Does submucosal fibrosis affect the results of endoscopic submucosal dissection of early gastric tumors?

Jeong, Jae Yoon; Oh, Young Ha; Yu, Yeon Hwa; Park, Hye Sun; Lee, Hang Lak; Eun, Chang Soo; Han, Dong Soo

doi:10.1016/j.gie.2012.03.172

Cited by 58 publications

(45 citation statements)

References 15 publications

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“…A previous study reported that the presence of ulceration was associated with a long procedure time [7]. The presence of endoscopic ulceration was associated with submucosal fibrosis, and the fibrosis or inflammation caused by ulceration made it more difficult to lift the tumor tissue from the muscle layer, lengthening the procedure time [17,18]. We speculate that PPI administration improved inflammation, made it easier to dissect the submucosa, and thereby shortened the procedure time.…”

Section: Discussionmentioning

confidence: 78%

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

et al. 2015

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Background In ulcerative early gastric cancer, improvement and exacerbation of ulceration repeat as a malignant cycle. Moreover, early gastric cancer combined with ulcer is associated with a low curative resection rate and high risk of adverse events. The aim of this study was to investigate the ulcer healing rate and clinical outcomes with the administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer. Methods A total of 136 patients with differentiated early gastric cancer with ulcer who met the expanded indications for endoscopic submucosal dissection were reviewed between June 2005 and June 2014. Eighty-one patients were given PPI before endoscopic submucosal dissection and 55 patients were not given PPI. Results The complete ulcer healing rate was significantly different between the two groups (59.3 % vs. 23.6 %, P \ 0.001). The procedure time was 38.1 ± 35.7 and 50.8 ± 50.2 min (P = 0.047). However, no significant differences were detected in the en bloc resection rate, complete resection rate, and adverse events including bleeding and perforation. Multivariate analysis showed that administration of PPI (OR = 10.83, P \ 0.001) and mucosal invasion (OR = 24.43, P \ 0.001) were independent factors that predicted complete healing of ulceration. The calculated accuracy for whether complete healing of the ulcer after PPI administration can differentiate mucosal from submucosal invasion was 75.3 %. Conclusions Administration of PPI before ESD in differentiated EGC meeting the expanded criteria is effective to heal the ulcer lesion and reduce the mean procedure time. Complete healing of the ulcer after PPI administration suggests mucosal cancer.

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Section: Discussionmentioning

confidence: 78%

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

et al. 2015

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“…Although that study included lesions with fibrosis possibly caused by extrinsic factors, our examination found similar results with respect to the proportion of lesions with fibrosis between the two types of LSTs. Besides obvious cases, the occurrence of submucosal fibrosis seems more likely in the presence of ulceration, tumor size ≥30 mm, submucosal invasion, and depressed-types of gastric tumors [12, 16]. In our cases, even though the mean size of LST-Gs was significantly larger than that of LST-NGs (30.5 mm versus 23.4 mm) and most LST-NGs were of the pseudodepressed type, we found no difference in the frequency of fibrosis between the two types of LSTs.…”

Section: Discussionmentioning

confidence: 99%

“…The entire lesion was scanned using a digital microscope camera at 4X magnification and was examined on computer. The distribution of fibrotic areas did not seem uniform within the same lesion, and considering that there is no well-established method to classify histologically the degree of submucosal fibrosis for colorectal lesions, the method that was reported for gastric lesions was adopted [12]. This system takes into account the intensity and extent of the fibrotic areas.…”

Section: Methodsmentioning

confidence: 99%

Histological Distinction between the Granular and Nongranular Types of Laterally Spreading Tumors of the Colorectum

Goto

Sakamoto

Mitomi

et al. 2014

Gastroenterology Research and Practice

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Colorectal laterally spreading tumors (LSTs), which are classified into granular (LST-G) and nongranular (LST-NG) types, are a good indication for endoscopic treatment. In practice, the nongranular type is more difficult to remove endoscopically than the granular type. It might be assumed that some histological differences exist between these subtypes. The objective of this study was to analyze histological features of laterally spreading tumors and compare between the granular and the nongranular types. A total of 32 cases of LSTs resected endoscopically being intramucosal tumors with no previous treatment were analyzed. The disposition of the muscularis mucosae, the vascular density, and the degree of fibrosis of the submucosal layer were determined. The outline of the muscularis mucosae in LST-NG was almost flat, but that of LST-G was wavy. The submucosal vascular density was significantly greater in the LST-NGs (61.4 ± 24.3/mm2) than in the LST-Gs (43 ± 22.4/mm2; P = 0.033). There was no clear difference in the degree of submucosal fibrosis between the subtypes. A flat disposition of the muscularis mucosae and a more densely vascularized submucosal layer were characteristics of LST-NGs compared to the LST-Gs. These findings may play a role when performing the endoscopic resection of LSTs.

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“…48,64,65 Ulceration was not associated with PPB, 14 27 Submucosal fibrosis has also been analyzed and was not identified as an independent risk factor. 13,14,61,67 The presence of scarring was not identified as an influence on PPB in 3 studies, 32,51,58 although it was associated with higher PPB in 2 studies. 36,59 After meta-analysis, increased tumor and specimen size, flat/depressed morphology (Fig.…”

Section: Risk Factors For Post-esd Bleeding Risk Factormentioning

confidence: 93%

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

Libânio

Costa

Pimentel‐Nunes

et al. 2016

Gastrointestinal Endoscopy

117

127

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Does submucosal fibrosis affect the results of endoscopic submucosal dissection of early gastric tumors?

Cited by 58 publications

References 15 publications

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

Effects of administration of a proton pump inhibitor before endoscopic submucosal dissection for differentiated early gastric cancer with ulcer

Histological Distinction between the Granular and Nongranular Types of Laterally Spreading Tumors of the Colorectum

Risk factors for bleeding after gastric endoscopic submucosal dissection: a systematic review and meta-analysis

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