Repeat endoscopic submucosal dissection for recurrent gastric cancers after endoscopic submucosal dissection

AIM:To clarify the safety and efficacy of repeat endoscopic submucosal dissection(re-ESD)for locally recurrent gastric cancers after ESD.METHODS:A retrospective evaluation was performed of the therapeutic efficacy,complications and followup results from ESD treatment for early gastric cancers in 521 consecutive patients with 616 lesions at St.Luke`s International Hospital between April 2004 and November 2012.In addition,tumor size,the size of resected specimens and the operation time were compared between re-ESD and initial ESD procedures.A flex knife was used as the primary surgical device and a hook knife was used in cases with severe fibrosis in the submucosal layer.Continuous variables were analyzed using the non-parametric Mann-Whitney U test and are expressed as medians(range).Categorical variables were analyzed using a Fisher’s exact test and are reported as proportions.Statistical significance was defined as a P-value less than 0.05.RESULTS:The number of cases in the re-ESD group and the initial ESD group were 5 and 611,respectively.The median time interval from the initial ESD to re-ESD was 14(range,4-44 mo).En bloc resection with free lateral and vertical margins was successfully performed in all re-ESD cases without any complications.No local or distant recurrence was observed during the median follow-up period of 48(range,11-56 mo).Tumor size was not significantly different between the re-ESD group and the initial ESD group(median 22 mm vs 11mm,P=0.09),although the size of resected specimens was significantly larger in the re-ESD group(median 47 mm vs 34 mm,P<0.05).There was a nonsignificant increase observed in re-ESD operation time compared to initial ESD(median 202 min vs 67 min,respectively,P=0.06).CONCLUSION:Despite the low patient number and short follow-up,the results suggest that re-ESD is a safe and effective endoscopic treatment for recurrent gastric cancer after ESD.

Endoscopic band ligation for bleeding lesions in the small bowel

AIM: To investigate the safety and efficacy of endo-scopic band ligation(EBL) for bleeding lesions in the small bowel.METHODS: This is a retrospective study evaluating EBL in six consecutive patients(three males, three fe-males, 46-86 years of age) treated between May 2009 and February 2014: duodenal vascular ectasia; 1, je-junal bleeding diverticulum; 1, ileal Dieulafoy's lesion; 1 and ileal bleeding diverticula; 3. The success of the initial hemostasis was evaluated, and patients were observed for early rebleeding(within 30 d after EBL), and complications such as perforation and abscess for-mation. Follow-up endoscopies were performed in four patients.RESULTS: Initial hemostasis was successfully achieved with EBL in all six patients. Eversion was not sufficient in four diverticular lesions. Early rebleeding occurred three days after EBL in one ileal diverticulum, and arepeat endoscopy revealed dislodgement of the O-band and ulcer formation at the banded site. This rebleeding was managed conservatively. Late rebleeding occurred in this case(13 and 21 mo after initial EBL), and re-EBL was performed. Follow-up endoscopies revealed scar formation and the disappearance of vascular lesions at the banded site in the case with a duodenal bleeding lesion, and unresolved ileal diverticula in three cases. Surgery or transarterial embolization was not required without any complications during the median follow-up period of 45(range, 2-83) mo.CONCLUSION: EBL is a safe and effective endoscopic treatment for hemostasis of bleeding lesions in the small bowel.