Endoscopic mucosal resection

Soetikno, Roy; Gotoda, Takuji; Nakanishi, Yukihiro; Soehendra, Nib

doi:10.1067/mge.2003.130

Cited by 500 publications

(308 citation statements)

References 76 publications

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“…EMR is a diagnostic and therapeutic technique with multiple applications in clinical practice (1)(2)(3)(4)(5)(6)(7)(8). Learning to perform EMR is relatively easy, and for this reason it has become widely available in recent years (2,17).…”

Section: Discussionmentioning

confidence: 99%

“…Endoscopic mucosal resection (EMR) consists of resecting a superficial tumor of the gastrointestinal tract (esophagus, stomach, colon or rectum) by endoscopic means with curative intention (R0 resection) (1)(2)(3)(4)(5). An EMR-resected lesion may be submitted for pathological examination.…”

Section: Introductionmentioning

confidence: 99%

“…At present EMR has become widely available in clinical practice in both Asian and Western countries (1)(2)(3)(4)(5). However, EMR presents a number of limitations: a) technical difficulty; b) risk for complications: bleeding (2-29%), perforation (0.36%) and stenosis (mainly in the esophagus); and c) restricted to superficial lesions with no lymphatic spread and size < 1-1.5 cm (1)(2)(3)(4)(5)(6)(7)(8). Lesions with a diameter > 1.5 cm cannot be completely resected with a single EMR procedure, and repeated mucosectomies (several fragments) or endoscopic submucosal dissection (ESD) (allowing to resect the entire lesion in a single piece) will be required (2).…”

Section: Introductionmentioning

confidence: 99%

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Training model for teaching endoscopic submucosal dissection of gastric tumors

Vázquez-Sequeiros¹,

Miquel²,

Olcina³

et al. 2009

Rev. esp. enferm. dig.

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Introduction: the elevated risk of complications and technical complexity of endoscopic submucosal dissection (ESD) has limited its implementation in our medical system.Objective: to design and evaluate a training program for learning the ESD technique.Methods: four endoscopists with no experience with ESD underwent a 4-step training program: 1) review of the existing literature, didactic material, and theoretical aspects of ESD; 2) ESD training in an ex-vivo animal model; 3) ESD training in an in-vivo animal model (supervised by ESD expert); and 4) ESD performance in a patient. A standard gastroscope and an ESD knife (IT, Flex or Hook-knife Olympus ® ) were employed. The classical ESD technique was performed: rising of the lesion, circumferential incision, and submucosal dissection.Results: ex-vivo animal model: 6 x swine stomach/esophagus -cost < 100 euro; 6 x ESD: antrum (n = 2), body (n = 3) and fundus/cardia (n = 1)-; size of resected specimen: 4-10 cm; ESD duration: 105-240 minutes; therapeutic success: 100%; complications: perforation (1/6: 16%) sealed with clips. In-vivo animal model: 6 ESD (antrum/body of stomach: 4; esophagus: 2); size: 2-5 cm; duration: 40-165 minutes; success: 100%; complications: 0%. Patient: ESD of a gastric lesion located in the antrum/body; size: 3 cm; duration 210 minutes; a complete resection was achieved; no complications.Conclusions: the results of the present study support the usefulness of this model for learning ESD in our system. Key words: Endoscopic submucosal dissection. ESD. Submucosal resection. Large endoscopic resection. INTRODUCTIONEndoscopic mucosal resection (EMR) consists of resecting a superficial tumor of the gastrointestinal tract (esophagus, stomach, colon or rectum) by endoscopic means with curative intention (R0 resection) (1-5). An EMR-resected lesion may be submitted for pathological examination. One of the advantages of EMR compared with surgical resection is its lower morbidity/mortality and cost. At present EMR has become widely available in clinical practice in both Asian and Western countries (1-5). However, EMR presents a number of limitations: a) technical difficulty; b) risk for complications: bleeding (2-29%), perforation (0.36%) and stenosis (mainly in the esophagus); and c) restricted to superficial lesions with no lymphatic spread and size < 1-1.5 cm (1-8). Lesions with a diameter > 1.5 cm cannot be completely resected with a single EMR procedure, and repeated mucosectomies (several fragments) or endoscopic submucosal dissection (ESD) (allowing to resect the entire lesion in a single piece) will be required (2). It is generally assumed that it is better to resect tumoral lesions in single pieces, as we can be sure the tumor has been completely resected, and it also facilitates sample orientation at the time of the pathology study (8)(9)(10)(11)(12)(13)(14)(15). Furthermore, ESD allows to perfom wider and deeper resections versus EMR (2). However, the learning curve for ESD (high technical difficulty) is longer (compared with EMR), and compli...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Training model for teaching endoscopic submucosal dissection of gastric tumors

Vázquez-Sequeiros¹,

Miquel²,

Olcina³

et al. 2009

Rev. esp. enferm. dig.

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“…Endoscopic mucosal resection (EMR) has been widely established as a safe and reasonable procedure for superficial gastrointestinal neoplasia [3,4]. However, the tumors are frequently removed in fragments [5,6], and specimens obtained by such piecemeal resection render pathological staging inaccurate [7].…”

mentioning

confidence: 99%

Optimal Duration of Proton Pump Inhibitor for Healing Artificial Ulcers After Endoscopic Submucosal Dissection for Early Gastric Cancer

Gotoda

2011

Dig Dis Sci

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“…The objectives of performing EMR are to remove superficial neoplastic lesions and to obtain specimens for accurate pathologic staging (20) . One of the major complications of EMR is perforation (15,16) .…”

Section: Introductionmentioning

confidence: 99%

Comparative results of gastric submucosal injection with hydroxypropyl methylcellulose, carboxymethylcellulose and normal saline solution in a porcine model

Lenz

Sena

Nakao

et al. 2010

Arq. Gastroenterol.

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-Context -Endoscopic mucosal resection is an established modality for excision of sessile lesions in the gastrointestinal tract. Submucosal fluid injection creates a cushion and may prevent thermal injury and perforation. Objectives -This blind study investigated the performance of three different solutions to create submucosal fluid cushions in porcine stomach. Methods -Three solutions were injected in the stomach of nine pigs BR1: normal saline solution, carboxymethylcellulose 0.5% and hydroxypropyl methylcellulose 0.25%. In each pig, submucosal injections with 6 mL per test-solution were performed. One drop of methylene blue was added to all injections for better visualization. The time for the bleb to disappear was recorded. Results -The overall median time of visible submucosal cushion was 37 minutes (range 12-60 min) for hydroxypropyl methylcellulose, 31 minutes for carboxymethylcellulose (range 10-43 min) and 19 minutes for normal saline solution (range 8-37 min). There was no statistically significant difference neither between normal saline solution and carboxymethylcellulose (P = 0.146) nor carboxymethylcellulose and hydroxypropyl methylcellulose (P = 0.119) but the median duration of hydroxypropyl methylcellulose was significantly longer than normal saline solution (P = 0.039). Conclusions -The length of hydroxypropyl methylcellulose submucosal fluid cushion is longer in comparison with normal saline solution. The median time for carboxymethylcellulose was not longer than normal saline solution. Hydroxypropyl methylcellulose, in the concentration of 0.25%, may be a durable alternative for submucosal injection.

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Endoscopic mucosal resection

Cited by 500 publications

References 76 publications

Training model for teaching endoscopic submucosal dissection of gastric tumors

Training model for teaching endoscopic submucosal dissection of gastric tumors

Optimal Duration of Proton Pump Inhibitor for Healing Artificial Ulcers After Endoscopic Submucosal Dissection for Early Gastric Cancer

Comparative results of gastric submucosal injection with hydroxypropyl methylcellulose, carboxymethylcellulose and normal saline solution in a porcine model

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