The diagnosis of early gastric cancer(EGC) is of great interest because its endoscopic and surgical treatment presents the best chance for a cure.With technical development,endoscopic submucosal dissection(ESD) has be...The diagnosis of early gastric cancer(EGC) is of great interest because its endoscopic and surgical treatment presents the best chance for a cure.With technical development,endoscopic submucosal dissection(ESD) has been widely performed for the curative treatment of EGC in Korea.Multinational studies of ESD for EGC will be the next missions that overcome these limitations and global guidelines will be processed for ESD for EGC.展开更多
AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist...AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.展开更多
Background:Heterotopic gastric mucosa(HGM)is the most reported epithelial heterotopia,but it is very rare in the rectum and anus.Methods:The first case of an asymptomatic adult male with a large nonpolypoid HGM in the...Background:Heterotopic gastric mucosa(HGM)is the most reported epithelial heterotopia,but it is very rare in the rectum and anus.Methods:The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection(ESD)is reported.The systematic review was based on a comprehensive search of MEDLINE,EMBASE and Google Scholar.Studies on humans were identified with the term‘heterotopic gastric mucosa in the rectum and/or anus.’Results:The search identified 79 citations,and 72 cases were evaluated comprising the present report.Congenital malformations were observed in 17(24%)patients;rectal duplication accounted for most of the cases.The HGM was located in the anus and perineal rectum in 25 cases(41%)and low,middle and proximal pelvic rectum in 20(33%),five(8%)and 11 cases(18%),respectively.Morphology was nonpolypoid in 37 cases(51%),polypoid in 26 cases(36%)and ulcerated in nine cases(13%).Specific anorectal symptoms were reported by 50(69%)patients of the whole study population,and by 33(97%)of 34 patients≤18 years.Complications were observed in 23 cases(32%).The HGM was excised in 50 cases(83%).Endoscopic resection was performed in 17 cases(34%);resection was piecemeal in five of 12 lesions≥5mm,required argon plasma coagulation in two cases and was associated with residual tissue in two(17%).Intestinal metaplasia and an adenoma with lowgrade dysplasia were described in three adults(4%).Discussion:This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications,mainly in the pediatric population,and a risk of malignancy in adults.Its complete excision should be recommended,and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery.展开更多
Endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)techniques have reduced the need for surgery in early esophageal and gastric cancers and thus has lessened morbidity and mortality in these dis...Endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)techniques have reduced the need for surgery in early esophageal and gastric cancers and thus has lessened morbidity and mortality in these diseases.ESD is a relatively new technique in western countries and requires rigorous training to reproduce the proficiency of Asian countries,such as Korea and Japan,which have very high complete(en bloc)resection rates and low complication rates.EMR plays a valuable role in early esophageal cancers.ESD has shown better en bloc resection rates but it is easier to master and maintain proficiency in EMR;it also requires less procedural time.For early esophageal adenocarcinoma arising from Barrett’s,ESD and EMR techniques are usually combined with other ablative modalities,the most common being radiofrequency ablation because it has the largest dataset to prove its success.The EMR techniques have been used with some success in early gastric cancers but ESD is currently preferred for most of these lesions.ESD has the added advantage of resecting into the submucosa and thus allowing for endoscopic resection of more aggressive(deeper)early gastric cancer.展开更多
文摘The diagnosis of early gastric cancer(EGC) is of great interest because its endoscopic and surgical treatment presents the best chance for a cure.With technical development,endoscopic submucosal dissection(ESD) has been widely performed for the curative treatment of EGC in Korea.Multinational studies of ESD for EGC will be the next missions that overcome these limitations and global guidelines will be processed for ESD for EGC.
文摘AIM:To identify the determinants of endoscopic submucosal dissection(ESD) operation time.METHODS:This investigation was conducted as a single-center,prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital.A total of 173 patients underwent ESD operations performed by Dr.Lu from July 2007 to December 2011,and 183 lesions were enrolled.Patient gender,age,tumor location,gross type,tumor size,pathological type and adhesions were recorded prospectively.The order of treatment represented the experience of the operator.Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.RESULTS:Univariate analysis showed the ESD time was closely related to the gender(P = 0.0210),tumor size(P < 0.0001),location(P < 0.0001),gross type(P < 0.0001) and adhesion(P = 0.0010).The surgical proficiency level was associated with ESD time in unit area(P < 0.0001).Multivariate analysis revealed that the ESD time was positively correlated with tumor size(P < 0.0001),adhesion(P < 0.0001) and location(P < 0.0001),but negatively correlated with surgical proficiency level(P = 0.0046).CONCLUSION:Large tumor size,adjacency to the cardia,and adhesion are predictors of a long ESD time,whereas high surgical proficiency level predicts a short ESD time.
基金We thank Mrs.Christel Strohn,and Mrs.Sara Piazza for their assistance in German translation.Author contributions:GI designed the research,FI and GI performed the research,TG,YS,and GC critically reviewed the final version of the paper,and GI and FI wrote the paper.
文摘Background:Heterotopic gastric mucosa(HGM)is the most reported epithelial heterotopia,but it is very rare in the rectum and anus.Methods:The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection(ESD)is reported.The systematic review was based on a comprehensive search of MEDLINE,EMBASE and Google Scholar.Studies on humans were identified with the term‘heterotopic gastric mucosa in the rectum and/or anus.’Results:The search identified 79 citations,and 72 cases were evaluated comprising the present report.Congenital malformations were observed in 17(24%)patients;rectal duplication accounted for most of the cases.The HGM was located in the anus and perineal rectum in 25 cases(41%)and low,middle and proximal pelvic rectum in 20(33%),five(8%)and 11 cases(18%),respectively.Morphology was nonpolypoid in 37 cases(51%),polypoid in 26 cases(36%)and ulcerated in nine cases(13%).Specific anorectal symptoms were reported by 50(69%)patients of the whole study population,and by 33(97%)of 34 patients≤18 years.Complications were observed in 23 cases(32%).The HGM was excised in 50 cases(83%).Endoscopic resection was performed in 17 cases(34%);resection was piecemeal in five of 12 lesions≥5mm,required argon plasma coagulation in two cases and was associated with residual tissue in two(17%).Intestinal metaplasia and an adenoma with lowgrade dysplasia were described in three adults(4%).Discussion:This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications,mainly in the pediatric population,and a risk of malignancy in adults.Its complete excision should be recommended,and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery.
文摘Endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR)techniques have reduced the need for surgery in early esophageal and gastric cancers and thus has lessened morbidity and mortality in these diseases.ESD is a relatively new technique in western countries and requires rigorous training to reproduce the proficiency of Asian countries,such as Korea and Japan,which have very high complete(en bloc)resection rates and low complication rates.EMR plays a valuable role in early esophageal cancers.ESD has shown better en bloc resection rates but it is easier to master and maintain proficiency in EMR;it also requires less procedural time.For early esophageal adenocarcinoma arising from Barrett’s,ESD and EMR techniques are usually combined with other ablative modalities,the most common being radiofrequency ablation because it has the largest dataset to prove its success.The EMR techniques have been used with some success in early gastric cancers but ESD is currently preferred for most of these lesions.ESD has the added advantage of resecting into the submucosa and thus allowing for endoscopic resection of more aggressive(deeper)early gastric cancer.
