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
AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results. METHODS: We retrospectively reviewed data from 554 cases of 534 ...AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results. METHODS: We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Reendoscopy was examined in 142 cases and biopsywas performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed. RESULTS: Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type Ⅳ (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027). CONCLUSION: High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.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
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.
基金Supported by Chung-Nam National University Hospital Fund
文摘AIM: To investigate how many discrepancies occur in patients before and after endoscopic treatment of referred adenoma and the reason for these results. METHODS: We retrospectively reviewed data from 554 cases of 534 patients who were referred from primary care centres for adenoma treatment and treated for endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) at Chungnam National University Hospital, from July 2006 to June 2009. Reendoscopy was examined in 142 cases and biopsywas performed in 108 cases prior to treatment. Three endoscopists (1, 2 and 3) performed all EMRs or ESDs and three pathologists (1, 2 and 3) diagnosed most of the cases. Transfer notes, medical records and endoscopic pictures of these cases were retrospectively reviewed and analyzed. RESULTS: Adenocarcinoma was 72 (13.0%) cases in total 554 cases after endoscopic treatment of referred adenoma. When the grade of dysplasia was high (55.0%), biopsy number was more than three (22.7%), size was no smaller than 2.0 cm (23.2%), morphologic type was depressed (35.8%) or yamada type Ⅳ (100%), and color was red (30.9%) or mixed-or-undetermined (25.0%), it had much more malignancy rate than the others (P < 0.05). All 18 cases diagnosed as adenocarcinoma in the re-endoscopic forceps biopsy were performed by endoscopist 1. There were different malignancy rates according to the pathologist (P = 0.027). CONCLUSION: High grade dysplasia is the most important factor for predicting malignancy as a final pathologic diagnosis before treating the referred gastric adenoma. This discrepancy can occur mainly through inappropriately selecting a biopsy site where cancer cells do not exist, but it also depends on the pathologist to some extent.
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.
