MyMedR

Displaying all 2 publications

Abstract:

Sort:

Fulltext Tips for safety in endoscopic submucosal dissection for colorectal tumors

Yoshida N, Naito Y, Murakami T, Hirose R, Ogiso K, Inada Y, et al.

Ann Transl Med, 2017 Apr;5(8):185.
PMID: 28616400 DOI: 10.21037/atm.2017.03.33

In Japan, endoscopic submucosal dissection (ESD) becomes one of standard therapies for large colorectal tumors. Recently, the efficacy of ESD has been reported all over the world. However, it is still difficult even for Japanese experts in some situations. Right-sided location, large tumor size, high degree of fibrosis, difficult manipulation is related with the difficulty. However, improvements on ESD devices, suitable strategies, and increase of operators' experiences enable us to solve these problems. In this chapter, we introduce recent topics about various difficult factors of colorectal ESD and the tips such as strategy, devices, injection, and traction method [Pocket-creation method (PCM) etc.].
Fulltext The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection

Yoshida N, Naito Y, Yasuda R, Murakami T, Hirose R, Ogiso K, et al.

Endosc Int Open, 2018 Aug;6(8):E975-E983.
PMID: 30083587 DOI: 10.1055/a-0593-5818

Background and study aims: Severe fibrosis poses a challenge in colorectal endoscopic submucosal dissection (ESD). Recently, the pocket-creation method (PCM) has been developed for overcoming various difficulties of ESD. A specific tapered hood is used for adequate traction in the PCM, and endoscopic operability becomes stable in the pocket. In this study, we investigated the efficacy of the PCM in ESD for cases with severe fibrosis.
Patients and methods : We retrospectively reviewed 1000 consecutive colorectal ESD cases (April 2006 to January 2017). Since 2016, the PCM was performed in 58 cases. The indications for ESD included (1) tumors ≥ 20 mm in size diagnosed as intramucosal cancer or high-grade dysplasia and part of T1a cancer using magnifying endoscopic examinations and (2) tumors that appeared impossible to resect with endoscopic mucosal resection because of suspected fibrosis. We identified 120 cases with severe fibrosis and compared them to cases without severe fibrosis. Additionally, the 120 severe fibrosis cases were divided into the PCM and non-PCM groups. En bloc resection, procedure time, discontinuation, and complications were analyzed between these 2 groups.
Results: Among all 1000 ESDs, severe fibrosis and discontinuation rates were 12.0 % (120 cases) and 1.8 % (18 cases), respectively. Regarding the comparison between cases with severe fibrosis and with no severe fibrosis, there were significant differences about en bloc resection rate (78.3 % vs. 95.7 %, P 0.6.
Conclusions: In cases with severe fibrosis, the PCM with ESD improved en bloc resection rates and shortened the procedure time compared to the conventional non-PCM method. Additionally, the PCM reduced the discontinuation rate.

Filters

Please provide feedback to Administrator ([email protected])

External Links