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Published in:

01-02-2010

Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasias

Authors: Naoki Ishii, Noriyuki Horiki, Toshiyuki Itoh, Masayo Uemura, Masataka Maruyama, Shoko Suzuki, Shino Uchida, Yusuke Izuka, Katsuyuki Fukuda, Yoshiyuki Fujita

Published in: Surgical Endoscopy | Issue 2/2010

Abstract

Background

Superficial esophageal neoplasias resected in piecemeal manner with endoscopic mucosal resection (EMR) sometimes recur locally, and additional treatments need to be developed. Efficacy and safety of endoscopic submucosal dissection (ESD) for esophageal neoplasias are not sufficiently demonstrated, so we conducted a retrospective study to evaluate the efficacy and safety of ESD for superficial esophageal neoplasias.

Methods

Thirty-seven superficial esophageal neoplasias consisted of 34 squamous cell neoplasias and 3 columnar neoplasias in 35 patients were treated with ESD from May 2006 to July 2008. Patients were regularly followed up with endoscopy every 6 months, and with echoendoscope and computed tomography every year. Therapeutic efficacy, complications, and follow-up results were evaluated.

Results

The mean size of the resected neoplasias and that of the resected specimens were 22 mm (range 10–83 mm) and 41 mm (range 18–90 mm), respectively. The mean duration of the ESD procedures was 117 min (range 40–235 min). The overall rates of en bloc resection and of free margin resection were 100% (37/37) and 95% (35/37), respectively. The mean follow-up period of 19 months (range 7–32 months) revealed no local or distant recurrence. There were no complications such as bleeding or perforation in any case. In all nine cases, the strictures were successfully managed with prophylactic endoscopic balloon dilation.

Conclusions

ESD with a combination of small-caliber-tip transparent hood and flex knife is a safe endoscopic treatment for superficial esophageal neoplasias and enables large en bloc resection.

Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25:445–450CrossRefPubMed

Inoue H, Tani M, Nagai K, Kawano T, Takeshita K, Endo M et al (1999) Treatment of esophageal and gastric tumors. Endoscopy 31:47–55CrossRefPubMed

Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225CrossRefPubMed

Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229CrossRefPubMed

Neuhaus H, Costamagna G, Deviere J, Fockens P, Ponchon T, Rosch T (2006) Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy 38:1016–1023CrossRefPubMed

Mandard AM, Tourneux J, Gignoux M, Blanc L, Segol P, Mandard JC (1980) In situ carcinoma of the esophagus. Macroscopic study with particular reference to the Lugol test. Endoscopy 12:51–57CrossRefPubMed

Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo S (2004) Narrow band imaging system with magnifying endoscopy for superficial esophageal lesion. Gastrointest Endosc 59:288–295CrossRefPubMed

Goda K, Tajiri H, Ikegami M, Urashima M, Nakayoshi T, Kaise M (2007) Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett’s adenocarcinoma. Gastrointest Endosc 65:36–46CrossRefPubMed

Wolfsen HC, Crook JF, Krishna M, Achem SR, Devault KR, Bouras EP et al (2008) Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s esophagus. Gastroenterology 135:24–31CrossRefPubMed

10.

Katada C, Muto M, Manabe T, Ohtsu A, Yoshida S (2005) Local recurrence of squamous-cell carcinoma of the esophagus after EMR. Gastrointest Endosc 61:219–225CrossRefPubMed

11.

Pech O, May A, Grossner L, Rabenstein T, Manner H, Huijsmans J et al (2007) Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 39:30–35CrossRefPubMed

12.

Tanabe S, Koizumi W, Higuchi K, Sasaki T, Nakatani K, Hanaoka N et al (2008) Clinical outcomes of endoscopic oblique aspiration mucosectomy for superficial esophageal cancer. Gastrointest Endosc 67:814–820CrossRefPubMed

13.

Inoue H, Honda T, Nagai K, Kawano T, Yoshino K, Takeshita K et al (1997) Ultra-high magnification endoscopic observation of carcinoma in situ of the esophagus. Dig Endosc 9:16–18CrossRef

14.

Kumagai Y, Toi M, Inoue H (2002) Dynamism of tumour vasculature in the early phase of cancer progression: outcomes from oesophageal cancer research. Lancet Oncol 3:604–610CrossRefPubMed

15.

Endoscopic Classification Review Group (2005) Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578CrossRef

16.

Yahagi N, Fujishiro M, Imagawa A, Kakushima N, Iguchi M, Omata M (2004) Endoscopic submucosal dissection for the reliable en bloc resection of colorectal mucosal tumors. Dig Endosc 16:89–92CrossRef

17.

Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T et al (2003) Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694CrossRefPubMed

18.

Yamamoto H, Yube T, Isoda N, Sato Y, Sekine Y, Higashizawa T et al (1999) A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 50:251–256CrossRefPubMed

19.

Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Matsuura T et al (2004) Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy 36:584–589CrossRefPubMed

20.

Stolte M (2003) The new Vienna classification of epithelia neoplasia of gastrointestinal tract: advantages and disadvantages. Virchows Arch 442:99–106PubMed

21.

Higuchi K, Tanabe S, Koizumi W, Sasaki T, Nakatani K, Saigenji K et al (2007) Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma. Endoscopy 39:36–40CrossRefPubMed

22.

Natsugoe S, Baba M, Yoshinaga H, Kijima F, Shimada M, Shirao K et al (1998) Mucosal squamous cell carcinoma of the esophagus: a clinicopathologic study of 30 cases. Oncology 55:235–241CrossRefPubMed

23.

Tajima Y, Nakanishi Y, Ochiai A, Tachimori Y, Kato H, Watanabe H et al (2000) Histopathologic findings predicting lymph node metastasis and prognosis of patients with superficial esophageal carcinoma: analysis of 240 surgically resected tumors. Cancer 88:1285–1293CrossRefPubMed

24.

Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232:733–742CrossRefPubMed

25.

Buskens CJ, Westerterp M, Lagarde SM, Bergman JJ, ten Kate FJ, van Lanschot JJ (2004) Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. Gastrointest Endosc 60:703–710CrossRefPubMed

26.

Ishihara R, Iishi H, Uedo N, Takeuchi Y, Yamamoto S, Yamada T et al (2008) Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 68:1066–1072CrossRefPubMed

27.

Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M et al (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:67–70CrossRef

28.

Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S et al (2006) Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 4:688–694CrossRefPubMed

29.

Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053CrossRefPubMed

30.

Roth JA, Putnam JB Jr (1994) Surgery for cancer of the esophagus. Semin Oncol 21:453–461PubMed

31.

Dimick JB, Goodney PP, Orringer MB, Birkmeyer JD (2005) Specialty training and mortality after esophageal cancer resection. Ann Thorac Surg 80:282–286CrossRefPubMed

Title: Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasias
Authors: Naoki Ishii
Noriyuki Horiki
Toshiyuki Itoh
Masayo Uemura
Masataka Maruyama
Shoko Suzuki
Shino Uchida
Yusuke Izuka
Katsuyuki Fukuda
Yoshiyuki Fujita
Publication date: 01-02-2010
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 2/2010
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0560-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasias

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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