A Western single-center experience with endoscopic submucosal dissection for early gastrointestinal cancers

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.

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

“…However, Sakamoto et al [22] and Ohata et al [23] showed that 30 ESD treatments performed independently in the colon were sufficient to obtain an acceptable R0 resection rate, procedure duration, and complication rate. This learning curve was confirmed by studies showing that during the first 25 treatments, the perforation rates were 12-28% [24][25][26][27]. In a European study, Probst et al [15] observed a considerable improvement in resection parameters after two endoscopists each performed 25 procedures as the procedure time decreased from about 200 to 136 min and the proportion of R0 resections increased from 48 to 84.5%.…”

Endoscopic submucosal dissection of early gastric neoplasia with a water jet–assisted knife: a Western, single-center experience

“…[3][4][5] A few small series also were reported from Western countries. [6][7][8][9][10][11] However, ESD has not yet been standardized, and it is technically difficult, time consuming, and potentially hazardous. 7 The aim of this study was to evaluate the efficacy and safety of ESD by use of a new water jet-assisted ESD (WESD) system in patients with early gastric neoplastic lesions.…”

Complete Endoscopic Closure (Clipping) of a Large Esophageal Perforation After Pneumatic Dilation in a Patient with Achalasia

“…It should be emphasized that the successful treatment of this case can be at least partially attributed to the increased confidence and expertise in the management of acute perforations as a result of the advanced training on endoscopic submucosal dissection recently pursued by one of the authors (S.C.) at one of the most experienced Japanese institutions. 10 Because of the lack of large prospective trials, the efficacy of clipping and the role of contamination, for large as well as for small timely repaired perforations, remain to be further determined. Provided that the complication is promptly recognized and that the edges of the tear are clean and easily approachable, clipping should be considered as a safe and useful technique to attempt to obliterate even large iatrogenic esophageal perforations.…”