Therapeutic and Diagnostic Approaches in Colonoscopy

Gastroenterology Research and Practice

Kugai

et al. 2013

Self Cite

Purpose. The aim of this study was to examine the characteristics of difficult cases and the learning curve in colorectal endoscopic submucosal dissection (ESD). Methods. We studied 518 colorectal tumors treated by ESD. Patients were divided into 2 groups such as the difficult ESD group and non-difficult ESD group in view of procedure time and procedure speed, respectively. The clinical features in each group were analyzed, and we also examined cases with severe fibrosis. Furthermore, we divided all cases into 5 periods according to experience of ESDs and investigated the rates of difficult and perforation cases. Results. In view of both procedure time and procedure speed, there were significant differences about mean tumor size, rates of severe fibrosis and perforation, and en bloc resection rate between the two groups. Severe fibrosis was detected in protruding tumors >40 mm in diameter. With respect to the learning curve, the rate of difficult and perforation cases decreased significantly in the late periods compared to the first period. Conclusions. Large tumor size, high rates of severe fibrosis and perforation, and low rate of en bloc resection are related with difficult ESD cases. The increasing of experiences can decrease the rate of difficult cases and perforation.

“…Perforation is the primary complication of colorectal ESD, and it can cause fatal peritonitis [15]. Knife coagulation is the most common cause of perforation [6].…”

Section: Discussionmentioning

confidence: 99%

Prediction and Treatment of Difficult Cases in Colorectal Endoscopic Submucosal Dissection

Gastroenterology Research and Practice

Kugai

et al. 2013

Self Cite

“…1). [11][12][13] By increasing the ratio of 450-nm laser light slightly rather than BLI mode, a BLI-bright mode can be set with a stronger fluorescent light (Fig. 1).…”

Section: Bli Systemmentioning

confidence: 99%

“…The BLI light is useful for acquiring mucosal surface information such as vascular and surface patterns. [11][12][13] We previously reported the efficacy of BLI for determining invasion depth in early colon cancer. 11 However, the ability of BLI to differentiate between neoplastic and non-neoplastic polyps and details regarding the function of BLI remain unknown.…”

Section: Introductionmentioning

confidence: 99%

Ability of a novel blue laser imaging system for the diagnosis of colorectal polyps

Yagi

et al. 2013

Digestive Endoscopy

Self Cite

101

“…The clutch cutter (Fujifilm Medical) and SB knife Jr (Sumitomo Bakelite Co., Tokyo, Japan) are grasping-type scissor forceps [13, 14]. At our institution, Flush knife BT is mainly used because it can effectively administer local injections, and the clutch cutter is used secondarily when the risk of perforation is high because of poor submucosal elevation [15]. …”

Section: Devicesmentioning

confidence: 99%

“…At our institution, conscious sedation is performed with midazolam (Dormicum; Astellas Pharma Inc., Tokyo, Japan) and pentazocine (Pentajin; Daiichi Sankyo Co., Tokyo, Japan) with monitoring with an automatic blood pressure monitor. In our previous ESD study that included 105 cases, there were 22 patients for whom the operation time exceeded 2.5 h, and 15 of these 22 patients (68.1%) experienced restlessness despite conscious sedation [15]. In contrast, among the 83 patients with an operation time of <2.5 h, restlessness occurred in only 10 (12.0%).…”

Section: Other Complicationsmentioning

confidence: 99%

Prevention and Management of Complications of and Training for Colorectal Endoscopic Submucosal Dissection

Yagi

Gastroenterology Research and Practice

et al. 2013

Self Cite

Endoscopic submucosal dissection (ESD) is reported to be an efficient treatment with a high rate of en bloc resection for large colorectal tumors in Japan and some other Western and Asian countries. ESD is considered less invasive than laparoscopic colectomy. However, ESD carries a higher risk of perforation than endoscopic mucosal resection (EMR). Various devices and training methods for colorectal ESD have been developed to solve the difficulties. In this review, we describe the complications of colorectal ESD and prevention of those complications. On the other hand, colorectal ESD is difficult for less-experienced endoscopists. The unique step-by-step ESD training system is performed in Japan. Additionally, appropriate training, including animal model training, for colorectal ESD should be acquired before working on clinical cases.