Endoscopic Submucosal Dissection for Gastrointestinal Superficial Lesions: Initial Experience in a Single Portuguese Center

Abstract

IntroductionEndoscopic submucosal dissection (ESD) is a minimally invasive organ-sparing endoscopic technique which allows en bloc resection of premalignant and early malignant lesions of the gastrointestinal tract regardless of size. In spite of the promising results, mainly from Japanese series, ESD is still not being widely used in western countries. This study aims to report the feasibility, safety and effectiveness of ESD technique for treating premalignant and early malignant gastrointestinal (GI) lesions (esophagus, gastric and rectum) in a Portuguese center.Patient and MethodsFrom December 2011 to November 2014, 34 GI lesions were treated by ESD. The location, en bloc and pathological complete resection (R0) rates, procedure time, complications and local recurrence were retrospectively evaluated.ResultsFrom 34 resected lesions, 18 were gastric (GL), 15 were rectal (RL) and one esophageal (EL). En bloc resection for each location was 17/18 (94%), 11/15 (73%) and 1/1 respectively. R0 was achieved in 16/18 (89%) GL, 9/15 (60%) RL and 1/1 EL. Mean resection time was 67 min for GL, 142 min for RL and 40 min for EL. Complications included immediate (6%) and delayed (3%) minor bleeding but no perforation. One local residual lesion from a RL was reported in the follow-up, effectively treated with an endoscopic technique. Disease-specific survival was 100% over a mean follow-up period of 14 months.ConclusionESD has shown to be a safe and feasible resection method, achieving high R0, low recurrence and complication rates. Our results are similar to those reported in other international series.

A highly intuitive and ergonomic redundant joint master device for four‐degrees of freedom flexible endoscopic surgery robot

“…Surgical instruments were not used in this experiment. Each point (diameter: 2 mm) was placed such that a 30 mm‐diameter circle was formed by referring to the lesion size in the ESD 27 . When the metal tip touched a point, the buzzer was activated to indicate a correct touch.…”

Effect of backlash hysteresis of surgical tool bending joints on task performance in teleoperated flexible endoscopic robot

“…Considering that the average size of lesions treated with endoscopic submucosal dissection (ESD) was 21 mm, 17 the experimental test bed of a 30-mm size for the pointing task was designed as shown in Figure 7B. A needle simulating an electric knife was used as a tip of the surgical tool for performing the second task.…”

Clinical Management after Endoscopic Submucosal Dissection for Early Gastric Cancer: Sticking to the Gastroenterologist May Be the Best Option!

“…Compared with surgery, a recent systematic review documented a lower morbidity for ESD and a similar 5-year survival [ 3 ]. These outstanding results of ESD in EGC have been observed not only in Asia but also in reference centers in Western countries [ 4 , 5 ].…”