Saline-Assisted Endoscopic Resection of Rectal Carcinoids: Cap Aspiration Method Versus Simple Snare Resection

Nagai, Takayuki; Torishima, Ryutaro; Nakashima, Hirotaka; Ookawara, Hitoshi; Uchida, Akihiro; Kai, Shunkichi; Sato, Rikiya; Murakami, Kaoru; Fujioka, Toshio

doi:10.1055/s-2004-814248

Cited by 59 publications

(36 citation statements)

References 16 publications

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“…To facilitate a complete histologic resection, modified EMR techniques, such as EMR-C or ESMR-L, are recommended to treat such lesions [11][12][13]. However, the best endoscopic treatment for small rectal NETs remains a topic of debate.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

et al. 2018

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Background/Aims: The therapeutic strategies for small rectal neuroendocrine tumors (NETs) have not been standardized. We examined the efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) and the long-term outcomes after endoscopic treatment. Methods: A total of 181 patients with rectal NETs <10 mm who were treated between May 2002 and May 2017 were retrospectively enrolled. All the lesions had been resected using ESMR-L, and the follow-up strategies were determined according to the pathological examinations. The long-term outcomes after a 53-month follow-up period were also evaluated. Results: R0 resection was achieved in 180 cases (99.4%). Lymphovascular invasion was confirmed in 67 cases (37.0%), while a curative resection was achieved in 114 cases (63.0%). One perforation (0.6%) and 11 cases with delayed bleeding (6.1%) were observed. A multivariate logistic regression analysis revealed that a tumor size > 5 mm (OR 2.06; 95% CI 1.04–4.08, p = 0.04) was a significant independent predictor of the presence of lymphovascular invasion. Of the 67 patients with non-curative resections, 11 patients underwent additional surgery; lymph node metastasis was confirmed in 2 cases (18.2%). No local or distant metastases were observed during the follow-up period in 77 patients with a curative resection, 9 patients who received additional surgery, and 50 patients with non-curative resections. Conclusion: ESMR-L is an easy, safe and effective treatment for rectal NETs <10 mm in diameter, and the prognosis of patients seems to be good, despite a relatively high rate of lymphovascular invasion.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

et al. 2018

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“…In the past few years, different groups have focused on finding new substances for submucosal injection instead of saline solutions, in the expectation that these new substances would produce a longer elevation time of the submucosal cushions and/or facilitate the transsection of the submucosa (hyaluronic acid) [16,17] . Other innovations have concentrated on the resection instruments [17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

Selective Fluid Cushion in the Submucosal Layer by Water Jet: Advantage for Endoscopic Mucosal Resection

et al. 2007

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Background/Aim: Numerous new techniques have recently been reported and described for the endoscopic mucosal resection of large superficial lesions of the gastrointestinal tract. We present here for the first time the application of a water jet dissector for mucosa elevation. Materials and Methods: In an ex vivo study, the effectiveness of a water jet dissector (Helix Hydro-Jet®) placed directly on the stomach walls of 8 pigs was examined to create a mucosal elevation. After having determined optimal pressures, angle of application, and application times, 13 submucosal fluid cushions were produced in different areas of the stomach walls of 8 pigs in vivo, and the sizes of the resulting submucosal cushions were measured. Results: Using pressures between 30 and 70 bar, it was routinely possible to create submucosal fluid cushions in the stomach wall ex vivo as well as in vivo. Histological examination showed a selective edema in the submucosa without damage to the deeper mucosal layers of the gastric wall. Conclusions: The capacity of a targeted high-pressure water jet to penetrate the mucosa and selectively create a fluid cushion in the submucosa facilitates endoscopic resection of the mucosa. This new method could contribute to ameliorate the endoscopic treatment of mucosal tumors which previously could not be resected endoscopically due to their size, extent, or location.

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“…Evidence for ESD in the duodenum is limited to case series and thus far requires further research and development.Resection beyond the deep margin in EMR can be aided by lifting the submucosal plane with submucosal injection. Aspiration with a cap may result in a more reliable deeper resection, as has been concluded in studies examining rectal carcinoid tumor resection [29][30][31][32][33]. In a metaanalysis of several small series, Dalenback, et al concluded that endoscopic removal of duodenal carcinoids <10 mm, outside the periampullary region, with no EUS signs of invasion, is safe and effective [34].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Mucosal Resection of Duodenal Carcinoid Tumors: A Single Tertiary Care Center Experience

Harnden¹,

Walker²,

Balmadrid³

et al. 2015

GHOA

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Saline-Assisted Endoscopic Resection of Rectal Carcinoids: Cap Aspiration Method Versus Simple Snare Resection

Abstract: Endoscopic resection with aspiration lumpectomy is a useful and safe method for resection of small carcinoid tumors of the rectum.

Cited by 59 publications

References 16 publications

Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device

Selective Fluid Cushion in the Submucosal Layer by Water Jet: Advantage for Endoscopic Mucosal Resection

Endoscopic Mucosal Resection of Duodenal Carcinoid Tumors: A Single Tertiary Care Center Experience

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