Oral higher dose prednisolone to prevent stenosis after endoscopic submucosal dissection for early esophageal cancer

BACKGROUND Esophageal stenosis is one of the main complications of endoscopic submucosal dissection(ESD)for the treatment of large-area superficial esophageal squamous cell carcinoma and precancerous lesions(≥3/4 of the lumen).Oral prednisone is useful to prevent esophageal stenosis,but the curative effect remains controversial.AIM To share our experience of the precautions against esophageal stenosis after ESD to remove large superficial esophageal lesions.METHODS Between June 2019 and March 2022,we enrolled patients with large superficial esophageal squamous cell carcinoma and high-grade intraepithelial neoplasia experienced who underwent ESD.Prednisone(50 mg/d)was administered orally on the second morning after ESD for 1 mo,and tapered gradually(5 mg/wk)for 13 wk.RESULTS In total,14 patients met the inclusion criteria.All patients received ESD without operation-related bleeding or perforation.There were 11 patients with≥3/4 and<7/8 of lumen mucosal defects and 1 patient with≥7/8 of lumen mucosal defect and 2 patients with the entire circumferential mucosal defects due to ESD.The longitudinal extension of the esophageal mucosal defect was<50 mm in 3 patients and≥50 mm in 11 patients.The esophageal stenosis rate after ESD was 0%(0/14).One patient developed esophageal candida infection on the 30th d after ESD,and completely recovered after 7 d of administration of oral fluconazole 100 mg/d.No other adverse events of oral steroids were found.CONCLUSION Oral prednisone(50 mg/d)and prolonged prednisone usage time may effectively prevent esophageal stricture after ESD without increasing the incidence of glucocorticoid-related adverse events.However,further investigation of larger samples is required to warrant feasibility and safety.

Magnetic anchor technique assisted endoscopic submucosal dissection for early esophageal cancer

BACKGROUND Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage.With the widespread application of endoscopic technologies,the need for early detection and diagnosis of esophageal cancer has gradually been realized.Endoscopic submucosal dissection(ESD)has become the standard of care for managing early tumors of the esophagus,stomach,and colon.However,due to the steep learning curve,difficult operation,and technically demanding nature of the procedure,ESD has currently been committed to the development of various assistive technologies.AIM To explore the feasibility and applicability of magnetic anchor technique(MAT)-assisted ESD for early esophageal cancer.METHODS Isolated pig esophagi were used as the experimental model,and the magnetic anchor device was designed by us.The esophagi used were divided into two groups,namely the operational and control groups,and 10 endoscopists completed the procedure.The two groups were evaluated for the following aspects:The total operative time,perforation rate,rate of whole mucosal resection,diameter of the peering mucosa,and scores of endoscopists’feelings with the procedure,including the convenience,mucosal surface exposure degree,and tissue tension.In addition,in the operational group,the soft tissue clip and the target magnet(TM)were connected by a thin wire through a small hole at the tail end of the TM.Under gastroscopic guidance,the soft tissue clip was clamped to the edge of the lesioned mucosa,which was marked in advance.By changing the position of the anchor magnet(AM)outside the esophagus,the pulling force and pulling direction of the TM could be changed,thus exposing the mucosal peeling surface and assisting the ESD.RESULTS Herein,each of the two groups comprised 10 isolated esophageal putative mucosal lesions.The diameter of the peering mucosa did not significantly differ between the two groups(2.13±0.06 vs 2.15±0.06,P=0.882).The total operative time was shorter in the operational group than in the control group(17.04±0.22 min vs 21.94±0.23 min,P<0.001).During the entire experiment,the TM remained firmly connected with the soft tissue clip and did not affect the opening,closing,and release of the soft tissue clip.The interaction between the TM and AM could provide sufficient tissue tension and completely expose the mucosa,which greatly assists the surgeon with the operation.There was no avulsion of the mucosa,and mucosal lesions were intact when peeled.Therefore,the scores of endoscopists’feelings were higher in the operational group than in the control group in terms of the convenience(9.22±0.19 vs 8.34±0.15,P=0.002),mucosal surface exposure degree(9.11±0.15 vs 8.25±0.12,P<0.001),and tissue tension(9.35±0.13 vs 8.02±0.17,P<0.001).The two groups did not significantly differ in the perforation rate and rate of whole mucosal resection.CONCLUSION We found MAT-assisted ESD safe and feasible for early esophageal cancer.It could greatly improve the endoscopic operation experience and showed good clinical application prospects.

Efficacy and safety of endoscopic submucosal dissection for early gastric cancer and precancerous lesions in elderly patients

BACKGROUND With advancements in the development of endoscopic technologies,the endo-scopic submucosal dissection(ESD)has been one of the gold-standard therapies for early gastric cancer.AIM To investigate the efficacy and safety ESD in the treatment of early gastric cancer and precancerous lesions in the elderly patients.METHODS Seventy-eight elderly patients with early gastric cancer and precancerous lesions admitted to the Third Affiliated Hospital of Qiqihar Medical University were se-lected and classified into two groups according to the different surgical therapies they received between January 2021 and June 2022.Among them,39 patients treated with ESD were included in an experimental group,and 39 patients treated with endoscopic mucosal resection(EMR)were included in a control group.We compared the basic intraoperative conditions,postoperative short-term recovery,long-term recovery effects and functional status of gastric mucosa between the two groups;the basic intraoperative conditions included lesion resection,intra-operative bleeding and operation time;the postoperative short-term recovery assessment indexes were length of hospital stay and incidence of surgical complic-ations;and the long-term recovery assessment indexes were the recurrence rate at 1 year postoperatively and the survival situation at 1 year and 3 years postoper-atively;and we compared the preoperative and predischarge serum pepsinogen I(PG I)and PG II levels and PG I/PG II ratio in the two groups before surgery and discharge.RESULTS The curative resection rate and the rate of en bloc resection were higher in the experimental group than in the control group.The intraoperative bleeding volume was higher in the experimental group than in the control group.The operation time was longer in the experimental group than that in the control group,and the rate for base residual focus was lower in the experimental group than that of the control group,and the differences were all statistically significant(all P<0.05).The length of hospital stay was longer in the experi-mental group than in the control group,and the incidence of surgical complications,1-year postoperative recu-rrence rate and 3-year postoperative survival rate were lower in the experimental group than in the control group,and the differences were statistically significant(all P<0.05).However,the difference in the 1-year postoperative survival rate was not statistically significant between the two groups(P>0.05).Before discharge,PG I and PG I/PG II ratio were elevated in both groups compared with the preoperative period,and the above indexes were higher in the experimental group than those in the control group,and the differences were statistically significant(both P<0.05).Moreover,before discharge,PG II level was lower in both groups compared with the preoperative period,and the level was lower in the experimental group than in the control group,and the differences were all statistically significant(all P<0.05).CONCLUSION Compared with EMR,ESD surgery is more thorough.It reduces the rate of base residual focus,recurrence rate,surgical complications,and promotes the recovery of gastric cells and glandular function.It is safe and suitable for clinical application.

Challenges and advancing strategies of endoscopic submucosal dissection for early gastric cancer:The puzzle of eCura C1

In this editorial,we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection(ESD),starting from the consideration recently made by Zhu et al.Specifically,we evaluate the management of eCura C1 lesions,where decisions regarding further interventions are pivotal yet contentious.Collaboration among endoscopists,surgeons,and pathologists is underscored to refine risk assessment and personalize therapeutic management.Recent advancements in ESD techniques and interdisciplinary collaboration offer opportunities for outcome optimization in managing eCura C1 lesions.Moreover,despite needing further clinical validation,molecular biomarkers have emerged as promising tools for enhancing prognostication.This manuscript highlights the ongoing research attempts to define treatment paradigms effectively and evaluates the potential of emerging options,ultimately aiming to improve patient care and outcomes in this complex clinical scenario.

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.

Guide Function of Number of Gastrointestinal Endoscope Cases for Endoscopic Submucosal Dissection Training of Early Gastric Cancer:A Teaching Article

This study aimed to determine the guide function of the number of gastrointestinal endoscope cases for the endoscopic submucosal dissection training of early gastric cancer.Three physicians in our center who began to learn ESD in July 2021 are selected and designate them as operators 1⁃3.The number of gastrointestinal endoscope cases performed by operators 1⁃3 before June 2021 was extracted,and the dissection speed among different operators in the ESD training stage was compared.The number of gastrointestinal endoscope cases performed by operator 1 was 3677,that by operator 2 was 4897 and that by operator 3 was 9249.The average dissection speed of operator 1 was 0.132 cm^(2)/min,operator 2 was 0.145 cm^(2)/min,and operator 3 was 0.174 cm^(2)/min.The dissection speed was ranked as operator 1<operator 2<operator 3,and one case of R0 resection was not achieved in both operator 1 and operator 2.Operator 3 achieved R0 resection in all 10 patients.With the increasing of number of gastrointestinal endoscope cases,the dissection speed and the stability of operation of endoscopists in the ESD training will increase.

Feasibility of same-day discharge following endoscopic submucosal dissection for esophageal or gastric early cancer

BACKGROUND Endoscopic submucosal dissection(ESD)is an established technique for the treatment of early gastrointestinal neoplasia.Generally,multi-day(M-D)admission is required for patients undergoing ESD due to potential complications.AIM To evaluate the feasibility of a same-day(S-D)discharge strategy for ESD of the esophagus or stomach.METHODS The data of patients who underwent esophageal or gastric ESD were retrospectively collected from January 2018 to December 2021 at Peking University Cancer Hospital.The propensity score matching(PSM)method was applied to balance the unevenly distributed patient baseline characteristics between the S-D and M-D groups.Intraoperative and postoperative parameters were compared between the matched groups.RESULTS Among the 479 patients reviewed,470 patients,including 91 in the S-D group and 379 in the M-D group,fulfilled the inclusion and exclusion criteria.Following PSM,78 patients in each group were paired using the 1:1 nearest available score match algorithm.No significant difference was found between groups with respect to intraoperative and postprocedural major adverse events(AEs).Tumor size,complete resection rate,and procedural duration were comparable between the groups.The S-D group demonstrated a significantly shorter length of hospital stay(P<0.001)and lower overall medical expenses(P<0.001)compared with the M-D group.CONCLUSION The S-D discharge strategy may be feasible and effective for esophagogastric ESD,and the procedural-related AEs can be managed successfully.

Comparative efficacy and safety between endoscopic submucosal dissection,surgery and definitive chemoradiotherapy in patients with cT1N0M0 esophageal cancer

BACKGROUND Endoscopic submucosal dissection(ESD)and surgical resection are the standard of care for cT1N0M0 esophageal cancer(EC),whereas definitive chemoradiotherapy(d-CRT)is a treatment option.Nevertheless,the comparative efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC remain unclear.AIM To compare the efficiency and safety of ESD,surgery and d-CRT for cT1N0M0 EC.METHODS We retrospectively analyzed the hospitalized data of a total of 472 consecutive patients with cT1N0M0 EC treated at Sun Yat-sen University Cancer center between 2017-2019 and followed up until October 30th,2022.We analyzed demographic,medical recorded,histopathologic characteristics,imaging and endoscopic,and follow-up data.The Kaplan-Meier method and Cox proportional hazards modeling were used to analyze the difference of survival outcome by treatments.Inverse probability of treatment weighting(IPTW)was used to minimize potential confounding factors.RESULTS We retrospectively analyzed patients who underwent ESD(n=99)or surgery(n=220)or d-CRT(n=16)at the Sun Yat-sen University Cancer Center from 2017 to 2019.The median follow-up time for the ESD group,the surgery group,and the d-CRT group was 42.0 mo(95%CI:35.0-60.2),45.0 mo(95%CI:34.0-61.75)and 32.5 mo(95%CI:28.3-40.0),respectively.After adjusting for background factors using IPTW,the highest 3-year overall survival(OS)rate and 3-year recurrence-free survival(RFS)rate were observed in the ESD group(3-year OS:99.7% and 94.7% and 79.1%;and 3-year RFS:98.3%,87.4% and 79.1%,in the ESD,surgical,and d-CRT groups,respectively).There was no difference of severe complications occurring between the three groups(P≥0.05).Multivariate analysis showed that treatment method,histology and depth of infiltration were independently associated with OS and RFS.CONCLUSION For cT1N0M0 EC,ESD had better long-term survival and lower hospitalization costs than those who underwent d-CRT and surgery,with a similar rate of severe complications occurring.

Early gastric cancer recurrence after endoscopic submucosal dissection:Not to be ignored!

This editorial comments on the article“Efficacy of multi-slice spiral computed tomography in evaluating gastric cancer recurrence after endoscopic submucosal dissection”.We focus on the importance of paying more attention to postendoscopic submucosal dissection(ESD)gastric cancer recurrence in patients with early gastric cancer(EGC)and how to manage it effectively.ESD has been a wellknown treatment and the mainstay for EGC,with the advantages of less invasion and fewer complications when compared with traditional surgical procedures.Despite a lower local recurrence rate after ESD,the problem of postoperative recurrence in patients with EGC has become increasingly non-ignorable with the global popularization of ESD technology and the increasing number of post-ESD patients.

Endoscopic submucosal dissection and endoscopic mucosal resection for esophageal and gastric lesions:A comparison of procedures

Objective Esophageal and gastric lesions are effectively managed with minimally invasive upper endoscopic procedures such as endoscopic mucosa resection(EMR)and endoscopic submucosal dissection(ESD),offering patients alternatives to invasive interventions.While ESD is well established in Eastern Asia,its adoption in Denmark for superficial esophageal cancer is recent.This study presents real-world data on the feasibility,safety,and hospitalization duration associated with ESD and EMR for esophageal and gastric lesions.Methods A retrospective analysis was conducted on patients who underwent ESD or EMR at a specialized center in Denmark from October 2016 to June 2022.Data on treatment,indication,lesion location,hospitalization duration,procedure duration,specimen size,complications,recurrence,and one-year overall survival were collected.Statistical comparisons utilized the Mann-Whitney U test,independent sample median test,and chi-squared test.Results The study included 130 patients(144 procedures):72 underwent ESD and 58 underwent EMR.Compared with EMR,ESD resulted in greater percentages of en bloc and R0 resections(98.8%vs.64.1%,p<0.001;and 83.9%vs.23.8%,p<0.001),greater complication rates(28.7%vs.3.1%,p<0.001)and longer procedure times(119.5 min vs.37.0 min,p<0.001).The ESD procedure time significantly decreased over time(p=0.01).The local recurrence rates were 14.5%for ESD and 23.8%for EMR(p=0.767).The one-year overall survival rates were similar between the groups(95.8%vs.94.8%,p=0.553).Conclusion Both ESD and EMR are safe and viable for treating esophageal and gastric lesions.ESD offers advantages but requires more time and skill.These findings support the literature,emphasizing the importance of considering patient-specific factors and surgeon proficiency in selecting the appropriate procedure.

Effect of endoscopic submucosal dissection on gastrointestinal function and nutritional status in patients with early gastric cancer

BACKGROUND Gastric cancer(GC)endangers the survival and prognosis of patients worldwide.Improving the prognosis of patients with early GC(EGC)is crucial to prolong their survival time.AIM To analyze the effects of endoscopic submucosal dissection(ESD)on gastrointestinal function and nutritional status in patients with EGC.METHODS Eighty patients with EGC between January 2021 and January 2024 were divided according to different surgical protocol into following two groups:42 patients who underwent ESD in the ESD group and 38 patients treated with endoscopic mucosal resection(EMR)in the EMR group.Two groups were compared in the operative indices,lesion resection rate,postoperative recovery of gastrointestinal function,nutritional status,and incidence of surgical complications.RESULTS The overall resection rate of the lesion in the ESD group was higher.The operative bleeding volume and operation time were higher and gastrointestinal ventilation time was shorter in the ESD group than those in the EMR group(P<0.05).The nutritional statuses of the two groups decreased after operation;however,the levels of albumin,prealbumin,hemoglobin,and transferrin were higher in the ESD group than in the EMR group(P<0.05).The post-operative pepsinogen(PG)I level in the ESD group was higher than that in the EMR group,and the PG II level was lower than that in the EMR group(P<0.05).The incidence of postoperative complications was compared between the two groups(P>0.05).CONCLUSION ESD can promote the immediate recovery of patient’s postoperative gastrointestinal function,improve their nutritional level,and signifies its application in patients with EGC.

Prospects of polyglycolic acid sheets for the treatment of esophageal stricture after esophageal endoscopic submucosal dissection

Esophageal cancer is the seventh most common type of cancer and the sixth leading cause of cancer-related mortality worldwide.Endoscopic submucosal dissection(ESD)is widely used for the resection of early esophageal cancer.However,post-ESD esophageal stricture is a common long-term complication,which requires attention.Patients with post-ESD esophageal stricture often experience dysphagia and require multiple dilatations,which greatly affects their quality of life and increases healthcare costs.Therefore,to manage post-ESD esophageal stricture,researchers are actively exploring various strategies,such as pharmaceutical interventions,endoscopic balloon dilation,and esophageal stenting.Although steroids-based therapy has achieved some success,steroids can lead to complications such as osteoporosis and infection.Meanwhile,endoscopic balloon dilatation is effective in the short term,but is prone to recurrence and perforation.Additionally,esophageal stenting can alleviate the stricture,but is associated with discomfort during stenting and the complication of easy displacement also present challenges.Tissue engineering has evolved rapidly in recent years,and hydrogel materials have good biodegradability and biocompatibility.A novel type of polyglycolic acid(PGA)sheets has been found to be effective in preventing esophageal stricture after ESD,with the advantages of a simple operation and low complication rate.PGA membranes act as a biophysical barrier to cover the wound as well as facilitate the delivery of medications to promote wound repair and healing.However,there is still a lack of multicenter,large-sample randomized controlled clinical studies focused on the treatment of post-ESD esophageal strictures with PGA membrane,which will be a promising direction for future advancements in this field.

Editorial article to:Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer

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.

Effect of polyglycolic acid sheet plus esophageal stent placement in preventing esophageal stricture after endoscopic submucosal dissection in patients with earlystage esophageal cancer: A randomized, controlled trial

AIM To assess the effect of polyglycolic acid(PGA) plus stent placement compared with stent placement alone in the prevention of post-endoscopic submucosal dissection(ESD) esophageal stricture in early-stage esophageal cancer(EC) patients. METHODS Seventy EC patients undergoing ESD were enrolled in this randomized, controlled study. Patients were allocated randomly at a 1:1 ratio into two groups as follows:(1) PGA plus stent group(PGA sheet-coated stent placement was performed); and(2) Stent group(only stent placement was performed). This study was registered on http://www.chictr.org.cn(No. chictrinr-16008709). RESULTS The occurrence rate of esophageal stricture in the PGA plus stent group was 20.5%(n = 7), which was lower than that in the stent group(46.9%, n = 15)(P = 0.024). The mean value of esophageal stricture time was 59.6 ± 16.1 d and 70.7 ± 28.6 d in the PGA plus stent group and stent group(P = 0.174), respectively. Times of balloon dilatation in the PGA plus stent group were less than those in the stent group [4(2-5) vs 6(1-14), P = 0.007]. The length(P = 0.080) and diameter(P = 0.061) of esophageal strictures were numerically decreased in the PGA plus stent group, whereas no difference in location(P = 0.232) between the two groups was found. Multivariate logistic analysis suggested that PGA plus stent placement(P = 0.026) was an independent predictive factor for a lower risk of esophageal stricture, while location in the middle third(P = 0.034) and circumferential range = 1/1(P = 0.028) could independently predict a higher risk of esophageal stricture in EC patients after ESD. CONCLUSION PGA plus stent placement is more effective in preventing post-ESD esophageal stricture compared with stent placement alone in EC patients with earlystage disease.

Endoscopic submucosal dissection vs endoscopic mucosal resection for early gastric cancer: A meta-analysis

AIM: To compare endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for early gastric cancer(EGC).METHODS: Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Schol-ar and Cochrane library databases. Quality of each included study was assessed according to current Co-chrane guidelines. Primary endpoints were en bloc re-section rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and re-currence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects mod-els(in case of low heterogeneity) or DerSimonian and Laird test for random-effects models(in case of high heterogeneity).RESULTS: Ten retrospective studies(8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR(stan-dardized mean difference 1.73, 95%CI: 0.52-2.95, P =0.005) and the "en bloc " and histological complete re-section rates were significantly higher in the ESD group [OR = 9.69(95%CI: 7.74-12.13), P < 0.001 and OR = 5.66,(95%CI: 2.92-10.96), P < 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09,(95%CI: 0.05-0.17), P < 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67,(95%CI, 2.77-7.87), P < 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49(0.6-3.71), P = 0.39].CONCLUSION: In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR.

Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma and precancerous lesions

AIM To evaluate the clinical outcomes of patients who underwent endoscopic submucosal tunnel dissection(ESTD) for esophageal squamous cell carcinoma(ESCC) and precancerous lesions.METHODS ESTD was performed in 289 patients. The clinical outcomes of the patients and pathological features of the lesions were retrospectively reviewed.RESULTS A total of 311 lesions were included in the analysis. The en bloc rate, complete resection rate, and curative resection rate were 99.04%, 81.28%, and 78.46%, respectively. The ESTD procedure time was 102.4 ± 35.1 min, the mean hospitalization time was 10.3 ± 2.8 d, and the average expenditure was 3766.5 ± 846.5 dollars. The intraoperative bleeding rate was 6.43%, the postoperative bleeding rate was 1.61%, the perforation rate was 1.93%, and the postoperative infection rate was 9.65%. Esophageal stricture and positive margin were severe adverse events, with an incidence rate of 14.79% and 15.76%, respectively. No tumor recurrence occurred during the follow-up period. CONCLUSION ESTD for ESCC and precancerous lesions is feasible and relatively safe, but for large mucosal lesions, the rate of esophageal stricture and positive margin is high.

Comparison of endoscopic submucosal dissection with surgical gastrectomy for early gastric cancer: An updated meta-analysis

BACKGROUND There are several surgical options for treating early gastric cancers(EGCs), such as endoscopic resection, laparoscopic or open gastrectomy with D1 or D2 lymphadenectomy. Endoscopic resection for EGC with low risk of lymph node metastasis has been widely accepted as a therapeutic alternative. The role of endoscopic submucosal dissection(ESD) in treating EGC is not well established,especially when compared with resection surgery cases in a long-term follow-up scope.AIM To compare the safety and efficacy of the short-and long-term outcomes between ESD and resection surgery.METHODS We searched the databases of PubMed, EMBASE, Web of Science, and the Cochrane Library from January 1990 to June 2018, enrolling studies reporting short-or long-term outcomes of ESD in comparison with resection surgery for EGC. The quality of the studies was assessed by the Newcastle-Ottawa Quality Assessment Scale. Stata software(version 12.0) was used for the analysis. Pooling analysis was conducted using either fixed-or random-effects models depending on heterogeneity across studies.RESULTS Fourteen studies comprising 5112 patients were eligible for analysis(2402 for EGC and 2710 for radical surgery). Our meta-analysis demonstrated that the ESD approach showed advantages through decreased operation time [weighted mean difference(WMD):-140.02 min, 95%CI:-254.23 to-34.82 min, P = 0.009], shorter hospital stay(WMD:-5.41 d, 95% CI:-5.93 to-4.89 d, P < 0.001), and lowerpostoperative complication rate [Odds ratio(OR) = 0.39, 95%CI: 0.28-0.55, P <0.001). Meanwhile, EGC patients who underwent ESD had higher recurrence rate(OR = 9.24, 95%CI: 5.94-14.36, P < 0.001) than resection surgery patients.However, the long-term survival including overall survival [Hazard ratio(HR) =0.51, 95%CI: 0.26-1.00, P = 0.05] and event-free survival(HR = 1.59, 95%CI: 0.66-9.81, P = 0.300) showed no significant differences between these two groups.CONCLUSION In the treatment of EGC, ESD was safe and feasible in comparison with resection surgery, with advantages in several surgical and post-operative recovery parameters. Although the recurrence rate was higher in ESD group, the longterm survival was still comparable in these two groups, suggesting ESD could be recommended as standard treatment for EGC with indications.

Endoscopic submucosal dissection for early gastric cancer with undifferentiated-type histology:A meta-analysis

AIM: To evaluate the efficacy and safety of endoscopicsubmucosal dissection(ESD) for early gastric cancer(EGC) with undifferentiated-type histology.METHODS: A systematic literature review was conducted using the core databases. Complete resection,curative resection, en bloc resection, recurrence and adverse event rate were extracted and analyzed. A random effect model was applied. The methodological quality of the enrolled studies was assessed using the Newcastle-Ottawa Scale. Publication bias was evaluated using a funnel plot, the trim and fill method, Egger's test,and a rank correlation test.RESULTS: Fourteen retrospective studies between2009 and 2014 were identified(972 EGC lesions with undifferentiated-type histology). The total en bloc and complete resection rates were estimated as92.1%(95%CI: 87.4%-95.2%) and 77.5%(95%CI:69.3%-84%), respectively. The total curative resection rate was 61.4%(95%CI: 44.5%-75.9%). The overall recurrence rate was 7.6%(95%CI: 3.4%-16%).Limited to histologically diagnosed expanded-criteria lesions, the en bloc and complete resection rates were91.2% and 85.6%, respectively. The curative resection rate was 79.8%.CONCLUSION: In this analysis, ESD is a technically feasible treatment modality for EGC with undifferentiatedtype histology. Long-term studies are needed to confirm these therapeutic outcomes.

Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer

AIM: To investigate the effectiveness of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in treating superficial esophageal cancer (SEC).

Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies. METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESDhad premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography. RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence. CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.