BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric cancer.The analysis of the epidemiological char...BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric cancer.The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD.AIM To analyze the features of gastric mucosal tumors at different differentiation levels,and to explore the prognostic factors of ESD.METHODS We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021,according to the latest Japanese guidelines(sixth edition),and divided them into low-grade intrae-pithelial neoplasia(LGIN),high-grade intraepithelial neoplasia(HGIN),and computed tomography at 3,6 and 12 months after ESD.We compared clinicopathologic characteristics,ESD efficacy,and complications with different degrees of differentiation,and analyzed the related factors associated with ESD.RESULTS HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients(P<0.001)and accounted for more 0-IIc(P<0.001),atrophic gastritis was common(P<0.001),and irregular microvascular patterns(IMVPs)and demarcation lines(DLs)were more obvious(P<0.001).There was more infiltration in the undifferentiated carcinoma tissue(P<0.001),more abnormal folds and poorer mucosal peristalsis(P<0.001),and more obvious IMVPs,irregular microsurface patterns and DLs(P<0.05)than in the LGIN and HGIN tissues.The disease-free survival rates at 2,5,and 8 years after ESD were 95.0%,90.1%,and 86.9%,respectively.Undifferen-tiated lesions(HR 5.066),white moss(HR 7.187),incomplete resection(HR 3.658),and multiple primary cancers(HR 2.462)were significantly associated with poor prognosis.CONCLUSION Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics,which are closely related to the safety and efficacy of ESD.展开更多
Endoscopic polypectomy and endoscopic mucosal resection(EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as o...Endoscopic polypectomy and endoscopic mucosal resection(EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller(< 5 mm) polyps and is possibly also suitable for the removal of noncancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection(ESD)offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer.The latest addition to endoscopic resection techniques is endoscopic fullthickness resection with specifically developed devices for flexible endoscopy.This method is very useful for the treatment of smaller difficult-to-resect lesions,e.g., recurrence with scar formation after previous endoscopic resections.展开更多
Treatment strategies,whether as follow-up or"total incisional biopsy"for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen,are controversial due ...Treatment strategies,whether as follow-up or"total incisional biopsy"for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen,are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment.Based on the histological findings of the biopsy specimen,it is difficult to differentiate between reactive or regenerative changes,inflammation and neoplastic changes,intraepithelial and invasive tumors.Therefore,gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and highfrequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection(ESD),a therapeutic option for gastric intraepithelial neoplasia,including low-grade neoplasms.Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.展开更多
Esophageal cancer is one of the leading causes of cancer-related death and is associated with high morbidity and mortality.It carries a poor prognosis as more than half of patients present with advanced and unresectab...Esophageal cancer is one of the leading causes of cancer-related death and is associated with high morbidity and mortality.It carries a poor prognosis as more than half of patients present with advanced and unresectable disease.One contributing factor is the increased risk of lymph node metastases at early stages of disease.As such,it is essential to detect squamous cell neoplasia (SCN) at an early stage.In order to risk stratify lesions,endoscopists must be able to perform image enhanced endoscopy including magnification and Lugol's chromoendoscopy.The assessment of both the horizontal extent and depth of any lesion is also of utmost importance prior to treatment.Endoscopic mucosal resection and submucosal dissection remain the standard of care with literature supportive their respective use.Radiofrequency ablation and other endoscopic treatments are currently available although should not be considered first line at this time.Our objective is to review the current options for the endoscopic diagnosis and treatment of esophageal SCN.展开更多
BACKGROUND Management of superficial bowel neoplasia(SBN)in early stages is associated with better outcomes.The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced ...BACKGROUND Management of superficial bowel neoplasia(SBN)in early stages is associated with better outcomes.The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques(ERTs).However,there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.AIM To investigate the knowledge,attitude,and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’infrastructures toward these techniques.METHODS An online 2-pages questionnaire was used.The first page comprised demographic data,and questions for all physicians,about the knowledge(11 questions)of and attitude(5 questions)toward ERTs as a therapeutic option for SBN.The second page investigated the practice of ERTs by endoscopists(6 questions)and the infrastructures of their endoscopy units(14 questions).The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.RESULTS The complete responses were 833/2300(36.2%).The majority of the participants were males(n=560,67.2%),middle-aged(n=366,43.9%),consultants(n=464,55.7%),gastroenterologists(n=678,81.4%),spending≥15 years in practice(n=368,44.2%),and were working in university hospitals(n=569,68.3%).The majority correctly identified the definition of SBN(88.4%)and the terms polypectomy,endoscopic mucosal resection(EMR),and endoscopic submucosal dissection(ESD)(92.1%,90.2%,and 89.1%respectively).However,26.9%,43.2%and 49.5%did not recognize the clear indication of polypectomy,EMR,and ESD respectively.Although 68.1%of physicians are convinced about the ERTs for management of SBN;only 8.9%referred all candidate cases for ERTs.About 76.5%of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9%and 7.2%respectively.About 71.6%and 88.4%of endoscopists did not perform EMR or ESD in the last one year.Consequently,the complication rate reported by endoscopists was limited to 18.1%(n=103)of endoscopists.Only 25.8%of endoscopists feel confident in the management of ERTs-related complications and a half(49.9%)were not sure about their competency.Regarding the end-oscopy units’infrastructures,only 4.2%of the centers had their endoscopes 100%armed with optical enhancements and 54.4%considered their institutions ready for managing ERTs-related complications.Only 18.3%(n=104)of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding(26.7%),and perforations(17%).CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs.The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.展开更多
AIM:To report outcomes on patients undergoing radiofrequency ablation(RFA)for early oesophageal squamous neoplasia from a National Registry.METHODS:A Prospective cohort study from 8 tertiary referral centres in the Un...AIM:To report outcomes on patients undergoing radiofrequency ablation(RFA)for early oesophageal squamous neoplasia from a National Registry.METHODS:A Prospective cohort study from 8 tertiary referral centres in the United Kingdom.Patients with squamous high grade dysplasia(HGD)and early squamous cell carcinoma(ESCC)confined to the mucosa were treated.Visible lesions were removed by endoscopic mucosal resection(EMR)before RFA.Following initial RFA treatment,patients were followed up 3monthly.Residual flat dysplasia was treated with RFA until complete reversal dysplasia(CR-D)was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or beyond.The main outcome measures were CR-D at 12 mo from start of treatment,long term durability,progression to cancer and adverse events.RESULTS:Twenty patients with squamous HGD/ESCC completed treatment protocol.Five patients(25%)had EMR before starting RFA treatment.CR-D was 50%at12 mo with a median of 1 RFA treatment,mean 1.5(range 1-3).Two further patients achieved CR-D with repeat RFA after this time.Eighty per cent with CR-D remain dysplasia free at latest biopsy,with median follow up 24 mo(IQR 17-54).Six of 20 patients(30%)progressed to invasive cancer at 1 year.Four patients(20%)required endoscopic dilatations for symptomatic structuring after treatment.Two of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per patient.The other 2 patients required only a single dilatation to achieve an adequate symptomatic response.One patient developed cancer during follow up after end of treatment protocol.CONCLUSION:The role of RFA in these patients re-mains unclear.In our series 50%patients responded at12 mo.These figures are lower than limited published data.展开更多
Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion...Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of en- bloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects:(1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator’s skill, and (3) organ characteristics.展开更多
Endoscopic resection(ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosa...Endoscopic resection(ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection(EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy(MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resectioncap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.展开更多
基金Supported by Development Program of Shaanxi Province,No.2021SF-221.
文摘BACKGROUND Gastric cancer is a common malignant tumor of the digestive tract,and endosco-pic submucosal dissection(ESD)is the preferred treatment for early-stage gastric cancer.The analysis of the epidemiological characteristics of gastric mucosal tumors with different differentiation degrees and the influencing factors of long-term ESD efficacy may have certain significance for revealing the development of gastric cancer and ESD.AIM To analyze the features of gastric mucosal tumors at different differentiation levels,and to explore the prognostic factors of ESD.METHODS We retrospectively studied 301 lesions in 285 patients at The Second Affiliated Hospital of Xi'an Jiaotong University from 2014 to 2021,according to the latest Japanese guidelines(sixth edition),and divided them into low-grade intrae-pithelial neoplasia(LGIN),high-grade intraepithelial neoplasia(HGIN),and computed tomography at 3,6 and 12 months after ESD.We compared clinicopathologic characteristics,ESD efficacy,and complications with different degrees of differentiation,and analyzed the related factors associated with ESD.RESULTS HGIN and differentiated carcinoma patients were significantly older compared with LGIN patients(P<0.001)and accounted for more 0-IIc(P<0.001),atrophic gastritis was common(P<0.001),and irregular microvascular patterns(IMVPs)and demarcation lines(DLs)were more obvious(P<0.001).There was more infiltration in the undifferentiated carcinoma tissue(P<0.001),more abnormal folds and poorer mucosal peristalsis(P<0.001),and more obvious IMVPs,irregular microsurface patterns and DLs(P<0.05)than in the LGIN and HGIN tissues.The disease-free survival rates at 2,5,and 8 years after ESD were 95.0%,90.1%,and 86.9%,respectively.Undifferen-tiated lesions(HR 5.066),white moss(HR 7.187),incomplete resection(HR 3.658),and multiple primary cancers(HR 2.462)were significantly associated with poor prognosis.CONCLUSION Differentiations of gastric mucosal tumors have different epidemiological and endoscopic characteristics,which are closely related to the safety and efficacy of ESD.
文摘Endoscopic polypectomy and endoscopic mucosal resection(EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller(< 5 mm) polyps and is possibly also suitable for the removal of noncancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection(ESD)offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer.The latest addition to endoscopic resection techniques is endoscopic fullthickness resection with specifically developed devices for flexible endoscopy.This method is very useful for the treatment of smaller difficult-to-resect lesions,e.g., recurrence with scar formation after previous endoscopic resections.
文摘Treatment strategies,whether as follow-up or"total incisional biopsy"for gastric noninvasive intraepithelial neoplasia diagnosed by examination of an endoscopic forceps biopsy specimen,are controversial due to problems associated with the diagnostic accuracy of endoscopic forceps biopsy and questions about the safety and efficacy of endoscopic treatment.Based on the histological findings of the biopsy specimen,it is difficult to differentiate between reactive or regenerative changes,inflammation and neoplastic changes,intraepithelial and invasive tumors.Therefore,gastric neoplasia diagnosed as noninvasive intraepithelial often develop into invasive carcinoma during follow-up.Recent advances in endoscopic modalities and treatment devices,such as image-enhanced endoscopy and highfrequency generators,may make endoscopic treatment,such as endoscopic submucosal dissection(ESD),a therapeutic option for gastric intraepithelial neoplasia,including low-grade neoplasms.Future studies are required to evaluate whether ESD is a valid strategy for gastric intraepithelial neoplasm with regard to safety and cost effectiveness.
文摘Esophageal cancer is one of the leading causes of cancer-related death and is associated with high morbidity and mortality.It carries a poor prognosis as more than half of patients present with advanced and unresectable disease.One contributing factor is the increased risk of lymph node metastases at early stages of disease.As such,it is essential to detect squamous cell neoplasia (SCN) at an early stage.In order to risk stratify lesions,endoscopists must be able to perform image enhanced endoscopy including magnification and Lugol's chromoendoscopy.The assessment of both the horizontal extent and depth of any lesion is also of utmost importance prior to treatment.Endoscopic mucosal resection and submucosal dissection remain the standard of care with literature supportive their respective use.Radiofrequency ablation and other endoscopic treatments are currently available although should not be considered first line at this time.Our objective is to review the current options for the endoscopic diagnosis and treatment of esophageal SCN.
文摘BACKGROUND Management of superficial bowel neoplasia(SBN)in early stages is associated with better outcomes.The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques(ERTs).However,there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.AIM To investigate the knowledge,attitude,and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’infrastructures toward these techniques.METHODS An online 2-pages questionnaire was used.The first page comprised demographic data,and questions for all physicians,about the knowledge(11 questions)of and attitude(5 questions)toward ERTs as a therapeutic option for SBN.The second page investigated the practice of ERTs by endoscopists(6 questions)and the infrastructures of their endoscopy units(14 questions).The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.RESULTS The complete responses were 833/2300(36.2%).The majority of the participants were males(n=560,67.2%),middle-aged(n=366,43.9%),consultants(n=464,55.7%),gastroenterologists(n=678,81.4%),spending≥15 years in practice(n=368,44.2%),and were working in university hospitals(n=569,68.3%).The majority correctly identified the definition of SBN(88.4%)and the terms polypectomy,endoscopic mucosal resection(EMR),and endoscopic submucosal dissection(ESD)(92.1%,90.2%,and 89.1%respectively).However,26.9%,43.2%and 49.5%did not recognize the clear indication of polypectomy,EMR,and ESD respectively.Although 68.1%of physicians are convinced about the ERTs for management of SBN;only 8.9%referred all candidate cases for ERTs.About 76.5%of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9%and 7.2%respectively.About 71.6%and 88.4%of endoscopists did not perform EMR or ESD in the last one year.Consequently,the complication rate reported by endoscopists was limited to 18.1%(n=103)of endoscopists.Only 25.8%of endoscopists feel confident in the management of ERTs-related complications and a half(49.9%)were not sure about their competency.Regarding the end-oscopy units’infrastructures,only 4.2%of the centers had their endoscopes 100%armed with optical enhancements and 54.4%considered their institutions ready for managing ERTs-related complications.Only 18.3%(n=104)of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding(26.7%),and perforations(17%).CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs.The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
基金Supported by The CRUK UCL Early Cancer Medicine CentreBARRX Medical Inc Grant Supported to Lovat LBCovidien plc to support research infrastructure
文摘AIM:To report outcomes on patients undergoing radiofrequency ablation(RFA)for early oesophageal squamous neoplasia from a National Registry.METHODS:A Prospective cohort study from 8 tertiary referral centres in the United Kingdom.Patients with squamous high grade dysplasia(HGD)and early squamous cell carcinoma(ESCC)confined to the mucosa were treated.Visible lesions were removed by endoscopic mucosal resection(EMR)before RFA.Following initial RFA treatment,patients were followed up 3monthly.Residual flat dysplasia was treated with RFA until complete reversal dysplasia(CR-D)was achieved or progression to invasive Squamous cell cancer defined as infiltration into the submucosa layer or beyond.The main outcome measures were CR-D at 12 mo from start of treatment,long term durability,progression to cancer and adverse events.RESULTS:Twenty patients with squamous HGD/ESCC completed treatment protocol.Five patients(25%)had EMR before starting RFA treatment.CR-D was 50%at12 mo with a median of 1 RFA treatment,mean 1.5(range 1-3).Two further patients achieved CR-D with repeat RFA after this time.Eighty per cent with CR-D remain dysplasia free at latest biopsy,with median follow up 24 mo(IQR 17-54).Six of 20 patients(30%)progressed to invasive cancer at 1 year.Four patients(20%)required endoscopic dilatations for symptomatic structuring after treatment.Two of these patients have required serial dilatations thereafter for symptomatic dysphagia with a median of 4 dilatations per patient.The other 2 patients required only a single dilatation to achieve an adequate symptomatic response.One patient developed cancer during follow up after end of treatment protocol.CONCLUSION:The role of RFA in these patients re-mains unclear.In our series 50%patients responded at12 mo.These figures are lower than limited published data.
文摘Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it:injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of en- bloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects:(1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator’s skill, and (3) organ characteristics.
文摘Endoscopic resection(ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection(EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy(MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resectioncap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited.
