Impact of tumor location on clinical outcomes of gastric endoscopic submucosal dissection

Yoon, Ji Young; Shim, Choong Nam; Chung, Sung Pil; Park, Wan; Chung, Hyunsoo; Lee, Hyuk; Shin, Sung Kwan; Lee, Sang Kil; Lee, Yong Chan; Park, Jun Chul

doi:10.3748/wjg.v20.i26.8631

Cited by 29 publications

(31 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It has been reported that the prolongation of ESD duration increases the rate of complications [20, 21], and, thus, it is also very important to choose the lesion treatment with a clear expectation of the time requirements for each stage (e.g., incision and dissection) in consideration of the skill level of the operator.…”

Section: Discussionmentioning

confidence: 99%

Procedure Time for Gastric Endoscopic Submucosal Dissection according to Location, considering Both Mucosal Circumferential Incision and Submucosal Dissection

Kaneko

Matsumoto

Ueyama

et al. 2016

Gastroenterology Research and Practice

View full text Add to dashboard Cite

Background. Previous assessments of technical difficulty and procedure time for endoscopic submucosal dissection (ESD) of gastric neoplasms did not take into account several critical determinants of these parameters. However, two key phases of ESD determine the total procedure time: the mucosal circumference incision speed (CIS) and submucosal dissection speed (SDS). Methods. We included 302 cases of en bloc and R0 resection of gastric neoplasms performed by 10 operators who had completed the training program at our hospital. Twelve locations were classified based on multiple criteria, such as condition of surrounding mucosa, lesion vascularity, presence of submucosal fat, ulcers, scars, fibrosis, and scope and device maneuverability. Lesions in different locations were classified into three groups based on the length of the procedure: fast, moderate, or late. Results. A significant difference was found in CIS and SDS for each location (p < 0.01), which demonstrates the validity of this classification system. In several locations, CIS and SDS were not consistent with each other. Conclusion. CIS and SDS did not correspond to each other even for lesions in the same location. Consideration of ESD procedure time for gastric neoplasms requires a more elaborate classification system than that previously reported.

show abstract

Section: Discussionmentioning

confidence: 99%

Procedure Time for Gastric Endoscopic Submucosal Dissection according to Location, considering Both Mucosal Circumferential Incision and Submucosal Dissection

Kaneko

Matsumoto

Ueyama

et al. 2016

Gastroenterology Research and Practice

View full text Add to dashboard Cite

show abstract

“…Therefore, we need to estimate the extent of GC to determine which therapeutic modality would be best for each patient. The location of the lesion is also a risk factor for residual tumors . Tumors located at the upper third of the stomach need more time to be resected when ESD is conducted and usuallly result in a high rate of incomplete and piecemeal resections.…”

Section: Discussionmentioning

confidence: 99%

“…The location of the lesion is also a risk factor for residual tumors. 12 Tumors located at the upper third of the stomach need more time to be resected when ESD is conducted and usuallly result in a high rate of incomplete and piecemeal resections. In our study tumor location was a significant risk factor for LM + .…”

Section: Discussionmentioning

confidence: 99%

Relevant risk factors for positive lateral margin after en bloc endoscopic submucosal dissection for early gastric adenocarcinoma

Cui

et al. 2016

J of Digest Diseases

View full text Add to dashboard Cite

show abstract

“…Risk factors for intraoperative perforation during gastric ESD are listed in Table . For location, upper third, middle third,greater curvature and remnant stomach, were reported to be high‐risk areas for intraoperative perforation. Other risk factors included tumor size, invasion depth,submucosal fibrosis, elevated macroscopic type and old age .…”

Section: Adverse Events Related To Gastric Esdmentioning

confidence: 99%

“…Other risk factors included tumor size, 99,102 invasion depth, 108,109 submucosal fibrosis, 107,110 elevated macroscopic type 107 and old age. 108 Long procedure time 103,107,108,112 and piecemeal resection 103 were also reported to be associated with the incidence of perforation, those might be due to not only tumor-related factor but also the endoscopist-related factor. Interestingly, Lim et al 111 suggested prior workload (i.e.…”

Section: Prevention and Management Of Perforation During Gastric Esdmentioning

confidence: 99%

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Yamamoto

Kikuchi

Nagami

et al. 2019

Digestive Endoscopy

101

View full text Add to dashboard Cite

Prevention therapy is recommended for lesions >1/2 of the esophageal circumference. Locoregional steroid injection is recommended for lesions >1/2–3/4 of the esophageal circumference and oral steroids are recommended for lesions >1/2 of the subtotal circumference. For lesions of the entire circumference, oral steroid combined with injection steroid is considered. Endoscopic balloon dilatation (EBD) is the first choice of treatment for stricture after esophageal endoscopic submucosal dissection (ESD). Radical incision and cutting or self‐expandable metallic stent can be considered for refractory stricture after EBD. In case of intraoperative perforation during esophageal ESD, endoscopic clip closure should be initially attempted. Surgery is considered for treatment of delayed perforation. Current standard practice for prevention of delayed bleeding after gastric ESD includes prophylactic coagulation of vessels on post‐ESD ulcers and giving proton pump inhibitors. Chronic kidney disease stage 4 or 5, multiple antithrombotic drug use, anticoagulant use, and heparin bridging therapy are high‐risk factors for delayed bleeding after gastric ESD. Intraoperative perforation during gastric ESD is initially managed by endoscopic clip closure. If endoscopic clip closure is difficult, other methods such as over‐the‐scope clip (OTSC), polyglycolic acid (PGA) sheet shielding etc. are attempted. Delayed perforation usually requires surgical intervention, but endoscopic closure by OTSC or PGA sheet may be considered. Resection of three‐quarters of the circumference is a risk factor for stenosis after gastric ESD. Giving prophylactic local steroid injection and/or oral steroid is reported, but effectiveness has not been fully verified as has been done for esophageal stricture. The main management method for gastric stenosis is EBD but it may cause perforation.

show abstract

Impact of tumor location on clinical outcomes of gastric endoscopic submucosal dissection

Abstract: More advanced endoscopic techniques are required during ESD for lesions located in the upper third or posterior wall of the stomach to decrease complications and improve therapeutic outcomes.

Cited by 29 publications

References 23 publications

Procedure Time for Gastric Endoscopic Submucosal Dissection according to Location, considering Both Mucosal Circumferential Incision and Submucosal Dissection

Procedure Time for Gastric Endoscopic Submucosal Dissection according to Location, considering Both Mucosal Circumferential Incision and Submucosal Dissection

Relevant risk factors for positive lateral margin after en bloc endoscopic submucosal dissection for early gastric adenocarcinoma

Management of adverse events related to endoscopic resection of upper gastrointestinal neoplasms: Review of the literature and recommendations from experts

Contact Info

Product

Resources

About