In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2023;15(11):634-680.Gastric cancer(GC)remains the fifth most common malignancy and the fourt...In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2023;15(11):634-680.Gastric cancer(GC)remains the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide.The overall prevalence of GC has declined,although that of proximal GC has increased over time.Thus,a significant proportion of GC cases and deaths can be avoided if preventive interventions are taken.Early GC(EGC)is defined as GC confined to the mucosa or submucosa.Endoscopic resection is considered the most appropriate treatment for precancerous gastrointestinal lesions improving patient quality of life,with reduced rates of complications,shorter hospitalization period,and lower costs when compared to surgical resection.Endoscopic mucosal resection(EMR)and endoscopic sub-mucosal dissection(ESD)are representative endoscopic treatments for EGC and precancerous gastric lesions.Standard EMR implies injection of a saline solution into the sub-mucosal space,followed by excision of the lesion using a snare.Complete resection rates vary depending on the size and severity of the lesion.When using conventional EMR methods for lesions less than 1 cm in size,the complete resection rate is approximately 60%,whereas for lesions larger than 2 cm,the complete resection rate is low(20%-30%).ESD can be used to remove tumors exceeding 2 cm in diameter and lesions associated with ulcers or submucosal fibrosis.Compared with EMR,ESD has higher en bloc resection rates(90.2%vs 51.7%),higher complete resection rates(82.1 vs 42.2%),and lower recurrence rates(0.65%vs 6.05%).Thus,innovative techniques have been introduced.展开更多
Aim: The aim of this study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer based on approximately 10 years’ experience. Methods: Endoscopic submucosal dissect...Aim: The aim of this study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer based on approximately 10 years’ experience. Methods: Endoscopic submucosal dissection was performed in 1272 patients with early gastric cancer (1657 lesions). We examined en bloc resection rate, curative resection rate, local recurrence rate, procedure time, and complications. Results: The overall en bloc resection rate was 98.6% for all lesions treated by ESD. The median procedure time of the operation was 54.3 minutes (range 5 - 632 min). The incidence of positive horizontal and vertical margins was 3.8% and 4.0%, respectively. The incidence was 2.5% each for perforation and postoperative bleeding. There were no deaths related to ESD. Local recurrence was observed in 10 lesions (0.06%). Conclusion: Since the procedure time and incidence of complications have been reduced, endoscopic submucosal dissection has been considered a standard treatment for early gastric cancer.展开更多
The field of endoscopy has progressed markedly and become widespread in recent years, and the role of minimally invasive endoscopic treatment has become increasingly more important with the increase in the number of p...The field of endoscopy has progressed markedly and become widespread in recent years, and the role of minimally invasive endoscopic treatment has become increasingly more important with the increase in the number of patients in whom gastric cancer is detected at an early stage. In addition, the characteristics of early gastric cancer, which can be curably treated by mucosal resection alone just as by surgical cancer resection, were clarified, and endoscopic submucosal dissection (ESD) was developed as a highly curable, minimally invasive treatment, that is gaining popularity. In this paper, we describe the technical details and complications of ESD for early gastric cancer, including their management.展开更多
Various traction devices have been developed to secure a visual field and sufficient tension at the dissection plane during endoscopic submucosal dissection(ESD).However,few large-scale studies have investigated the e...Various traction devices have been developed to secure a visual field and sufficient tension at the dissection plane during endoscopic submucosal dissection(ESD).However,few large-scale studies have investigated the effectiveness of traction devices in gastric ESD.Clip-with-line(CWL)is one such traction device that is widely used in cases of gastric ESD.The CONNECT-G trial was the first multicenter randomized controlled trial to compare conventional ESD with CWLassisted ESD(CWL-ESD)for superficial gastric neoplasms.Overall,no significant intergroup difference was observed in terms of the gastric ESD procedure time.However,subgroup analysis according to lesion location revealed a significant reduction in the procedure time of gastric ESD for the lesion located at the greater curvature of the middle and upper third of the stomach in the CWL-ESD group.In this subgroup analysis,lesion location was categorized as follows:anterior wall,posterior wall,lesser curvature,and greater curvature of the upper,middle,and lower thirds of the stomach.However,the gastric ESD procedure time showed no significant difference,except for lesions located at the greater curvature of the upper and middle thirds of the stomach.The traction direction of CWL in the stomach was limited to the cardia and changed depending on the lesion location.Therefore,outcomes of the CONNECT-G trail suggest that the effectiveness of CWL was influenced by lesion location,i.e.,traction direction.Further studies are warranted to investigate the optimal traction direction in gastric ESD.展开更多
We review the use of Endoscopic Mucosal Resection in the treatment of early colorectal cancer. Newer endoscopic imaging modalities have lead to earlier detection of advanced lesions thus enabling endoscopic curative t...We review the use of Endoscopic Mucosal Resection in the treatment of early colorectal cancer. Newer endoscopic imaging modalities have lead to earlier detection of advanced lesions thus enabling endoscopic curative therapy of lesions that would otherwise need surgery. Early outcomes data suggest promising results. But further long term prospective studies are needed.展开更多
There has been tremendous progress in endoscopic techniques for the management of premalignant or malignant gastric lesions.Gastric cancer remains the second most common cause of cancer related mortality worldwide.Thi...There has been tremendous progress in endoscopic techniques for the management of premalignant or malignant gastric lesions.Gastric cancer remains the second most common cause of cancer related mortality worldwide.This means that there is a need for early detection and diagnosis of premalignant lesions or early cancer in clinical practice.Despite substantial development of endoscopic resection techniques,the management of gastric premalignant lesions is controversial because of the lack of consensus and accurate risk stratification.Future study of various aspects would clarify these issues but in the meantime we should reconsider the current algorithm approach for the management of gastric low grade dysplasia.展开更多
文摘In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2023;15(11):634-680.Gastric cancer(GC)remains the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide.The overall prevalence of GC has declined,although that of proximal GC has increased over time.Thus,a significant proportion of GC cases and deaths can be avoided if preventive interventions are taken.Early GC(EGC)is defined as GC confined to the mucosa or submucosa.Endoscopic resection is considered the most appropriate treatment for precancerous gastrointestinal lesions improving patient quality of life,with reduced rates of complications,shorter hospitalization period,and lower costs when compared to surgical resection.Endoscopic mucosal resection(EMR)and endoscopic sub-mucosal dissection(ESD)are representative endoscopic treatments for EGC and precancerous gastric lesions.Standard EMR implies injection of a saline solution into the sub-mucosal space,followed by excision of the lesion using a snare.Complete resection rates vary depending on the size and severity of the lesion.When using conventional EMR methods for lesions less than 1 cm in size,the complete resection rate is approximately 60%,whereas for lesions larger than 2 cm,the complete resection rate is low(20%-30%).ESD can be used to remove tumors exceeding 2 cm in diameter and lesions associated with ulcers or submucosal fibrosis.Compared with EMR,ESD has higher en bloc resection rates(90.2%vs 51.7%),higher complete resection rates(82.1 vs 42.2%),and lower recurrence rates(0.65%vs 6.05%).Thus,innovative techniques have been introduced.
文摘Aim: The aim of this study was to examine the safety and efficacy of endoscopic submucosal dissection (ESD) for early gastric cancer based on approximately 10 years’ experience. Methods: Endoscopic submucosal dissection was performed in 1272 patients with early gastric cancer (1657 lesions). We examined en bloc resection rate, curative resection rate, local recurrence rate, procedure time, and complications. Results: The overall en bloc resection rate was 98.6% for all lesions treated by ESD. The median procedure time of the operation was 54.3 minutes (range 5 - 632 min). The incidence of positive horizontal and vertical margins was 3.8% and 4.0%, respectively. The incidence was 2.5% each for perforation and postoperative bleeding. There were no deaths related to ESD. Local recurrence was observed in 10 lesions (0.06%). Conclusion: Since the procedure time and incidence of complications have been reduced, endoscopic submucosal dissection has been considered a standard treatment for early gastric cancer.
文摘The field of endoscopy has progressed markedly and become widespread in recent years, and the role of minimally invasive endoscopic treatment has become increasingly more important with the increase in the number of patients in whom gastric cancer is detected at an early stage. In addition, the characteristics of early gastric cancer, which can be curably treated by mucosal resection alone just as by surgical cancer resection, were clarified, and endoscopic submucosal dissection (ESD) was developed as a highly curable, minimally invasive treatment, that is gaining popularity. In this paper, we describe the technical details and complications of ESD for early gastric cancer, including their management.
文摘Various traction devices have been developed to secure a visual field and sufficient tension at the dissection plane during endoscopic submucosal dissection(ESD).However,few large-scale studies have investigated the effectiveness of traction devices in gastric ESD.Clip-with-line(CWL)is one such traction device that is widely used in cases of gastric ESD.The CONNECT-G trial was the first multicenter randomized controlled trial to compare conventional ESD with CWLassisted ESD(CWL-ESD)for superficial gastric neoplasms.Overall,no significant intergroup difference was observed in terms of the gastric ESD procedure time.However,subgroup analysis according to lesion location revealed a significant reduction in the procedure time of gastric ESD for the lesion located at the greater curvature of the middle and upper third of the stomach in the CWL-ESD group.In this subgroup analysis,lesion location was categorized as follows:anterior wall,posterior wall,lesser curvature,and greater curvature of the upper,middle,and lower thirds of the stomach.However,the gastric ESD procedure time showed no significant difference,except for lesions located at the greater curvature of the upper and middle thirds of the stomach.The traction direction of CWL in the stomach was limited to the cardia and changed depending on the lesion location.Therefore,outcomes of the CONNECT-G trail suggest that the effectiveness of CWL was influenced by lesion location,i.e.,traction direction.Further studies are warranted to investigate the optimal traction direction in gastric ESD.
文摘We review the use of Endoscopic Mucosal Resection in the treatment of early colorectal cancer. Newer endoscopic imaging modalities have lead to earlier detection of advanced lesions thus enabling endoscopic curative therapy of lesions that would otherwise need surgery. Early outcomes data suggest promising results. But further long term prospective studies are needed.
文摘There has been tremendous progress in endoscopic techniques for the management of premalignant or malignant gastric lesions.Gastric cancer remains the second most common cause of cancer related mortality worldwide.This means that there is a need for early detection and diagnosis of premalignant lesions or early cancer in clinical practice.Despite substantial development of endoscopic resection techniques,the management of gastric premalignant lesions is controversial because of the lack of consensus and accurate risk stratification.Future study of various aspects would clarify these issues but in the meantime we should reconsider the current algorithm approach for the management of gastric low grade dysplasia.
