Indications and Techniques for Endoscopic Submucosal Dissection

Bhatt, Amit; Abe, Seiichiro; Kumaravel, Arthi; Vargo, John J.; Saito, Yutaka

doi:10.1038/ajg.2014.425

Cited by 126 publications

(83 citation statements)

References 52 publications

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“…Endoscopic intervention (endoscopic submucosal dissection, ESD) can be indicated for eSCCs confined to the mucosa or lamina propria (T1a or less in stage) without submucosal invasion 9, 10. Thus, it was very important to know depth of tumor invasion and the presence of lymph node metastasis.…”

Section: Methodsmentioning

confidence: 99%

Surgically resected T1‐ and T2‐stage esophageal squamous cell carcinoma: T and N staging performance of EUS and PET/CT

et al. 2018

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This study aimed to evaluate the frequency of nodal metastases and to disclose the diagnostic performance of endoscopic ultrasonography (EUS) and PET/CT in T and N staging in surgically resected early‐stage esophageal squamous cell carcinomas (eSCCs). Institutional review board approved this retrospective study with waiver of informed consent for reviewing medical record. We included 435 patients with an early T‐stage (Tis or T1a [≤T1a], T1b and T2) eSCC. The rates of metastatic lymphadenopathy were calculated. Then, the performance of EUS and PET/CT in subdividing T and N stages was assessed. 131 ≤ T1a, 234 T1b, and 70 T2 eSCCs were identified. In discriminating ≤T1a from other cancers, the sensitivity, specificity, and accuracy of EUS were 60.3% (79/131), 80.3% (244/304), and 74.3% (323/435) respectively. With ROC curve analysis, cut‐off value of SUVmax 3.05 at PET provided sensitivity 74.8% (98/131), specificity 70.1% (213/304), and accuracy 71.5% (311/435) for differentiating ≤T1a eSCCs from others. Ten (7.6%) of 131 ≤ T1a cancers had nodal metastasis. In discriminating N0 from node‐positive disease, sensitivity, specificity, and accuracy of EUS were 89.6% (267/298), 41.6% (57/137), and 74.5% (324/435), respectively, whereas those of PET/CT were 88.9% (265/298), 38.7% (53/137), and 73.1% (318/435) respectively. In >70% of patients with ≤T1a eSCCs, the tumor stage can be discriminated from higher stage cancers by using EUS or PET/CT. Substantial percentage (7.6%) of ≤T1a eSCC patients have nodal metastases, which are missed in more than half of the patients in clinical staging.

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Section: Methodsmentioning

confidence: 99%

Surgically resected T1‐ and T2‐stage esophageal squamous cell carcinoma: T and N staging performance of EUS and PET/CT

et al. 2018

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“…Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique that allows for en-bloc resection of early gastrointestinal tract cancers[1-3]. By achieving en-bloc resection, ESD has shown higher curative resection rates and lower recurrence rates than endoscopic mucosal resection (EMR)[4].…”

Section: Introductionmentioning

confidence: 99%

Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

Mortagy

Mehta

Parsi

et al. 2017

WJG

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Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon’s “second hand”. Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.

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“…ESD allows en bloc resection of large lesions and provides accurate histopathological results for patients [1–3]. The perforation rate during ESD is around 2% [4, 5].…”

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confidence: 99%

Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection

et al. 2016

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BackgroundAlthough several methods to create an effective counter traction for safer endoscopic submucosal dissection (ESD) have been reported, these methods do not overcome problems regarding delivery and ease of use. This randomized prospective study assessed the usefulness of ring-shaped thread counter traction, which not only allowed the safer colorectal ESD but also the easiest and lower cost counter traction without any special devices.MethodsForty-five patients diagnosed with colorectal lateral spreading tumors over 20 mm were allocated to the conventional ESD group (CE) (n = 22) and the ring-shaped thread counter traction ESD group (RE) (n = 21). The ring-shaped thread was hooked and lifted up to the contralateral mucosa with a hemoclip. The primary outcome was the dissected area per minute during ESD (cm2/min) (UMIN000020160).ResultsThere were significant differences in the dissection time (min), with 130.0 (56.0–240.0) versus 80 (35.0–130.0) min for the CE and RE groups, respectively (P = 0.001). For the dissected areas per minute (cm2/min), there was a significant difference, with 0.125 (0.1–0.18) versus 0.235 (0.16–0.36) min (P = 0.003) for the CE and RE groups, respectively. There were 1 cases of perforation during ESD in the CE compared to 0 for the RE, and this was no significantly different (P = 0.31). The procedure time of producing and setting the ring-shaped thread counter traction was approximately 1.80 (0.80–3.30) min only.ConclusionsThe ring-shaped thread counter traction is simple, effective, lower cost and does not require special devices to obtain repeated counter traction.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-016-5326-7) contains supplementary material, which is available to authorized users.

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Indications and Techniques for Endoscopic Submucosal Dissection

Cited by 126 publications

References 52 publications

Surgically resected T1‐ and T2‐stage esophageal squamous cell carcinoma: T and N staging performance of EUS and PET/CT

Surgically resected T1‐ and T2‐stage esophageal squamous cell carcinoma: T and N staging performance of EUS and PET/CT

Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

Novel effective and repeatedly available ring-thread counter traction for safer colorectal endoscopic submucosal dissection

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