Nonoperative treatment (percutaneous drainage, endoscopy, stent) is feasible, safe, and effective for staple line leaks in patients undergoing LSG; furthermore, it may avoid more mutilating procedures such as total gastrectomy.

In light of the results reported in the literature and on the basis of the present work, it seems that laparoscopic resection of GST should be considered as the treatment of choice. Wedge resection of anterior wall lesions is generally performed. The treatment of posterior wall lesions is still controversial. In our opinion the direct approach should be reserved for lesions located on the posterior wall of the body, which can be easily reached through the greater omentum, while the transgastric approach should be preferred for lesions located on the fundus and antrum. Manual excision allows a tailored operation; hand-sewn sutures are always feasible, and they are cheaper than stapled ones.

No abstract

Patients and Methods PatientsTwenty-fi ve unselected consecutive patients (10 men and 15 women; mean age, 70 years; range, 47-88 years) with EGICs underwent ESD at our institution from April 2007 to September 2009. There were 3 esophageal, 7 gastric, 1 duodenal, and 14 colonic lesions (Table 1). The mean size of the lesions was 25 mm (range, 10-50 mm). Inclusion criteria followed those of Oyama [9] for lesions of the esophagus; the extended Gotoda criteria for the stomach [10]; and laterally spreading tumors (LSTs) greater than 20 mm in diameter [11] or Paris 0-II type lesions for the colon. Preoperative evaluationDiagnostic endoscopy included contrast chromoscopy with 0.2% indigo carmine dye or 2.5% Lugol solutions, or narrow band imaging (NBI) inspection, together with magnifying endoscopy (110 to 150×; Olympus GIFQ160Z or CFQ160Z; Olympus, Tokyo, Japan). Histological assessment confi rmed the lesions as low-grade or high-grade noninvasive neoplasia (LGNIN or HGNIN).All the patients were informed by oral and written explanation about the planned treatment. They were aware of the level of experience in ESD of the two operators (S.C. and P.T.). This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and without any external fi nancial support. AbstractEndoscopic submucosal dissection (ESD) has gained worldwide acceptance as a treatment for early gastrointestinal cancers (EGICs). However, the management of these tumors in the Western world is still mainly surgical. Our aim was to evaluate the safety and feasibility of ESD at a European center. Based on the knowledge transferred by one of the most experienced Japanese institutions, we conducted a pilot study on 25 consecutive patients with EGICs located in the esophagus (n = 3), stomach (n = 7), duodenum (n = 1), and colon (n = 14) at our tertiary center over a 2-year-period. The main outcome measurements were complete (R0) resection, as well as en-bloc resection and the management of complications. The R0 and en-bloc resection rates were 100% and 84%, respectively. There were three cases of bleeding and fi ve cases of perforation. With a median follow up of 18 months, two recurrences were observed. We conclude that ESD for early esophageal and gastric cancers is feasible and effective, while colonic ESD requires more expertise.

Early postoperative esophagoscopy seems a safe and effective tool for the monitoring of the anastomosis healing after cervical esophagogastrostomy. The presence of extended mucosal ulcerations appeared as the most important factor in predicting BAS formation.