL),in Korean-speaking patients with IBD.METHODS The SHS was completed by 256 patients with Crohn’s disease(CD)and ulcerative colitis(UC).Individual SHS items were correlated with inflammatory bowel disease questionnaire(IBDQ)dimensions and with disease activity to assess validity.Test-retest reliability,responsiveness and patient or disease characteristics with probable association with high SHS scores were analyzed.RESULTS Of 256 patients with IBD,139(54.3%)had UC and 117(45.7%)had CD.The correlation coefficients between SHS questions about"symptom burden","activities of daily living",and"disease-related worry"and their corresponding dimensions in the IBDQ ranged from0.62 to 0.71,compared with correlation coefficients ranging from-0.45 to-0.61 for their non-corresponding dimensions.There was a stepwise increase in SHS scores,with increasing disease activity in both CD and UC(all P values<0.001).Reliability was confirmed with test-retest correlations ranging from 0.68 to 0.90(all P values<0.001).Responsiveness was confirmed with the patients who remained in remission.Their SHS scores remained unchanged,except for the SHS dimension"disease-related worry".In the multivariate analysis,female sex was associated with worse"general well-being"(OR=2.28,95%CI:1.02-5.08)along with worse disease activity.CONCLUSION The SHS is a valid and reliable measure of HRQOL in Korean-speaking patients with IBD.

Feasibility of full-spectrum endoscopy:Korea's first full-spectrum endoscopy colonoscopic trial

AIM: To evaluate the full-spectrum endoscopy(FUSE) colonoscopy system as the first report on the utility thereof in a Korean population.METHODS: We explored the efficacy of the FUSE colonoscopy in a retrospective, single-center feasibility study performed between February 1 and July 20, 2015. A total of 262 subjects(age range: 22-80) underwent the FUSE colonoscopy for colorectal cancer screening, polyp surveillance, or diagnostic evaluation. The cecal intubation success rate, the polyp detection rate(PDR), the adenoma detection rate(ADR), and the diverticulum detection rate(DDR), were calculated. Also, the success rates of therapeutic interventions were evaluated with biopsy confirmation.RESULTS: All patients completed the study and the success rates of cecal and terminal ileal intubation were 100% with the FUSE colonoscope; we found 313 polyps in 142 patients and 173 adenomas in 95. The overall PDR, ADR and DDR were 54.2%, 36.3%, and 25.2%, respectively, and were higher in males, and increased with age. The endoscopists and nurses involved considered that the full-spectrum colonoscope improved navigation and orientation within the colon.No colonoscopy was aborted because of colonoscope malfunction.CONCLUSION: The FUSE colonoscopy yielded a higher PDR, ADR, DDR than did traditional colonoscopy, without therapeutic failure or complications, showing feasible, effective, and safe in this first Korean trial.