Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study

Tsujii, Yoshiki; Nishida, Tsutomu; Nishiyama, Osamu; Yamamoto, Katsumi; Kawai, Naoki; Yamaguchi, Shinjiro; Yamada, Takuya; Yoshio, Toshiyuki; Kitamura, Shinji; Nakamura, Takeshi; Nishihara, Akihiro; Ogiyama, Hideharu; Nakahara, Masanori; Komori, Masato; Kato, Motohiko; Hayashi, Yoshito; Shinzaki, Shinichiro; Iijima, Hideki; Michida, Tomoki; Tsujii, Masahiko; Takehara, Tetsuo

doi:10.1055/s-0034-1391844

Cited by 188 publications

(165 citation statements)

References 28 publications

(42 reference statements)

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“…Conversely, one LSBE case developed several metachronous adenocarcinomas, which poses a problem regarding metachronous cancer from residual Barrett's epithelium. The cumulative 3-year metachronous cancer rate of LSBE (8.3%) was similar to that reported for esophageal SCC (9.9%) [25]. In view of the effective long-term outcome of ESD for esophageal SCC, metachronous cancers from LSBE in Japan may be controlled by repeat local resection using ESD.…”

Section: Discussionsupporting

confidence: 78%

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

et al. 2018

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Background: In recent years, effective outcomes of endoscopic submucosal dissection (ESD) for esophagogastric junction cancer including short-segment Barrett’s esophagus (SSBE) cancer have been reported. However, the efficacy of ESD for long-segment Barrett’s esophagus (LSBE) cancer is unknown. Aim: To clarify the treatment outcomes of ESD for LSBE cancer versus SSBE cancer. Methods: A total of 86 patients with 91 superficial Barrett’s esophageal adenocarcinomas who underwent ESD were enrolled; of these, 68 had underlying SSBE and 18 had LSBE. Procedure outcomes and prognosis were compared. Results: There was no significant difference in age and tumor diameter among patients. The only complication observed was stricture, but it was not significant (2 vs. 9%). No significant difference was observed in the negative horizontal margin rates (94.1 vs. 95.7%), R0 resection rates (83.8 vs. 82.6%), curative resection rates (72.1 vs. 73.9%), and noncurative factors. Both LSBE and SSBE cancer showed favorable 3-year overall survival rates (95.0 vs. 94.4%) in the median observation period of 28.5 months. Conclusions: ESD for LSBE cancer achieved procedure outcomes and short-term prognosis comparable to SSBE. ESD has the potential to be an effective therapeutic option for esophageal neoplasms in patients with LSBE.

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Section: Discussionsupporting

confidence: 78%

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

et al. 2018

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“…ESD is the first-line therapeutic option for superficial gastrointestinal tract tumors[1,6,18-20]. The devices used in ESD are important for performing the procedure safely.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection

Ohara

Toyonaga

Hoshi

et al. 2017

WJG

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AIMTo investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical practice.METHODSIn order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were analyzed.RESULTSFunctional experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065).CONCLUSIONOur results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspiration and knife insertion during ESD and reducing the frequency of knife removal and reinsertion.

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“…First, the DPC database lacks some information about clinicopathological features in esophageal ESD, such as the location, size, configuration, circumferential involvement, depth of lesions, submucosal invasion, submucosal adhesion, and the presence of scar tissue. However, a recent study conducted in Japan, which included 368 esophageal ESDs among 11 hospitals, suggested that there were no differences in lesion factors between the highvolume centers and low-volume centers [21]. The database also lacks data regarding experience of the endoscopists who perform ESD procedures, number of endoscopists working at the hospital, types of endoscopy knives used, use of carbon dioxide insufflation vs. room air insufflation, and duration of the procedure.…”

Section: Discussionmentioning

confidence: 99%

Hospital volume and adverse events following esophageal endoscopic submucosal dissection in Japan

et al. 2016

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Esophageal endoscopic submucosal dissection (ESD) has gradually acquired popularity as a minimally invasive surgery for early cancers not only in Japan, but also in other countries. However, most reported outcomes have been based on relatively small samples of patients from specialized centers. Therefore, the association between hospital volume and the rate of adverse events following esophageal ESD has been poorly understood. Using a nationwide administrative database in Japan, we identified patients who underwent esophageal ESD between 1 July 2007 and 31 March 2013. Hospital volume was defined as the number of esophageal ESD procedures performed per year at each hospital and was categorized into quartiles. In total, 12 899 esophageal ESD procedures at 699 institutions were identified during the study period. Perforation and perforation-related disorders were observed in 422 patients (3.3 %), and one patient died after perforation. There was a significant association between a lower hospital volume and a higher proportion of adverse events following esophageal ESD. Although not statistically significant, a similar tendency was observed in the occurrence of blood transfusion within 1 week after ESD and all-cause in-hospital death. Multivariable logistic regression analysis showed that hospitals with very high case volumes were less likely to experience adverse events following esophageal ESD than hospitals with very low volumes. The proportion of perforation and perforation-related disorders following esophageal ESD was permissibly low, and there was a linear association between higher hospital volume and lower rates of adverse events following esophageal ESD.

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Clinical outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms: a multicenter retrospective cohort study

Abstract: Esophageal ESD has become feasible with acceptable complication risks and favorable long term outcomes.

Cited by 188 publications

References 28 publications

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

Treatment Outcomes of Endoscopic Submucosal Dissection for Adenocarcinoma Originating from Long-Segment Barrett’s Esophagus versus Short-Segment Barrett’s Esophagus

Usefulness of a novel slim type FlushKnife-BT over conventional FlushKnife-BT in esophageal endoscopic submucosal dissection

Hospital volume and adverse events following esophageal endoscopic submucosal dissection in Japan

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