|
1
|
Yuan Z, Cui H, Xu Q, Gao J, Liang W, Cao B, Lin X, Song L, Huang J, Zhao R, Li H, Yu Z, Du J, Wang S, Chen L, Cui J, Zhao Y, Wei B. Total versus proximal gastrectomy for proximal gastric cancer after neoadjuvant chemotherapy: a multicenter retrospective propensity score-matched cohort study. Int J Surg 2024; 110:1000-1007. [PMID: 38085808 PMCID: PMC10871602 DOI: 10.1097/js9.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/09/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND This study aimed to analyze and compare the short-term and long-term outcomes of proximal gastrectomy (PG) and total gastrectomy (TG) in patients with locally advanced proximal gastric cancer (GC) following neoadjuvant chemotherapy (NACT). METHOD A multicenter retrospective cohort study and propensity score matching (PSM) were employed. The authors examined 367 patients with proximal GC who received NACT followed by PG ( n =164) or TG ( n =203) at two Chinese medical institutions between December 2009 and December 2022. Clinical and pathological parameters, postoperative complications, and 5-year overall survival (OS) and recurrence-free survival (RFS) were compared between the two groups. The dissection status and metastasis rate of each lymph node station were assessed. RESULTS After PSM, 80 patients were enrolled in both TG and PG group, and baseline characteristics were comparable between the groups (all P >0.05). The TG group had a higher total number of lymph nodes retrieved ( P <0.001) and longer operative time ( P =0.007) compared to the PG group. The incidence of Clavien-Dindo grade II or higher postoperative complications was similar between the TG group (21.3%, 17/80) and the PG group (17.5%, 14/80) ( P =0.689). The 5-year OS rates were 68.4 for the PG group and 66.0% for the TG group ( P =0.881), while the 5-year RFS rates were 64.8 and 61.9%, respectively ( P =0.571), with no statistically significant differences. Metastasis rates at lymph node stations #4d, #5, #6, and #12a were notably low in the TG group, with values of 2.74, 0.67, 1.33, and 1.74%, respectively. CONCLUSION For proximal GC patients following NACT, PG maintains comparable curative potential and oncological efficacy to TG, making it a safe option.
Collapse
Affiliation(s)
- Zhen Yuan
- School of Medicine, Nankai University, Tianjin
- Department of General Surgery, The First Medical Center
| | - Hao Cui
- School of Medicine, Nankai University, Tianjin
- Department of General Surgery, The First Medical Center
| | - Qixuan Xu
- Department of General Surgery, The First Medical Center
| | - Jingwang Gao
- Department of General Surgery, The First Medical Center
| | - Wenquan Liang
- Department of General Surgery, The First Medical Center
| | - Bo Cao
- Department of General Surgery, The First Medical Center
| | - Xia Lin
- Department of Gastrointestinal Surgery, Three Gorges Hospital, Chongqing University
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Liqiang Song
- School of Medicine, Nankai University, Tianjin
- Department of General Surgery, The First Medical Center
| | - Jun Huang
- School of Medicine, Nankai University, Tianjin
- Department of General Surgery, The First Medical Center
| | - Ruiyang Zhao
- Department of General Surgery, The First Medical Center
| | - Hanghang Li
- Department of General Surgery, The First Medical Center
| | - Zhiyuan Yu
- School of Medicine, Nankai University, Tianjin
- Department of General Surgery, The First Medical Center
| | - Jiajun Du
- Department of General Surgery, The First Medical Center
| | - Shuyuan Wang
- School of Medicine, Nankai University, Tianjin
- Department of Radiotherapy, The Fifth Medical Center, Chinese PLA General Hospital, Beijing
| | - Lin Chen
- Department of General Surgery, The First Medical Center
| | - Jianxin Cui
- Department of General Surgery, The First Medical Center
| | - Yongliang Zhao
- Department of General Surgery, The First Affiliated Hospital of Army Medical University, Chongqing, People’s Republic of China
| | - Bo Wei
- Department of General Surgery, The First Medical Center
| |
Collapse
|
|
2
|
Yokoyama K, Nakadate R, Takao T, Motomura D, Muragaki Y, Yokokohji Y. Usefulness of three-dimensional imaging in a flexible endoscopic surgery platform with multi-degrees-of-freedom articulating devices. Asian J Endosc Surg 2024; 17:e13275. [PMID: 38212266 DOI: 10.1111/ases.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/25/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND AIMS Recent studies on endoscopic submucosal dissection have aimed to reduce the difficulty of the procedure by using multi-degrees-of-freedom articulating devices. In this study, we evaluated the usefulness of adding three-dimensional (3D) video imaging into simulated endoscopic submucosal dissection tasks using multi-degrees-of-freedom devices. METHODS We designed an endoscopic platform with a 3D camera and two multi-degrees-of-freedom devices. Four ex vivo bench tasks were created, and a crossover study comparing 2D and 3D conditions was conducted on 15 volunteers. In each task, performance such as procedure time and accuracy were objectively evaluated. Additionally, a comprehensive visual analogue scale questionnaire was conducted. RESULTS In the tasks simulating submucosal flap grasping, marking, and full-area incision, the use of 3D imaging significantly improved the speed and accuracy of the multi-degrees-of-freedom device manipulation (p < .01). No significant differences were observed in the task that simulated the dissection procedure. Furthermore, it appears that the accuracy of recognizing curved surfaces may be reduced in the 3D environment. Operators reported subjective increases in recognizability and operability with the 3D camera, along with an increase in asthenopia (p < .01). CONCLUSIONS 3D vision improves the technical accuracy of certain simulated multi-degrees-of-freedom endoscopic submucosal dissection tasks and subjectively improved operating conditions, at the cost of increased eye strain.
Collapse
Affiliation(s)
- Kosuke Yokoyama
- Department of Medical Device Engineering, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Ryu Nakadate
- Department of Medical Device Engineering, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Toshitatsu Takao
- Department of Medical Device Engineering, Graduate School of Medicine, Kobe University, Kobe, Japan
- Department of Gastroenterology, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Douglas Motomura
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Yoshihiro Muragaki
- Department of Medical Device Engineering, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yasuyoshi Yokokohji
- Department of Mechanical Engineering, Graduate School of Engineering, Kobe University, Kobe, Japan
| |
Collapse
|
|
3
|
Takeuchi Y, Ang TL. Editorial: A learning curve for duodenal endoscopic submucosal dissection: Nuances and caveats. J Gastroenterol Hepatol 2022; 37:2023-2024. [PMID: 36396133 DOI: 10.1111/jgh.16025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Genetic Oncology, Division of Hereditary Tumors, Osaka International Cancer Institute, Osaka, Japan
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| |
Collapse
|
|
4
|
Abstract
OBJECTIVE An increasing use of endoscopic submucosal dissection (ESD) has been reported in Western countries, although some differences in training schemes and outcomes have been described. We aimed to report the training model, implementation, and outcomes of ESD in Portugal. METHODS All endoscopists trained at our center from our country (n = 9) were invited to a survey regarding: (a) training period; (b) ESD outcomes and (c) implementation of ESD in each respective center. RESULTS All endoscopists completed the survey. Learning ESD was centered on human ESD assistance in a high-volume center during a median time of 6 months and complemented mainly by hands-on courses (89%). During the surveyed period, a total of 1229 ESD were performed, mostly in gastric locations (74%). Median complete R0 and curative resection rate were 92% (IQR, 81-96.8) and 87% (IQR, 74-93.3), respectively, and median perforation rate was 0.89% (IQR, 0.25-6.22). The main limitations encountered during the implementation of ESD were related to the lack of initial mentoring or insufficient expertise to progress to more difficult lesions. CONCLUSION Learning ESD through participation in hands-on courses and visiting high-volume centers seems to be adequate to achieve a good competence at the initial stage of ESD, which in fact is in consonance with the European Society of Gastrointestinal Endoscopy recommendations. However, mentoring is essential for technical progression, and this represents the fundamental barrier during the adoption of ESD, which may be overcome by increasing hands-on training in animal or artificial simulators, but preferably with the implementation of a structured training program.
Collapse
|
|
5
|
Hong SW, Byeon JS. Endoscopic diagnosis and treatment of early colorectal cancer. Intest Res 2022; 20:281-290. [PMID: 35916019 PMCID: PMC9344247 DOI: 10.5217/ir.2021.00169] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Early colorectal cancer refers to cancer in the colorectum that is confined to the mucosa or submucosa and does not invade the muscularis propria, irrespective of lymph node or distant metastasis. As the number of persons undergoing screening colonoscopy increases, the proportion of patients diagnosed with precancerous colorectal lesions and early colorectal cancer also increases. In the last decade, innovative optical technologies for endoscopic diagnosis have been introduced and endoscopic treatment techniques such as endoscopic submucosal dissection have provided major breakthroughs in the management of early colorectal cancer. With these remarkable developments, endoscopic treatment has established itself as an alternative to surgical resection in the treatment of early colorectal cancer. This review will discuss the endoscopic diagnosis and treatment of early colorectal cancer. Furthermore, the unmet needs in this field and the latest research addressing those issues will be summarized.
Collapse
Affiliation(s)
- Seung Wook Hong
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
6
|
Emara MH, Zaghloul M, Ramadan HKA, Mohamed SY, Tag-Adeen M, Alzamzamy A, Alboraie M, Madkour A, Altonbary AY, Zaher TI, Elhassan AA, Abdeen N, Ahmed MH. Endoscopic resection of superficial bowel neoplasia: The unmet needs in the Egyptian practice. World J Gastrointest Endosc 2022; 14:235-249. [PMID: 35634486 PMCID: PMC9048489 DOI: 10.4253/wjge.v14.i4.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/22/2021] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of superficial bowel neoplasia (SBN) in early stages is associated with better outcomes. The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques (ERTs). However, there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice. AIM To investigate the knowledge, attitude, and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units' infrastructures toward these techniques. METHODS An online 2-pages questionnaire was used. The first page comprised demographic data, and questions for all physicians, about the knowledge (11 questions) of and attitude (5 questions) toward ERTs as a therapeutic option for SBN. The second page investigated the practice of ERTs by endoscopists (6 questions) and the infrastructures of their endoscopy units (14 questions). The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously. RESULTS The complete responses were 833/2300 (36.2%). The majority of the participants were males (n = 560, 67.2%), middle-aged (n = 366, 43.9%), consultants (n = 464, 55.7%), gastroenterologists (n = 678, 81.4%), spending ≥ 15 years in practice (n = 368, 44.2%), and were working in university hospitals (n = 569, 68.3%). The majority correctly identified the definition of SBN (88.4%) and the terms polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) (92.1%, 90.2%, and 89.1% respectively). However, 26.9%, 43.2% and 49.5% did not recognize the clear indication of polypectomy, EMR, and ESD respectively. Although 68.1% of physicians are convinced about the ERTs for management of SBN; only 8.9% referred all candidate cases for ERTs. About 76.5% of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9% and 7.2% respectively. About 71.6% and 88.4% of endoscopists did not perform EMR or ESD in the last one year. Consequently, the complication rate reported by endoscopists was limited to 18.1% (n = 103) of endoscopists. Only 25.8% of endoscopists feel confident in the management of ERTs-related complications and a half (49.9%) were not sure about their competency. Regarding the endoscopy units' infrastructures, only 4.2% of the centers had their endoscopes 100% armed with optical enhancements and 54.4% considered their institutions ready for managing ERTs-related complications. Only 18.3% (n = 104) of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding (26.7%), and perforations (17%). CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs. The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
Collapse
Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | | | - Salem Youssef Mohamed
- Department of Internal Medicine, Faculty of Medicine, Gastroenterology and Hepatology Unit, Zagazig University, Zagazig 44519, Egypt
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, South Valley University, Qena Faculty of Medicine, Qena 83523, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11841, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo11884, Egypt
| | - Ahmad Madkour
- Department of Endemic Medicine, Helwan University, Cairo 11795, Egypt
| | | | - Tarik I Zaher
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Ahmed Abo Elhassan
- Department of Tropical Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| |
Collapse
|
|
7
|
Emara MH, Zaghloul M, Ramadan HKA, Mohamed SY, Tag-Adeen M, Alzamzamy A, Alboraie M, Madkour A, Altonbary AY, Zaher TI, Elhassan AA, Abdeen N, Ahmed MH. Endoscopic resection of superficial bowel neoplasia: The unmet needs in the Egyptian practice. World J Gastrointest Endosc 2022; 14:236-250. [DOI: 10.4253/wjge.v14.i4.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of superficial bowel neoplasia (SBN) in early stages is associated with better outcomes. The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques (ERTs). However, there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.
AIM To investigate the knowledge, attitude, and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’ infrastructures toward these techniques.
METHODS An online 2-pages questionnaire was used. The first page comprised demographic data, and questions for all physicians, about the knowledge (11 questions) of and attitude (5 questions) toward ERTs as a therapeutic option for SBN. The second page investigated the practice of ERTs by endoscopists (6 questions) and the infrastructures of their endoscopy units (14 questions). The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.
RESULTS The complete responses were 833/2300 (36.2%). The majority of the participants were males (n = 560, 67.2%), middle-aged (n = 366, 43.9%), consultants (n = 464, 55.7%), gastroenterologists (n = 678, 81.4%), spending ≥ 15 years in practice (n = 368, 44.2%), and were working in university hospitals (n = 569, 68.3%). The majority correctly identified the definition of SBN (88.4%) and the terms polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) (92.1%, 90.2%, and 89.1% respectively). However, 26.9%, 43.2% and 49.5% did not recognize the clear indication of polypectomy, EMR, and ESD respectively. Although 68.1% of physicians are convinced about the ERTs for management of SBN; only 8.9% referred all candidate cases for ERTs. About 76.5% of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9% and 7.2% respectively. About 71.6% and 88.4% of endoscopists did not perform EMR or ESD in the last one year. Consequently, the complication rate reported by endoscopists was limited to 18.1% (n = 103) of endoscopists. Only 25.8% of endoscopists feel confident in the management of ERTs-related complications and a half (49.9%) were not sure about their competency. Regarding the endoscopy units’ infrastructures, only 4.2% of the centers had their endoscopes 100% armed with optical enhancements and 54.4% considered their institutions ready for managing ERTs-related complications. Only 18.3% (n = 104) of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding (26.7%), and perforations (17%).
CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs. The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.
Collapse
Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | - Mariam Zaghloul
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| | | | - Salem Youssef Mohamed
- Department of Internal Medicine, Faculty of Medicine, Gastroenterology and Hepatology Unit, Zagazig University, Zagazig 44519, Egypt
| | - Mohammed Tag-Adeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, South Valley University, Qena Faculty of Medicine, Qena 83523, Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Maadi Armed Forces Medical Complex, Military Medical Academy, Cairo 11841, Egypt
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo11884, Egypt
| | - Ahmad Madkour
- Department of Endemic Medicine, Helwan University, Cairo 11795, Egypt
| | | | - Tarik I Zaher
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Ahmed Abo Elhassan
- Department of Tropical Medicine, Suez Canal University, Ismailia 41522, Egypt
| | - Nermeen Abdeen
- Department of Tropical Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr Elshiekh 33516, Egypt
| |
Collapse
|
|
8
|
Stress Dispersion Design in Continuum Compliant Structure toward Multi-DOF Endoluminal Forceps. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12052480] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gastrointestinal cancer, when detected early, is treated by accessing the lesion through the natural orifice using flexible endoscopes. However, the limited degree-of-freedom (DOF) of conventional treatment devices and the narrow surgical view through the endoscope demand advanced techniques. In contrast, multi-DOF forceps systems are an excellent alternative; however, these systems often involve high fabrication costs because they require a large number of micro-parts. To solve this problem, we designed compact multi-DOF endoluminal forceps with a monolithic structure comprising compliant hinges. To allow an efficient stress dispersion at the base end when the hinge bends, we proposed a novel design method to obtain the hinge parameters using the beam of uniform strength theory. This method does not involve a high computational cost. The results show that the improved design with a variable hinge thickness can reduce the maximum bending stress, dispersing the stress in a larger area than that of the previous design considering a constant thickness of the hinge. Moreover, the experiments conducted in a prototype confirm that the radius of the curvature was significantly improved. The proposed method could aid in designing other continuum robots relying on compliant hinges.
Collapse
|
|
9
|
Uraoka T, Yunoki S, Sasaki M, Kinoshita S, Takatori Y, Hirai Y, Narita T, Ramberan H, Shimoda M, Yahagi N. Closure of gastric perforations during endoluminal resection using a novel biodegradable collagen sol: A feasibility survival study on porcine model (with video). Dig Endosc 2022; 34:105-112. [PMID: 33615579 DOI: 10.1111/den.13962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/16/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE A prior study using porcine colon demonstrated the feasibility of a novel injectable, temperature?responsive, and biodegradable collagen sol (ICS) that transforms from a liquid to a gel state in response to body temperature for endoscopic closure of perforation during endoscopic resection (ER). This study aims to report the acute and survival outcomes of ICS for gastric perforations during ER. METHODS In two experiments using nine live pigs under general anesthesia, four and six perforations (3-5\xA0mm) were created using an electrosurgical knife in acute and survival experiments, respectively. ICS was delivered to the perforations using an endoscopic catheter. In Experiment 1, a leak test and histopathology were performed on all explanted stomachs after euthanization. In Experiment 2, perforation sites were assessed by gastroscopy and histopathology 7, 14 and 28\xA0days post? RESULTS In Experiment 1, gastroscopy confirmed complete closure of the perforations with ICS and no evidence of leak. Subsequent histopathology revealed a fixation of collagen gel (CG) as a sealant agent at the perforation sites. There were no adverse effects related with ESD or the use of ICS. In Experiment 2, histopathology revealed a fixation of CG as a sealant agent, replacement with granulation tissue and no CG; and fibrotic tissue at 7, 14 and 28\xA0days, respectively. CONCLUSIONS This study presents a novel method using ICS, demonstrating promising efficacy and safety profile for endoscopic closure of perforations during ER. Further studies are necessary before translating to clinical use.
Collapse
Affiliation(s)
- Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shunji Yunoki
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute, Tokyo, Japan
| | - Motoki Sasaki
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Satoshi Kinoshita
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yusaku Takatori
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yuichiro Hirai
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takefumi Narita
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute, Tokyo, Japan
| | - Hemchand Ramberan
- Program in Endoscopic Oncology and Advanced Endoscopy, Riverside Regional Medical Center, Newport News, USA
| | - Masayuki Shimoda
- Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| |
Collapse
|
|
10
|
Bordillon P, Pioche M, Wallenhorst T, Rivory J, Legros R, Albouys J, Lepetit H, Rostain F, Dahan M, Ponchon T, Sautereau D, Loustaud-Ratti V, Geyl S, Jacques J. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 2021; 94:333-343. [PMID: 33548280 DOI: 10.1016/j.gie.2021.01.036] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Colonic endoscopic submucosal dissection (ESD) is particularly challenging and limited to a few expert centers. We recently conducted a pilot study on improvement of colonic ESD with systematic use of a countertraction device (double-clip traction with rubber band [DCT-ESD]). METHODS A French prospective multicenter study was conducted between March 2017 and September 2019, including all consecutive cases of naive colonic ESD. Since the first case of DCT-ESD in March 2017, all cases of colonic ESD have been performed using the DCT-ESD strategy in the 3 centers involved in the study. RESULTS Five hundred ninety-nine lesions with a mean size of 53 mm were included in this study, resected by 5 operators in 3 centers. The en bloc, R0, and curative resection rates were 95.7%, 83.5%, and 81.1%, respectively. The adverse event rates were 4.9% for perforation and 4.2% for postprocedure bleeding. Between 2017 and 2019, the rates of R0 and curative resections increased significantly from 74.7% in 2017 to 88.4% in 2019 (P = .003) and from 72.6% in 2017 to 86.3% in 2019 (P = .004), respectively. Procedure duration and speed of resection were 62.4 minutes and 39.4 mm2/minute, respectively. No differences were noted between operators. CONCLUSION DCT-ESD is a safe and reproducible technique, with results comparable with those of the large Japanese teams with speed of resection twice as high as previously reported studies. The DCT strategy is promising, cheap, and seems to be reproducible. Physicians performing colonic ESD should be aware of this promising tool to improve their results in ESD.
Collapse
Affiliation(s)
- Pierre Bordillon
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Mathieu Pioche
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | | | - Jérôme Rivory
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | - Romain Legros
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jérémie Albouys
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Hugo Lepetit
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Florian Rostain
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | - Martin Dahan
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Thierry Ponchon
- Service d'Hépato-gastro-entérologie, CHU Edouard Herriot, Lyon, France
| | - Denis Sautereau
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | | | - Sophie Geyl
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| | - Jérémie Jacques
- Service d'Hépato-gastro-entérologie, CHU Dupuytren, Limoges, France
| |
Collapse
|
|
11
|
Mahadev S, Vareedayah AA, Yuen S, Yuen W, Koller KA, Haber GB. Outcomes of a hybrid technique using EMR and endoscopic full-thickness resection for polyps not amenable to standard techniques (with video). Gastrointest Endosc 2021; 94:358-367.e1. [PMID: 33592228 DOI: 10.1016/j.gie.2021.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The full-thickness resection device (FTRD) offers a safe and effective approach for resection of complex colorectal lesions but is limited to lesions <2 cm in size. A hybrid approach-combining EMR with the FTRD-significantly expands the pool of lesions amenable to this technique; however, its safety and efficacy has not been well established. METHODS We report a single-center retrospective study of consecutive patients who underwent full-thickness resection (FTR) of colorectal lesions, either with a standalone FTRD or a hybrid (EMR + FTRD) approach. Outcomes of technical success, clinical success (macroscopically complete resection), R0 resection, and adverse events (AEs) were evaluated. RESULTS Sixty-nine FTR procedures (38 standalone FTR and 31 hybrid EMR + FTR) were performed on 65 patients. The most common indications were nonlifting polyp (43%) or suspected high-grade dysplasia or carcinoma (38%). Hybrid EMR + FTR permitted resection of significantly larger lesions (mean, 39 mm; range, 15-70 mm) compared with standalone FTR (mean, 17 mm; range, 7-25 mm; P < .01). Clinical success (91%), technical success (83%), and R0 resection (81%) rates did not differ between standalone and hybrid groups. Most patients (96%) were discharged home on the day of the procedure. Three AEs occurred, including 2 patients who developed acute appendicitis. CONCLUSIONS A hybrid approach combining EMR and FTRD maintains safety and efficacy while permitting resection of significantly larger lesions than FTRD alone.
Collapse
Affiliation(s)
- SriHari Mahadev
- Division of Gastroenterology & Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ashley A Vareedayah
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Sofia Yuen
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| | - William Yuen
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| | - Kristen A Koller
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gregory B Haber
- Division of Gastroenterology & Hepatology, Department of Medicine, New York University Langone Health, New York, New York, USA
| |
Collapse
|
|
12
|
Misumi Y, Nonaka K. Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection. J Clin Med 2021; 10:jcm10112511. [PMID: 34204078 PMCID: PMC8201364 DOI: 10.3390/jcm10112511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.
Collapse
|
|
13
|
Fernández-Esparrach G, Marín-Gabriel JC, de Tejada AH, Albéniz E, Nogales O, Del Pozo-García AJ, Rosón PJ, Goicotxea U, Uchima H, Terán A, Alberto A, Joaquín RS, Liseth RS, José S. Implementation of endoscopic submucosal dissection in a country with a low incidence of gastric cancer: Results from a prospective national registry. United European Gastroenterol J 2021; 9:718-726. [PMID: 34077636 PMCID: PMC8280798 DOI: 10.1002/ueg2.12101] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/16/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction Endoscopic submucosal dissection (ESD) has become the treatment of choice for early gastric malignancies. In recent years, the ESD technique has been implemented in Western countries with increasing use. Objectives To describe the results of gastric ESD in a Western country with a low incidence of gastric cancer. Patients and Methods The prospective national registry was conducted over 4 years in 23 hospitals, including 30 endoscopists. Epithelial and subepithelial lesions (SEL) qualified to complete removal with ESD were assessed. The technique, instruments, and solution for submucosal injection varied at the endoscopist's discretion. ESD was defined as difficult when: en‐bloc resection was not achieved, had to be converted to a hybrid resection, lasted more than 2 h or an intraprocedural perforation occurred. Additionally, independent risk factors for difficult ESD were analyzed. Results Two hundred and thirty gastric ESD in 225 patients were performed from January 2016 to December 2019 (196 epithelial and 34 SEL). Most lesions were located in the lower stomach (111; 48.3%). One hundred and twenty‐eight (55.6%) ESD were considered difficult. The median procedure time was 105 min (interquartile range [IQR]: 60–150). The procedure time for SEL was shorter than for epithelial lesions (90 min [45–121] vs. 110 min [62–160]; p = 0.038). En‐bloc, R0, and curative resection rates were 91.3%, 75.2%, and 70.9%, respectively. Difficult ESD had lower R0 resection rates than ESD that did not meet the difficulty criteria (64.8% and 87.6%; p = 0.000, respectively). Fibrosis and poor maneuverability were independent factors associated with difficult ESD (OR 3.6, 95%CI 1.1–11.74 and OR 5.07, 95%CI 1.6–16.08; respectively). Conclusions Although the number of cases is limited, the results of this analysis show acceptable en‐bloc and R0 rates in gastric ESD considering the wide variability in experience among the operators. Fibrosis and poor maneuverability were associated with more difficulty in completing ESD. Summarize the established knowledge on this subject
Endoscopic submucosal dissection (ESD) is the standard of care for treatment of early gastric cancers (GC). Due to a lower incidence of GC in European countries, the introduction of gastric ESD has been more gradual than in the East. ESD complications, technical and clinical success depend on the endoscopist's experience, the presence of submucosal fibrosis or invasive cancer, and poor access location. What are the significant and/or new findings of this study?
This study shows the results from a prospective nationwide registry of gastric ESD in a low GC incidence country. Despite a relative low number of cases, quite acceptable outcomes (en‐bloc, R0 and curative resection of 91.3%, 75.2% and 70.9%, respectively) were observed considering the wide variability in experience among the operators. Difficult ESD were mainly associated with the presence of submucosal fibrosis and poor maneuverability; however, independent pre‐procedural factors were not identified. There was a trend of association between ESD difficulty and the location of the lesion in the upper/middle stomach
Collapse
Affiliation(s)
- Gloria Fernández-Esparrach
- Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José-Carlos Marín-Gabriel
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute", Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Alberto H de Tejada
- Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain
| | - Eduardo Albéniz
- Complejo Hospitalario de Navarra, Navarrabiomed Biomedical Research Center, UPNA, IdiSNA, Pamplona, Spain
| | | | - Andres J Del Pozo-García
- Endoscopy Unit, Gastroenterology Department, "i+12 Research Institute", Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, Spain
| | | | - Unai Goicotxea
- Hospital Universitario de Donostia, San Sebastián, Spain
| | - Hugo Uchima
- Centro Médico Teknon, Barcelona, Barcelona, Spain
| | - Alvaro Terán
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | - Rivero-Sánchez Liseth
- Endoscopy Unit, Gastroenterology Department, ICMDM, CIBEREHD, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Santiago José
- Endoscopy Unit, Gastroenterology Department, IDIPHISA, Hospital Universitario Puerta de Hierro, Autonomous University of Madrid, Madrid, Spain
| | | |
Collapse
|
|
14
|
Pih GY, Lee JS, Ahn JY, Kim DH, Na HK, Lee JH, Jung KW, Choi KD, Song HJ, Lee GH, Jung HY. Is Ex Vivo Training before In Vivo Training Effective in Learning Gastric Endoscopic Submucosal Dissection? THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2020.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
|
15
|
Uraoka T, Yunoki S, Kinoshita S, Takatori Y, Hirai Y, Tanaka H, Narita T, Shimoda M. Novel temperature-responsive, biodegradable and injectable collagen sol for the endoscopic closure of colonic perforation holes: Animal study (with videos). Dig Endosc 2021; 33:616-620. [PMID: 32794223 DOI: 10.1111/den.13810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Endoscopic submucosal dissection (ESD) poses a risk of intraprocedural perforation. We have developed a biodegradable injectable collagen sol that undergoes a liquid-to-gel formation in response to body temperature. Here, we investigated the feasibility of this novel collagen sol for the endoscopic closure of iatrogenic perforation holes. METHODS In two experiments, 12 and 5 colonic perforation holes (3-5 mm) were made using an ESD knife in four and three live pigs under general anesthesia, respectively. In Experiment 1, collagen sol was delivered to the perforation holes using an endoscopic catheter. When the colon was expanded by CO2 insufflation, endo-clips were applied to the perforation holes. For Experiment 2, Collagen sol adjusted based on the Experiment 1 results was delivered to the perforation holes in the same manner. A leak test was performed for every colon after the pigs were killed, and the histology of the perforation sites was evaluated. RESULTS In both experiments, collagen sol was smoothly delivered to the target area and fixed as a gel on the perforation holes. Experiment 1, 83% (10/12) of the perforation holes were completely closed, and all endo-clips were placed with composure. Experiment 2, all perforation holes were completely closed with collagen gel. There was no leak from the perforation holes. Histology revealed a fixation of the collagen gel as an embolus agent in the perforation holes. CONCLUSIONS This novel collagen sol may be used for the endoscopic closure of intraprocedural perforation. Further studies will determine this collagen sol's clinical feasibility and safety.
Collapse
Affiliation(s)
- Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gumma, Japan
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Shunji Yunoki
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute, Tokyo, Japan
| | - Satoshi Kinoshita
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yusaku Takatori
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yuichiro Hirai
- Department of Gastroenterology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Hirohito Tanaka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gumma, Japan
| | - Takefumi Narita
- Biotechnology Group, Tokyo Metropolitan Industrial Technology Research Institute, Tokyo, Japan
| | - Masayuki Shimoda
- Department of Pathology, School of Medicine, Keio University, Tokyo, Japan
| |
Collapse
|
|
16
|
Vanbiervliet G, Moss A, Arvanitakis M, Arnelo U, Beyna T, Busch O, Deprez PH, Kunovsky L, Larghi A, Manes G, Napoleon B, Nalankilli K, Nayar M, Pérez-Cuadrado-Robles E, Seewald S, Strijker M, Barthet M, van Hooft JE. Endoscopic management of superficial nonampullary duodenal tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2021; 53:522-534. [PMID: 33822331 DOI: 10.1055/a-1442-2395] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
1: ESGE recommends that all duodenal adenomas should be considered for endoscopic resection as progression to invasive carcinoma is highly likely.Strong recommendation, low quality evidence. 2: ESGE recommends performance of a colonoscopy, if that has not yet been done, in cases of duodenal adenoma.Strong recommendation, low quality evidence. 3: ESGE recommends the use of the cap-assisted method when the location of the minor and/or major papilla and their relationship to a duodenal adenoma is not clearly established during forward-viewing endoscopy.Strong recommendation, moderate quality evidence. 4: ESGE recommends the routine use of a side-viewing endoscope when a laterally spreading adenoma with extension to the minor and/or major papilla is suspected.Strong recommendation, low quality evidence. 5: ESGE suggests cold snare polypectomy for small (< 6 mm in size) nonmalignant duodenal adenomas.Weak recommendation, low quality evidence. 6: ESGE recommends endoscopic mucosal resection (EMR) as the first-line endoscopic resection technique for nonmalignant large nonampullary duodenal adenomas.Strong recommendation, moderate quality evidence. 7: ESGE recommends that endoscopic submucosal dissection (ESD) for duodenal adenomas is an effective resection technique only in expert hands.Strong recommendation, low quality evidence. 8: ESGE recommends using techniques that minimize adverse events such as immediate or delayed bleeding or perforation. These may include piecemeal resection, defect closure techniques, noncontact hemostasis, and other emerging techniques, and these should be considered on a case-by-case basis.Strong recommendation, low quality evidence. 9: ESGE recommends endoscopic surveillance 3 months after the index treatment. In cases of no recurrence, a further follow-up endoscopy should be done 1 year later. Thereafter, surveillance intervals should be adapted to the lesion site, en bloc resection status, and initial histological result. Strong recommendation, low quality evidence.
Collapse
Affiliation(s)
- Geoffroy Vanbiervliet
- Department of Digestive Endoscopy, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Alan Moss
- Department of Endoscopic Services, Western Health, Melbourne, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Marianna Arvanitakis
- Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Urban Arnelo
- Department of Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Torsten Beyna
- Department of Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Nordrhein-Westfalen, Germany
| | - Olivier Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pierre H Deprez
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lumir Kunovsky
- Department of Gastroenterology and Internal Medicine, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianpiero Manes
- Aziende Socio Sanitaria Territoriale Rhodense, Gastroenterology, Garbagnate Milanese, Italy
| | - Bertrand Napoleon
- Service de Gastroentérologie, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Kumanan Nalankilli
- Department of Endoscopic Services, Western Health, Melbourne, Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Manu Nayar
- Department of Gastroenterology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Enrique Pérez-Cuadrado-Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Stefan Seewald
- Center of Gastroenterology Centre, Klinik Hirslanden, Zurich, Switzerland
| | - Marin Strijker
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, The Netherlands
| |
Collapse
|
|
17
|
Nakadate R, Iwasa T, Onogi S, Arata J, Oguri S, Okamoto Y, Akahoshi T, Eto M, Hashizume M. Surgical Robot for Intraluminal Access: An Ex Vivo Feasibility Study. CYBORG AND BIONIC SYSTEMS 2020; 2020:8378025. [PMID: 37063410 PMCID: PMC10097415 DOI: 10.34133/2020/8378025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/19/2020] [Indexed: 12/21/2022] Open
Abstract
Early-stage gastrointestinal cancer is often treated by endoscopic submucosal dissection (ESD) using a flexible endoscope. Compared with conventional percutaneous surgery, ESD is much less invasive and provides a high quality of life for the patient because it does not require a skin incision, and the organ is preserved. However, the operator must be highly skilled because ESD requires using a flexible endoscope with energy devices, which have limited degrees of freedom. To facilitate easier manipulation of these flexible devices, we developed a surgical robot comprising a flexible endoscope and two articulating instruments. The robotic system is based on a conventional flexible endoscope, and an extrapolated motor unit moves the endoscope in all its degrees of freedom. The instruments are thin enough to allow insertion of two instruments into the endoscope channel, and each instrument has a bending section that allows for up–down, right–left, and forward–backward motion. In this study, we performed an ex vivo feasibility evaluation using the proposed robotic system for ESD in a porcine stomach. The procedure was successfully performed by five novice operators without complications. Our findings demonstrated the feasibility of the proposed robotic system and, furthermore, suggest that even operators with limited experience can use this system to perform ESD.
Collapse
Affiliation(s)
- Ryu Nakadate
- Center for Advanced Medical Innovation, Kyushu University, Japan
| | - Tsutomu Iwasa
- Kitakyushu Municipal Medical Center, Kyushu University, Japan
| | - Shinya Onogi
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Japan
| | - Jumpei Arata
- Department of Mechanical Engineering, Kyushu University, Japan
| | - Susumu Oguri
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | | | - Tomohiko Akahoshi
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
| | - Masatoshi Eto
- Center for Advanced Medical Innovation, Kyushu University, Japan
- Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Japan
- Department of Urology, Kyushu University, Japan
| | | |
Collapse
|
|
18
|
Gastrectomy Versus Endoscopic Resection for Patients With Early-stage Gastric Adenocarcinoma: A Population-based Propensity Matching Study. J Clin Gastroenterol 2020; 54:871-878. [PMID: 31876838 DOI: 10.1097/mcg.0000000000001306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study aimed to compare the long-term results of patients who received these therapies. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried in this research for data of patients with early gastric adenocarcinoma who underwent gastrectomy or endoscopic resection from 2007 to 2015. Propensity score matching was selected to generate a balanced cohort. Competing-risk regression analysis was carried out on the matched cohort. Cancer-specific mortality (CSM) and other cause-specific mortality (OCSM) were compared using adjusted subdistribution hazard ratios (SHRs). RESULTS In this study, 2214 patients with 191 underwent endoscopic treatment (ET) and 2023 who underwent surgery were identified. After propensity score matching, 474 patients were included in the analysis. The use of ET increased over time in patients, especially for those with cardia diseases. The ratio of 5-year CSM between ET and gastrectomy groups was 13.12% to 14.24% and the ratio of 5-year OCSM between them was 22.48% versus 14.31%. After adjusting for associated clinicopathologic factors, patients in both groups had similar CSM (SHR=0.87, 95% credible interval: 0.47-1.64, P=0.69) and OCSM (SHR=1.59, 95% credible interval: 0.94-2.68, P=0.08) in multivariable analysis. CONCLUSION The long-term prognosis appears equivalent t in patients with endoscopic resection and gastrectomy.
Collapse
|
|
19
|
Costa-Santos MP, Ferreira AO, Mouradides C, Pérez-Cuadrado-Robles E, Yeung R, Garcés-Duran R, Snauwaert C, Dano H, Piessevaux H, Deprez PH. Is Lugol necessary for endoscopic resection of esophageal squamous cell neoplasia? Endosc Int Open 2020; 8:E1471-E1477. [PMID: 33043116 PMCID: PMC7541178 DOI: 10.1055/a-1198-4316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/22/2020] [Indexed: 12/27/2022] Open
Abstract
Background and study aims Recent evidence suggests that lugol chromoendoscopy (LCE) and narrow-band imaging (NBI) have comparable sensitivity for detection of superficial esophageal squamous cell carcinoma (SCC). However, LCE is time-consuming and associated with side effects. The aim of this study was to compare the effectiveness of NBI and LCE in defining resection margins of esophageal SCC. Patients and methods This was a retrospective observational cohort study of patients with esophageal SCC and dysplasia who underwent en-bloc resection between 1999 and 2017 at the Cliniques universitaires Saint-Luc, Brussels. Two groups were defined: 1) inspection with NBI only; and 2) inspection with LCE (with or without NBI). The primary endpoint was complete lateral resection rate. Multivariate regression was used to adjust for potential confounders. Results A total of 102 patients with 132 lesions were included. Lesions were inspected with LCE in 52 % (n = 68) and with NBI only in 48 % (n = 64). Lesions 0-IIa were more frequent in the NBI group (37 %) and 0-IIb (60 %) in LCE. Lesion location, size, and histology and resection technique (endoscopic submucosal dissection in 122/132 cases, 92 %) were similar between the groups. The rate of complete lateral resection for invasive carcinoma was 90 % in LCE group and 94 % in NBI group ( P = 0.498) and 65 % and 67 % ( P = 0.813), respectively, for dysplasia complete lateral resection. These results remained non-significant after adjusting for potential confounders. Conclusions Mucosal inspection and delineation of tumors with lugol chromoendoscopy before endoscopic resection of esophageal squamous cell lesions was not associated with increased complete lateral resection rate when compared to NBI.
Collapse
Affiliation(s)
| | | | - Christina Mouradides
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Enrique Pérez-Cuadrado-Robles
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ralph Yeung
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Rodrigo Garcés-Duran
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Snauwaert
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hélène Dano
- Pathology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hubert Piessevaux
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre H. Deprez
- Gastroenterology and Hepatology Department, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
|
20
|
Rajendran A, Pannick S, Thomas-Gibson S, Oke S, Anele C, Sevdalis N, Haycock A. Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy. Colorectal Dis 2020; 22:1085-1100. [PMID: 31925890 DOI: 10.1111/codi.14960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Abstract
AIM The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD). METHOD A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded. RESULTS A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases. CONCLUSION There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.
Collapse
Affiliation(s)
- A Rajendran
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK.,Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - S Pannick
- Department of Surgery and Cancer, Imperial College, London, UK
| | - S Thomas-Gibson
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S Oke
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - C Anele
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - A Haycock
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| |
Collapse
|
|
21
|
McCarty TR, Aihara H. Current state of education and training for endoscopic submucosal dissection: Translating strategy and success to the USA. Dig Endosc 2020; 32:851-860. [PMID: 31797470 DOI: 10.1111/den.13591] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/02/2019] [Indexed: 02/08/2023]
Abstract
Endoscopic submucosal dissection (ESD) is a rigorous and technically sophisticated method for removal of lesions within the gastrointestinal tract. Despite having advantages of en-bloc resection of lesions, regardless of size, and widespread use in Japan and Asia, ESD has not become widely adopted in the USA for a variety of reasons. Based upon Japanese education and the master-apprentice model, modification to the education system and additional techniques designed to facilitate broader adoption are required for trainees in the USA. This article will review the current state of education and training for ESD in the USA.
Collapse
Affiliation(s)
- Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
|
22
|
Lee JG, Park CH, Chung H, Park JC, Kim DH, Lee BI, Byeon JS, Jung HY. Current status and trend in training for endoscopic submucosal dissection: A nationwide survey in Korea. PLoS One 2020; 15:e0232691. [PMID: 32384112 PMCID: PMC7209322 DOI: 10.1371/journal.pone.0232691] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/19/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although endoscopic submucosal dissection (ESD) is widely used, the current status and trend in its training have yet to be fully evaluated. We aimed to investigate how ESD endoscopists have been trained in actual clinical practice. METHODS Endoscopists aged <45 years who have completed a gastroenterology fellowship or were currently in a fellowship for ≥2 years were included. We conducted a nationwide survey on the ESD training experiences of these endoscopists. RESULTS Among 79 young Korean endoscopists invited to participate in the survey, 68 (86.1%) trained in 24 major hospitals responded to the questionnaire. Twenty, 25, and 23 participants belonged to the second-year fellow, <5 years after training, and ≥5 years after training groups, respectively. Sixty-nine percent of the participants observed ≥50 ESD cases before starting ESD under supervision by an expert endoscopist. Additionally, 22% experienced ≥20 supervised ESDs during the training period. The proportion of the participants who underwent a hands-on course differed among the groups (≥5 years after training, 13.0%; <5 years after training, 40.0%; and second-year fellow, 50.0%; P = 0.027). ESD under supervision, observation, and hands-on course were the preferred methods for learning ESD (91.1%, 80.9%, and 35.3%, respectively). Overall, 42.6% of the participants were satisfied with their training program. More experience in supervised ESD (≥20 cases) was associated with an increased satisfaction (odds ratio, 6.65; 95% confidence interval, 1.62-36.31). CONCLUSIONS Observation and performance of ESD under the supervision of an expert endoscopist are the primary methods for learning ESD. Hands-on course program has been used more frequently in recent years.
Collapse
Affiliation(s)
- Jae Gon Lee
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyunsoo Chung
- Division of Gastroenterology, Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| |
Collapse
|
|
23
|
Maselli R, Iacopini F, Azzolini F, Petruzziello L, Manno M, De Luca L, Cecinato P, Fiori G, Staiano T, Rosa Rizzotto E, Angeletti S, Caruso A, Coppola F, Andrisani G, Viale E, Missale G, Panarese A, Mazzocchi A, Cesaro P, Campanale M, Occhipinti P, Tarantino O, Crosta C, Brosolo P, Sferrazza S, Rondonotti E, Amato A, Fuccio L, Costamagna G, Repici A. Endoscopic submucosal dissection: Italian national survey on current practices, training and outcomes. Dig Liver Dis 2020; 52:64-71. [PMID: 31629705 DOI: 10.1016/j.dld.2019.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Most of the evidence supporting endoscopic submucosal dissection (ESD) comes from Asia. European data are primarily reported by specialized referral centers and thus may not be representative of common European ESD practice. The aim of this study is to understand the current state of ESD practice across Italian endoscopy centers. METHODS All Italian endoscopists who were known to perform ESD were invited to complete a structured questionnaire including: operator features and competencies, ESD training details and clinical outcomes over a 2-year period. RESULTS Twenty-nine operators from 23 centers (69% response rate) completed the questionnaire: 18 (62%) were <50 years old; 7 (24%) were female; 16 (70%) were located in Northern Italy. Overall ESD volume was <40 cases in 9 (31%) operators, 40-80 in 8 (27.5%), 80-150 in 4 (13.8%) and >150 in 8 (27.5%). Colorectal ESD was predominant for operators with an experience >80 cases. En-bloc resection rates ranged from 77.2 to 97.2% depending on the anatomic location with an R0 resection rate range of 75.3-93.6%. ESD perforation rates in the colon and rectum were significantly lower when experience was >150 compared to 80-150 cases (p < 0.0001 and p = 0.006 for colon and rectum, respectively). CONCLUSION ESD in Italy is performed by a significant number of operators. Overall, Italian endoscopists performing ESD have achieved a good competence level. However, there is much variability in training protocols, initial supervision of procedures, practice settings, case mix and procedural volume/year that are likely responsible for some of the suboptimal resectional outcomes and increased perforation risk, mainly in the colon. Standardized training programs, practice parameters and auditing of outcomes are required.
Collapse
Affiliation(s)
- Roberta Maselli
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Milan, Italy.
| | | | - Francesco Azzolini
- Division of Gastroenterology & G.I. Endoscopy, Vita Salute San Raffaele University, Milan, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Division of Gastroenterology Fondazione A. Gemelli-Università Cattolica del Sacro Cuore Hospital, IRCCS, Rome, Italy
| | - Mauro Manno
- Digestive Endoscopy Unit, USL Modena, Carpi Hospital, Italy
| | - Luca De Luca
- Division of Gastroenterology & G.I. Endoscopy, Ospedali Riuniti Marche Nord Hospital, Pesaro, Italy
| | - Paolo Cecinato
- Unit of Gastroenterology and Digestive Endoscopy, USL-IRCCS Reggio Emilia Hospital, Reggio Emilia,Italy
| | - Giancarla Fiori
- IEO, Digestive Endoscopy Unit, Istituto Europeo di Oncologia IRCCS Hospital, Milano, Italy
| | - Teresa Staiano
- Digestive Endoscopy Unit, FPO-IRCCS Candiolo Cancer Institute, Candiolo, TO, Italy
| | - Erik Rosa Rizzotto
- Division of Gastroenterology & G.I. Endoscopy, S. Antonio Hospital, Padova, Italy
| | - Stefano Angeletti
- Digestive Endoscopy Unit, Sant'Andrea Hospital, a Sapienza university, Roma, Italy
| | - Angelo Caruso
- Division of Gastroenterology & G.I. Endoscopy, Baggiovara Hospital, AOU di Modena, Italy
| | - Franco Coppola
- Digestive Endoscopy Unit, Division of Gastroenterology, ASLTO4, Turin, Italy
| | | | - Edi Viale
- Division of Gastroenterology & G.I. Endoscopy, Vita Salute San Raffaele University, Milan, Italy
| | - Guido Missale
- Digestive Endoscopy Unit, ASST Spedali Civili, Brescia University, Italy
| | - Alba Panarese
- Department of Gastroenterology and Digestive Endoscopy, National Research Institute specialized in Gastroenterology ¨S. De Bellis¨ , Castellana Grotte, BA, Italy
| | - Alessandro Mazzocchi
- Gastroenterology Endoscopy Unit, San Giovanni Battista Hospital, San Giovanni battista, Italy
| | - Paola Cesaro
- Endoscopy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Mariachiara Campanale
- Digestive Endoscopy Unit, Division of Gastroenterology Fondazione A. Gemelli-Università Cattolica del Sacro Cuore Hospital, IRCCS, Rome, Italy
| | - Pietro Occhipinti
- Division of Gastroenterology, ¨ Maggiore della CaritਠHospital and University, Novara, Italy
| | - Ottaviano Tarantino
- Division of Gastroenterology & G.I. Endoscopy, San Giuseppe Hospital, ASL Toscana centro, Empoli, Italy
| | - Cristiano Crosta
- IEO, Digestive Endoscopy Unit, Istituto Europeo di Oncologia IRCCS Hospital, Milano, Italy
| | - Piero Brosolo
- Division of Gastroenterology, Hospital of Pordenone, Pordenone, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, APSS, Trento, Italy
| | - Emanuele Rondonotti
- Gastroenterology and Digestive Endoscopy Unit, Valduce Hospital, Como, Italy
| | - Arnaldo Amato
- Gastroenterology and Digestive Endoscopy Unit, Valduce Hospital, Como, Italy
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy; Cattolica del Sacro CuoreUniversity, Centre for Endoscopic Research Therapeutics and Training CERTT, Roma, Italy; Université de Strasbourg Institut d'Etudes Avancées USIAS, Strasbourg, France
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Milan, Italy; Humanitas University, Department of Biomedical Science, Milan, Italy
| |
Collapse
|
|
24
|
Fabritius M, Gonzalez JM, Becq A, Dray X, Coron E, Brenet-Defour L, Branche J, Gerard R, Lepage C, Poincloux L, Lienhart I, Bonniaud P, Bounnah MT, Rivory J, Lépilliez V, Subtil F, Saurin JC, Ponchon T, Jacques J, Pioche M. A simplified table using validated diagnostic criteria is effective to improve characterization of colorectal polyps: the CONECCT teaching program. Endosc Int Open 2019; 7:E1197-E1206. [PMID: 31579700 PMCID: PMC6773571 DOI: 10.1055/a-0962-9737] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/19/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction and study aims Accurate real-time endoscopic characterization of colorectal polyps is key to choosing the most appropriate treatment. Mastering the currently available classifications is challenging. We used validated criteria for these classifications to create a single table, named CONECCT, and evaluated the impact of a teaching program based on this tool. Methods A prospective multicenter study involving GI fellows and attending physicians was conducted. During the first session, each trainee completed a pretest consisting in histological prediction and choice of treatment of 20 colorectal polyps still frames. This was followed by a 30-minute course on the CONECCT table, before taking a post-test using the same still frames reshuffled. During a second session at 3 - 6 months, a last test (T3 M) was performed, including these same still frames and 20 new ones. Results A total 419 participants followed the teaching program between April 2017 and April 2018. The mean proportion of correctly predicted/treated lesions improved significantly from pretest to post-test and to T3 M, from 51.0 % to 74.0 % and to 66.6 % respectively ( P < 0.001). Between pretest and post-test, 343 (86.6 %) trainees improved, and 153 (75.4 %) at T3 M. Significant improvement occurred for each subtype of polyp for fellows and attending physicians. Between the two sessions, trainees continued to progress in the histology prediction and treatment choice of polyps CONECCT IIA. Over-treatment decreased significantly from 30.1 % to 15.5 % at post-test and to 18.5 % at T3 M ( P < 0.001). Conclusion The CONECCT teaching program is effective to improve the histology prediction and the treatment choice by gastroenterologists, for each subtype of colorectal polyp.
Collapse
Affiliation(s)
- Martin Fabritius
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jean-Michel Gonzalez
- Department of Endoscopy and Gastroenterology, Marseille university North Hospital, Marseille, France
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Aymeric Becq
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Department of Digestive Diseases, Sorbonne University & APHP, Saint-Antoine Hospital, Paris, France
| | - Xavier Dray
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Department of Digestive Diseases, Sorbonne University & APHP, Saint-Antoine Hospital, Paris, France
| | - Emmanuel Coron
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Department of Endoscopy and Gastroenterology, Nantes university Hospital, Nantes, France
| | - Lucie Brenet-Defour
- Department of Endoscopy and Gastroenterology, Reims university Hospital, Reims, France
| | - Julien Branche
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Department of Endoscopy and Gastroenterology, Lille university Hospital, Lille, France
| | - Romain Gerard
- Department of Endoscopy and Gastroenterology, Lille university Hospital, Lille, France
| | - Côme Lepage
- Department of Endoscopy and Gastroenterology, Reims university Hospital, Reims, France
| | - Laurent Poincloux
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Department of Endoscopy and Gastroenterology, Estaing university Hospital, Clermont-Ferrand, France
| | - Isabelle Lienhart
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Department of Endoscopy and Gastroenterology, Annecy Hospital, Metz-Tessy, France
| | - Paul Bonniaud
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Jérôme Rivory
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Vincent Lépilliez
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Department of Endoscopy and Gastroenterology, Mermoz hospital, Lyon.
| | - Fabien Subtil
- Univ. Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
| | - Jean-Christophe Saurin
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
| | - Thierry Ponchon
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Inserm U1032 LabTau, Lyon, France
| | - Jérémie Jacques
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Department of Endoscopy and Gastroenterology, Dupuytren university Hospital, Limoges, France
| | - Mathieu Pioche
- Department of Endoscopy and Gastroenterology, Pavillon L, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Research and development committee of the French Society of Digestive Endoscopy (SFED), Paris, France
- Inserm U1032 LabTau, Lyon, France
| |
Collapse
|
|
25
|
Araújo-Martins M, Pimentel-Nunes P, Libânio D, Borges-Canha M, Dinis-Ribeiro M. How Is Endoscopic Submucosal Dissection for Gastrointestinal Lesions Being Implemented? Results from an International Survey. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 27:1-17. [PMID: 31970235 PMCID: PMC6959092 DOI: 10.1159/000501404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/11/2019] [Indexed: 12/19/2022]
Abstract
Background and Study Aim Superficial gastrointestinal (GI) neoplasms can be treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD). These techniques are widely used in Eastern countries; however, its use in the West is limited. The aim of this study was to evaluate the current implementation of ESD in Western countries. Methods Western endoscopists (n = 279) who published papers related to EMR/ESD between 2005 and 2017 were asked to complete an online survey from December 2017 to February 2018. Results A total of 58 endoscopists (21%) completed the survey. Thirty performed ESD in the esophagus (52%), 45 in the stomach (78%), 36 in the co-lorectum (62%), and 6 in the duodenum (10%). The median total number of lesions ever treated per endoscopist was 190, with a median number per endoscopist in 2016 of 41 (7 [IQR 1-21], 6 [IQR 4-16], and 28 [5-63] in the esophagus, in the stomach, and in the colon and rectum, respectively). En bloc resection rates were 97% in the esophagus, 95% in the stomach, and 84% in the colorectum. Complete resection (R0) was achieved in 88, 91, and 81%, respectively. Curative rates were 69, 70, and 67%, respectively. Major complications (perforation or delayed bleeding) occurred more often in colorectal ESD (12 vs. 6% in the esophagus and 7% in the stomach). In the upper GI tract, the majority of resected lesions were intramucosal adenocarcinoma (59% in the esophagus; 47% in the stomach), while in the colorectum the majority were adenomas (59%). Conclusion ESD seems to be performed by a large number of centers and endoscopists. Our results suggest that ESD is being successfully implemented in Western countries, achieving a good rate of efficacy and safety according to European guidelines.
Collapse
Affiliation(s)
- Miguel Araújo-Martins
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Borges-Canha
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
|
26
|
An internal magnet traction device reduces procedure time for endoscopic submucosal dissection by expert and non-expert endoscopists: ex vivo study in a porcine colorectal model (with video). Surg Endosc 2019; 33:2696-2703. [PMID: 31069502 DOI: 10.1007/s00464-019-06817-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Efficacy of an internal magnet traction device (MTD) for gastric endoscopic submucosal dissection (ESD) by an expert endoscopist has been reported. We hypothesized that use of the MTD would enhance the performance of colorectal ESD in a non-expert endoscopist in ESD compared to the conventional technique. Primary aim of this study was to compare procedure times between conventional ESD (C-ESD) and MTD-assisted ESD (MTD-ESD) by expert and non-expert endoscopists in ESD. Secondary aims included rate of en bloc resection, iatrogenic injury, visualization score of the submucosal layer, and endoscopist satisfaction score. METHODS A total of 56 lesions were created in an ex vivo porcine colorectum. Two endoscopists completed C-ESD (n = 28) and MTD-ESD (n = 28). Lesions measured 3 cm in diameter and were located on either the anterior or posterior colorectal wall. The MTD consisted of a small neodymium magnet and nylon monofilament attached to a through-the-scope clip. The first MTD was deployed on the opposing colorectal wall of the target lesion and a second MTD was then deployed directly onto the distal margin of the lesion. RESULTS Total procedure time for MTD-ESD was significantly shorter than C-ESD for both expert (median: 15.8 vs. 19.3 min, p < 0.05) and non-expert (median: 21.3 vs. 33.9 min, p < 0.001) endoscopists. All lesions were resected en bloc. There was no iatrogenic muscularis propria injury in the MTD-ESD group. For both the expert and non-expert, scores for MTD-ESD were significantly higher for submucosal layer visualization (p < 0.05) and endoscopist satisfaction (p < 0.001) compared to C-ESD. CONCLUSIONS Use of the MTD significantly reduced procedure time for both expert and non-expert endoscopists performing ESD. Improving the efficiency, safety, and satisfaction of ESD with such a device particularly for non-expert endoscopists is appealing and could potentially minimize the complexity and duration of the procedure allowing for more widespread use of the technique.
Collapse
|
|
27
|
Yamazaki K, Moura EGHD, Veras MM, Mestieri LH, Sakai P. USEFULNESS OF GASTRIC SUBMUCOSAL DISSECTION DEPTH TO EVALUATE SKILL ACQUIREMENT IN SHORT TERM TRAINING COURSES IN ESD: AN EXPERIMENTAL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2018; 55:221-229. [PMID: 30540082 DOI: 10.1590/s0004-2803.201800000-58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/22/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is a complex endoscopic procedure, with high rates of adverse events and technical difficulties. To overcome that problem, many training centers published the importance of animal models for skill acquirement in ESD. However, no study has used the submucosal dissection depth (DSUB) as a parameter to evaluate the learning curve in ESD, which might be a relevant factor since an optimal resection plane is important to achieve a curative resection and avoid intraoperative complications. OBJECTIVE This study aimed to assess ESD skill acquirement after short-term training sessions by evaluating the submucosal dissection depth (DSUB) and the association with adverse events. METHODS This experimental study included 25 experienced endoscopists in therapeuthic procedures (>5years) and 75 specimens resected by ESD (three resections / endoscopist). Learning parameters (resection time, size, en bloc resection rate, bleeding, perforation and submucosal dissection depth) were prospectively evaluated. The percentages of DSUB of all specimens resected were calculated. RESULTS All specimens were resected from the gastric body (n=75). The mean size of the resected specimens was 23.97±7.2 mm. The number of adverse events, including bleeding, perforation, and death, were 17 (22.67%), 3 (4%), and 0 cases, respectively. The average mean time by the third dissection decreased from 28.44±9.73 to 18.72±8.81 min (P<0.001). The proportion of DSUB in the bleeding and non-bleeding group were respectively 37.97%±21.13% and 68.66%±23.99%, indicating a significant association between DSUB and bleeding incidence (P<0.001). The ROC curve analysis indicated a cut-off point of 61% (sensitivity, 64%; specificity, 94%) of submucosal dissection depth associated with bleeding. Therefore, when ESD was performed at a depth of >61% of the submucosal layer, the risk for bleeding during the procedure decreased (PPV, 0.97; 95% CI, 0.85-0.99). CONCLUSION Improvement in the learning curve in ESD and a better cognitive ability were seen by the third dissection in these short term training courses. And a significant association between DSUB and the risk of bleeding.
Collapse
Affiliation(s)
- Kendi Yamazaki
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Endoscopia Gastrointestinal, SP, Brasil
| | | | - Mariana Matera Veras
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, SP, Brasil
| | - Luiz Henrique Mestieri
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Endoscopia Gastrointestinal, SP, Brasil
| | - Paulo Sakai
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Endoscopia Gastrointestinal, SP, Brasil
| |
Collapse
|
|
28
|
Akizue N, Matsumura T, Maruoka D, Ishikawa K, Hang DV, Okimoto K, Saito K, Nakagawa T, Arai M, Kato N. Novel three-dimensional imaging system may facilitate gastric endoscopic submucosal dissection procedure: an ex vivo animal study. Endosc Int Open 2018; 6:E1431-E1435. [PMID: 30539065 PMCID: PMC6288759 DOI: 10.1055/a-0761-9649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/04/2018] [Indexed: 12/28/2022] Open
Abstract
Background and study aims Endoscopic submucosal dissection (ESD) requires advanced skills to perform safely without complications. The current study evaluated the usefulness of a novel three-dimensional (3D) imaging system in ESD using porcine stomachs. Methods Four endoscopists (two trainees and two experts) performed eight ESD procedures using both 3D and 2D images. The usefulness of 3D image versus 2D image was evaluated by visibility and procedure time. In addition, occurrence of eyestrain and dizziness in 3D image was assessed. Results En bloc resection was successfully achieved, without perforation, in all cases. The evaluation score in the 3D image group was better than that in the 2D image group, particularly depth perception was statistically significantly good. No significant difference was found in the working speed between the 2D and 3D image groups. Two examiners experienced eyestrain and dizziness while using the 3D image. Conclusions All the ESD procedures were performed safely. Depth perception using the 3D image was better than with the 2D image. A novel 3D image system may facilitate ESD.
Collapse
Affiliation(s)
- Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan,Corresponding author Tomoaki Matsumura, MD Department of GastroenterologyGraduate School of MedicineChiba UniversityInohana 1-8-1, Chiba-City, 260-8670Japan+81-43-226-2083+81-43-226-2088
| | - Daisuke Maruoka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kentaro Ishikawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Dao Viet Hang
- Endoscopic Center, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoo Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Makoto Arai
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
|
29
|
Kwak MS, Yang DH, Hwang SW, Bae JH, Soh JS, Lee S, Lee HS, Lee HJ, Park SH, Ye BD, Byeon JS, Myung SJ, Yang SK. Safety of simultaneous endoscopic submucosal dissection for two large colorectal neoplasias in the same patient. TURKISH JOURNAL OF GASTROENTEROLOGY 2018; 29:183-190. [PMID: 29749325 DOI: 10.5152/tjg.2018.17409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Multiple large colorectal lesions requiring endoscopic submucosal dissection (ESD) are sometimes diagnosed during colonoscopy. We evaluated the feasibility and safety of ESD of two colorectal lesions in one session. MATERIALS AND METHODS The lesions of 16 patients who underwent two ESD procedures in a single session (double ESD group) from November 2009 to July 2014 were matched with those of 64 patients who underwent a single ESD procedure (single ESD group) based on the size and location of the lesion and presence of submucosal fibrosis. RESULTS The net ESD time per patient was longer in double ESD group than in single ESD group (104.0±36.2 vs. 59.1±39.2 min, p<0.001). The net ESD time per lesion tended to be shorter in double ESD group than in single ESD group (49.6±30.0 vs. 59.1±39.2 min, p=0.077). The en bloc resection and curative resection rates did not differ between double ESD and single ESD groups (93.8 % vs. 98.4%, p=0.262; 90.6 % vs. 84.4 %, p=0.534, respectively). The intra- and postprocedural bleeding rates were 12.5% and 0% in double ESD group and 15.6% and 3.1% in single ESD group, respectively. Perforation occurred in two (6.3%) in double ESD group and in six (9.4%) in single ESD group (p=0.715). CONCLUSION Compared with the single ESD, two simultaneous colorectal ESD procedures in a patient did not increase complications; the en bloc and curative resection rates were similar when performed a single ESD procedure and two simultaneous ESD procedures.
Collapse
Affiliation(s)
- Min Seob Kwak
- Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gang Dong, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Ho Bae
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Seung Soh
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seohyun Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho-Su Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyo Jeong Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
|
30
|
Bahin FF, Heitman SJ, Rasouli KN, Mahajan H, McLeod D, Lee EYT, Williams SJ, Bourke MJ. Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis. Gut 2018; 67:1965-1973. [PMID: 28988198 DOI: 10.1136/gutjnl-2017-313823] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/29/2017] [Accepted: 09/10/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the cost-effectiveness of endoscopic submucosal dissection (ESD) and wide-field endoscopic mucosal resection (WF-EMR) for removing large sessile and laterally spreading colorectal lesions (LSLs) >20 mm. DESIGN An incremental cost-effectiveness analysis using a decision tree model was performed over an 18-month time horizon. The following strategies were compared: WF-EMR, universal ESD (U-ESD) and selective ESD (S-ESD) for lesions highly suspicious for containing submucosal invasive cancer (SMIC), with WF-EMR used for the remainder. Data from a large Western cohort and the literature were used to inform the model. Effectiveness was defined as the number of surgeries avoided per 1000 cases. Incremental costs per surgery avoided are presented. Sensitivity and scenario analyses were performed. RESULTS 1723 lesions among 1765 patients were analysed. The prevalence of SMIC and low-risk-SMIC was 8.2% and 3.1%, respectively. Endoscopic lesion assessment for SMIC had a sensitivity and specificity of 34.9% and 98.4%, respectively. S-ESD was the least expensive strategy and was also more effective than WF-EMR by preventing 19 additional surgeries per 1000 cases. 43 ESD procedures would be required in an S-ESD strategy. U-ESD would prevent another 13 surgeries compared with S-ESD, at an incremental cost per surgery avoided of US$210 112. U-ESD was only cost-effective among higher risk rectal lesions. CONCLUSION S-ESD is the preferred treatment strategy. However, only 43 ESDs are required per 1000 LSLs. U-ESD cannot be justified beyond high-risk rectal lesions. WF-EMR remains an effective and safe treatment option for most LSLs. TRIAL REGISTRATION NUMBER NCT02000141.
Collapse
Affiliation(s)
- Farzan F Bahin
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Steven J Heitman
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Khalid N Rasouli
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Hema Mahajan
- Department of Anatomical Pathology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Duncan McLeod
- Department of Anatomical Pathology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Eric Y T Lee
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Stephen J Williams
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
|
31
|
Friedel D, Stavropoulos SN. Introduction of endoscopic submucosal dissection in the West. World J Gastrointest Endosc 2018; 10:225-238. [PMID: 30364783 PMCID: PMC6198314 DOI: 10.4253/wjge.v10.i10.225] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/21/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is well established in Asia as a modality for selected advanced lesions of both the upper and lower gastrointestinal tract, but ESD has not attained the same niche in the West due to a variety of reasons. These include competition from traditional surgery, minimally invasive surgery and endoscopic mucosal resection. Other obstacles to ESD introduction in the West include time commitment for learning and doing procedures, a steep learning curve, special equipment, lack of mentors, cost issues, interdisciplinary conflicts, concern regarding complications and lack of support from institutions and interfacing departments. There are intrinsic differences in pathology prevalence (e.g., early gastric cancer) between the two regions that are less conducive for ESD implementation in the West. We will elaborate on these issues and suggest measures as well as a protocol to overcome these obstacles and hopefully allow introduction of ESD as a tenable option for appropriate patients.
Collapse
Affiliation(s)
- David Friedel
- Gastroenterology, NYU Winthrop Hospital, Mineola, NY 11501, United States
| | | |
Collapse
|
|
32
|
Pérez-Cuadrado-Robles E, Quénéhervé L, Margos W, Shaza L, Ivekovic H, Moreels TG, Yeung R, Piessevaux H, Coron E, Jouret-Mourin A, Deprez PH. Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors. Endosc Int Open 2018; 6:E1008-E1014. [PMID: 30083592 PMCID: PMC6075950 DOI: 10.1055/a-0577-7546] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The choice of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in non-ampullary superficial duodenal tumors (NASDTs) is challenging and the benefits of ESD remain unclear. The aim was to comparatively analyze the feasibility, outcomes and safety of these techniques in these lesions. PATIENTS AND METHODS This is an observational and retrospective study. All consecutive patients presenting with NASDTs who underwent EMR or ESD between 2005 and 2017 were included. The following main outcomes were comparatively evaluated: en-bloc and complete (R0) resection rates, and local recurrence. Secondary outcomes were perforation and delayed bleeding. RESULTS One hundred sixty-six tumors in 150 patients (age: 66 years, range: 31 - 83, 42.7 % males) were resected by ESD (n = 37) or EMR (n = 129) and included. The median procedure time (81 vs. 50 min, P = 0.007) and tumor size (25 vs. 20 mm, P = 0.01) were higher in the ESD group. The global malignancy rate was 50.3 %. There were no differences in en-bloc resection (29.7 % vs. 44.2 %, P = 0.115), complete resection (19.4 % vs. 35.5 %, P = 0.069), and local recurrence (14.7 % vs. 16.7 %, P = 0.788) rates. Tumor size was associated with recurrence (28 vs. 20 mm, P = 0.008), with a median follow-up of 6.5 months. Focal recurrence (n = 22, 13.3 %) was treated endoscopically in 86.4 %. En-bloc resection in the ESD group was comparable in large ( ≥ 20 mm) and small lesions (27.6 % vs. 37.5 %, P = 0.587), while this outcome decreased significantly in large lesions resected by EMR (17.4 % vs. 75 %, P < 0.001). Nine perforations were confirmed in 6 lesions (16.2 %) resected by ESD and 3 (2.3 %) by EMR ( P = 0.001). Endoscopic therapy was successful in all but 1 patient (88.9 %) presenting with a delayed perforation. CONCLUSIONS ESD may be an alternative to EMR and surgery in selected NASDTs, such as large duodenal tumors where EMR achieves low en-bloc resection rates and the local recurrence may be higher. However, this technique may have a higher risk of perforations.
Collapse
Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lucille Quénéhervé
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Walter Margos
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Leila Shaza
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hrvoje Ivekovic
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tom G. Moreels
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ralph Yeung
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hubert Piessevaux
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Emmanuel Coron
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Anne Jouret-Mourin
- Department of Pathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre H. Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium,Corresponding author Pierre H. Deprez Department of Hepato-GastroenterologyCliniques universitaires Saint-LucUniversité Catholique de LouvainBrusselsBelgium
| |
Collapse
|
|
33
|
Pérez-Cuadrado-Robles E, Quénéhervé L, Margos W, Moreels TG, Yeung R, Piessevaux H, Coron E, Jouret-Mourin A, Deprez PH. ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis. Endosc Int Open 2018; 6:E998-E1007. [PMID: 30083591 PMCID: PMC6075947 DOI: 10.1055/a-0579-9050] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/02/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) has been developed as an option for treatment of esophageal, gastric and colorectal lesions. However, there is no consensus on the role of ESD in duodenal tumors. METHODS This systematic review and meta-analysis compared ESD and endoscopic mucosal resection (EMR) in sporadic non-ampullary superficial duodenal tumors (NASDTs), including local experience. We conducted a search in PubMed, Scopus and the Cochrane library up to August 2017 to identify studies that compared both techniques reporting at least one main outcome (en-bloc/complete resection, local recurrence). Pooled outcomes were calculated under fixed and random-effect models. Subgroup analyses were conducted. RESULTS A total of 753 patients presenting with 784 NASDTs (242 ESD, 542 EMR) in 14 studies were included. Tumor size (MD: 5.88, [CI95 %: 2.15, 9.62], P = 0.002, I 2 = 79 %) and procedure time (MD: 65.65, [CI95 %: 40.39, 90.92], P < 0.00001, I 2 = 88 %) were greater in the ESD group. En-bloc resection rate was significantly higher in Asian studies (OR: 2.16 [CI95 %: 1.15, 4.08], P = 0.02, I 2 : 46 %). ESD provided a higher complete resection rate (OR: 1.63 [I95 %: 1.06, 2.50], P = 0.03, I 2 : 59 %), but there was no risk difference in the risk of local recurrence (RD: - 0.03 [CI95 %: - 0.07, 0.01], P = 0.15, I 2 : 0 %) or delayed bleeding. ESD was associated with an increased number of intraoperative perforations [RD: 0.12 (CI95 %: 0.04, 0.20), P = 0.002, I 2 : 56 %] and emergency surgery for delayed perforations. The inclusion of eligible studies was limited to retrospective series with inequalities in comparative groups. CONCLUSIONS Duodenal ESD for NASDTs may achieve higher en-bloc and complete resections at the expense of a greater perforation rate compared to EMR. The impact on local recurrence remains uncertain.
Collapse
Affiliation(s)
- Enrique Pérez-Cuadrado-Robles
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Lucille Quénéhervé
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Walter Margos
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tom G. Moreels
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ralph Yeung
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Hubert Piessevaux
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Emmanuel Coron
- Institut des Maladies de l’Appareil digestif, University Hospital of Nantes, France
| | - Anne Jouret-Mourin
- Department of Pathology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre H. Deprez
- Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
|
34
|
Chapelle N, Musquer N, Métivier-Cesbron E, Luet D, Volteau C, Le Rhun M, Coron E. Efficacy of a three-day training course in endoscopic submucosal dissection using a live porcine model: a prospective evaluation. United European Gastroenterol J 2018; 6:1410-1416. [PMID: 30386614 DOI: 10.1177/2050640618788694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/18/2018] [Indexed: 12/12/2022] Open
Abstract
Background Endoscopic submucosal dissection is currently regarded as the method of choice for the resection of superficial tumours. The objective of our study was to evaluate prospectively the efficiency of an endoscopic submucosal dissection training course using live anaesthetised pigs. Methods Fourteen novice endoscopists participated in three gastric endoscopic submucosal dissection training courses on anaesthetised pigs. Each trainee resected five 'fake' antral lesions. Resected specimen sizes, endoscopic submucosal dissection speeds and the complication rate were evaluated prospectively. Results Among the 70 procedures performed, 58 could be analysed. There was a strong increase in endoscopic submucosal dissection speed (from 9.7 mm2/minute to 30.4 mm2/minute) during the sessions, marked between the first two endoscopic submucosal dissections compared with the fourth and fifth. There was a significant relation between the surface area of the resected lesion and procedure speed (P < 0.0001). The complication rate was 8.6%. Conclusion There is a clear benefit from endoscopic submucosal dissection training courses on animal models. Improved endoscopist capability is evident from the third endoscopic submucosal dissection. These data validate the indispensable nature of dedicated training courses and echo the European Society of Gastrointestinal Endoscopy proposition for multistep learning, beginning on animal models.
Collapse
Affiliation(s)
- Nicolas Chapelle
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - Nicolas Musquer
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France.,CEREDI, Faculté de médecine, Angers, France
| | - Elodie Métivier-Cesbron
- CEREDI, Faculté de médecine, Angers, France.,Service de gastro-entérologie, CHU Angers, Angers, France
| | - Dominique Luet
- CEREDI, Faculté de médecine, Angers, France.,Service de gastro-entérologie, CHU Angers, Angers, France
| | | | - Marc Le Rhun
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France.,CEREDI, Faculté de médecine, Angers, France
| | - Emmanuel Coron
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France.,CEREDI, Faculté de médecine, Angers, France.,Université de Nantes, INSERM, Institut des Maladies de l'Appareil Digestif, The enteric nervous system in gut and brain disorders, Nantes, France
| |
Collapse
|
|
35
|
Wagner A, Neureiter D, Kiesslich T, Wolkersdörfer GW, Pleininger T, Mayr C, Dienhart C, Yahagi N, Oyama T, Berr F. Single-center implementation of endoscopic submucosal dissection (ESD) in the colorectum: Low recurrence rate after intention-to-treat ESD. Dig Endosc 2018; 30:354-363. [PMID: 29218732 DOI: 10.1111/den.12995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Colorectal endoscopic submucosal dissection (ESD) shows higher R0 resection and lower local recurrence rates than endoscopic mucosal resection (EMR) in Japan. In Europe, independent learning of ESD in the colorectum is feasible, but yet to be analyzed for curative resection and recurrence rates. METHODS After experimental training under supervision by Japanese experts (T.O., N.Y.), three endoscopists independently carried out 83 ESD procedures intention-to-treat for lesions in the entire colorectum of 67 patients in a prospective registry (November 2009 to June 2016). RESULTS ESD was feasible in 80 (96%) colorectal neoplasias (mean diameter 33.6 [± 1.8] mm), and three more required conversion to piecemeal EMR. The lesions were adenomas in 66% with low-grade intraepithelial neoplasia (LGIN), 29% with high-grade intraepithelial neoplasia, and 5% with carcinomas (G2, pT1). ESD had to be facilitated by the final use of snaring (hybrid-ESD, n = 45), especially in the initial learning period. En-bloc resection rate was 85%. Complications were microperforations (7%, conducive to one hemicolectomy), and delayed bleeding (1%) without mortality or long-term morbidity. Residual adenomas with LGIN (5%) after hybrid-ESD did not recur after endoscopic ablation. All malignant neoplasias (34%) were curatively resected without recurrence after a mean follow up of 19.5 (± 3.2) months. CONCLUSIONS During independent ESD learning in the colorectum, ESD intention-to-treat showed a low recurrence rate after appropriate training, and hybrid-ESD showed acceptable complication and recurrence rates, justifying hybrid-ESD as a strategy for self-completion and rescue.
Collapse
Affiliation(s)
- Andrej Wagner
- Department of Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Tobias Kiesslich
- Department of Medicine I, Paracelsus Medical University, Salzburg, Austria.,Laboratory for Tumour Biology and Experimental Therapies (TREAT), Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| | | | - Thomas Pleininger
- Department of Medicine I, Paracelsus Medical University, Salzburg, Austria
| | - Christian Mayr
- Department of Medicine I, Paracelsus Medical University, Salzburg, Austria.,Laboratory for Tumour Biology and Experimental Therapies (TREAT), Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| | | | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
| | - Frieder Berr
- Department of Medicine I, Paracelsus Medical University, Salzburg, Austria.,Laboratory for Tumour Biology and Experimental Therapies (TREAT), Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
| |
Collapse
|
|
36
|
Ebigbo A, Probst A, Römmele C, Messmann H. Step-up training for colorectal and gastric ESD and the challenge of ESD training in the proximal colon: results from a German Center. Endosc Int Open 2018; 6:E524-E530. [PMID: 29713678 PMCID: PMC5909775 DOI: 10.1055/a-0584-6457] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/12/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND STUDY AIMS The endoscopic submucosal dissection (ESD) of cancerous and precancerous lesions in the gastrointestinal (GI) tract is an effective but difficult-to-learn procedure, especially for Western endoscopists. We developed a step-up training protocol and evaluated its outcome on a single endoscopist using specific performance measures. PATIENTS AND METHODS The training protocol included a 12-month period of 50 observational and supervised ESD cases as well as 24 animal procedures. After completion of the protocol, ESD competency was evaluated in the first 30 independent ESD cases. Majority of lesions were located in the stomach and rectum. Performance measures included R0-resection rate, complication rate and resection speed. RESULTS R0 resection rate was 93 %, complication rate was 7 % and median resection speed was 6,77 cm 2 /h. 1 case of delayed perforation with subsequent hemicolectomy occurred in the descending colon. CONCLUSION The ESD step-up training protocol used in this study on a single endoscopist showed excellent outcomes for lesions in the rectum and stomach. However, ESD training in the upper colon remains a challenge.
Collapse
Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Klinikum Augsburg,Corresponding author Dr. Alanna Ebigbo Central Clinic of Augsburg – GastroenterologyStenglinstr. 2Augsburg 86156Germany+00498214002748
| | | | | | | |
Collapse
|
|
37
|
Schlachterman A, Yang D, Goddard A, Gotoda T, Draganov PV. Perspectives on endoscopic submucosal dissection training in the United States: a survey analysis. Endosc Int Open 2018; 6:E399-E409. [PMID: 29607391 PMCID: PMC5876020 DOI: 10.1055/s-0044-101452] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 01/03/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic submucosal dissection (ESD) is a widely accepted method for en-bloc resection of dysplastic lesions and early cancer in Asia and Europe. A limiting factor in adoption of ESD in the United States is perceived lack of training opportunities. The aims of this study were to: (1) evaluate ESD experience of attendees at a University-sponsored ESD training course; (2) characterize effectiveness of the current ESD training regimen and its impact on ESD adoption in the United States; and (3) gauge trainees' attitude towards ESD. PATIENTS AND METHODS An electronic anonymous survey was distributed to the 86 physicians who participated in the University of Florida's annual ESD course from 2014 to 2016. Main outcomes included participants' practice setting, prior training, current ESD techniques, and planned training. RESULTS A total of 34 participants (40 %) completed the survey. Most of the respondents routinely use one or more endoscopic mucosal resection (EMR) techniques (97.1 %) in their practice. Most respondents (79 %) had no experience with ESD on humans prior to the ESD course. Following completion of course training, more participants reported ongoing hands-on ESD exposure, with 15/34 (44 %) having performed ESD in humans. Most participants identified potential hurdles for adoption of ESD. CONCLUSION A dedicated ESD training course with hands-on experience, under the guidance of experts, notably increased use of ESD among participants. Limited availability of structured training opportunities, concerns over procedural length, lack of adequate number of lesions, and potential for serious adverse events (AEs) were identified as the main factors slowing adoption of ESD in the United States.
Collapse
Affiliation(s)
- Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Dennis Yang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - April Goddard
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine Nihon University School of Medicine, Tokyo, Japan
| | - Peter V. Draganov
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Florida, Gainesville, Florida, United States,Corresponding author Peter V. Draganov, MD Division of GastroenterologyUniversity of Florida1329 SW 16th Street, Suite 5251Gainesville, FL 32608+1-352-627-9002
| |
Collapse
|
|
38
|
Endoscopic eradication therapy for Barrett’s esophagus: Adverse outcomes, patient values, and cost-effectiveness. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
|
39
|
Küttner-Magalhães R, Dinis-Ribeiro M, Bruno MJ, Marcos-Pinto R, Rolanda C, Koch AD. Training in endoscopic mucosal resection and endoscopic submucosal dissection: Face, content and expert validity of the live porcine model. United European Gastroenterol J 2017; 6:547-557. [PMID: 29881610 DOI: 10.1177/2050640617742484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/17/2017] [Indexed: 12/15/2022] Open
Abstract
Introduction Endoscopic mucosal resection and endoscopic submucosal dissection are demanding procedures. This study aims to establish face, content and expert validity of the live porcine model in performing endoscopic mucosal resection, endoscopic submucosal dissection, complication management and to assess it as a training tool. Material and methods Tutors and trainees participating in live porcine model endoscopic mucosal resection and endoscopic submucosal dissection workshops filled out a questionnaire regarding the realism of the model compared to human setting and its role as a learning tool. A 10-point Likert scale was used. Results Ninety-one endoscopists (13 tutors; 78 trainees) were involved in four workshops. Median global classifications for the realism of the life porcine model ranged between 7.0-8.0 (interquartile range 5.0-9.0). Procedures resembled human cases with a median of 9.0 (8.0-9.0) for oesophageal multiband endoscopic mucosal resection; 8.5 (8.0-9.0) for oesophageal endoscopic submucosal dissection; 9.0 (8.0-10.0) for gastric endoscopic submucosal dissection; and 9.0 (8.5-9.75 and 8.0-9.69) for complication detection and management. The animal model as a learning tool had median scores of 9.0 (7.0-10.0) considering how procedures are performed; 9.0-9.5 (8.0-10.0) for usefulness for beginners; and 9.0-10.0 (5.0-10.0) regarding it a prerequisite. Conclusions Training in a live porcine model was considered very realistic compared to the human setting and was highly appreciated as a learning tool. This is the first study to establish face, content and expert validity of the live porcine model in performing multiband endoscopic mucosal resection, oesophageal and gastric endoscopic submucosal dissection. The validation of this model provides the rationale to incorporate it into formal teaching programmes.
Collapse
Affiliation(s)
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Oncology Portuguese Institute of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) and Center for Research in Health Technologies and Services (CINTESIS), Faculty of Medicine of Porto, Porto, Portugal
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ricardo Marcos-Pinto
- Department of Gastroenterology, Santo António Hospital, Porto Hospital Centre, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS) and Center for Research in Health Technologies and Services (CINTESIS), Faculty of Medicine of Porto, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Carla Rolanda
- Department of Gastroenterology, Braga Hospital, Braga, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.,ICVS/3B's, PT Government Associate Laboratory, Braga, Portugal
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
|
40
|
Kasapidis P, Bassioukas S, Mavrogenis G, Tribonias G, Delis K, Georgopoulos S, Christodoulou D, Emmanouil T, Paraskeva K, Panteris V, Papalois A, Triantafillidis J, Tsiamoulos Z, Fukuhara T, Komeda Y, Kashida H. Experimental gastric endoscopic submucosal dissection: training in a porcine model. Ann Gastroenterol 2017; 30:446-449. [PMID: 28655983 PMCID: PMC5479999 DOI: 10.20524/aog.2017.0147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/05/2017] [Indexed: 12/18/2022] Open
Abstract
Background Endoscopic submucosal dissection (ESD) requires special skills and a long procedure time for a quality-controlled procedure. A universal training system remains to be established. Hands-on courses in animal models before advancing to the human colon appear to be essential, especially in Europe. The learning curve is a prerequisite in ESD, in order to improve technical outcomes and decrease the rate of procedural adverse events. Methods In the experimental research center of ELPEN Pharmaceuticals, 18 European endoscopists, inexperienced at ESD, performed gastric ESDs in porcine models. The course lasted two days and was conducted under the supervision of experts. Results A total of 72 of 76 ESDs were completed en bloc (94.7%). The procedural time and cutting speed differed significantly between the first and second day: 48±4.4 vs. 43±4.8 min (P=0.0045), and 1.38±0.20 vs. 1.63±0.23 cm2/min (P=0.0033), respectively. The complications were not significantly different between the two groups: five (13.88%) vs. four (11%) episodes of bleeding (P>0.05). The perforation rate was similar, at two episodes per day (5.55%). We documented an acceptable rate of en bloc resections and complications. Conclusion ESD demands a new level of endoscopic skills in Europe. A formal sequential training program, using porcine models, may benefit countries with a low volume of cases.
Collapse
Affiliation(s)
- Panagiotis Kasapidis
- Head, Department of Gastroenterology and Endoscopy Unit, Central Clinic, Athens, Greece (Panagiotis Kasapidis)
| | | | - Georgios Mavrogenis
- Department of Endoscopy, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis)
| | - Georgios Tribonias
- Department of Endoscopy, Eugenideio Hospital, Athens, Greece (Georgios Tribonias)
| | - Konstantinos Delis
- Department of Gastroenterology, Metropolitan Hospital, Piraeus, Greece (Konstantinos Delis)
| | - Sotirios Georgopoulos
- Department of Gastroenterology and Endoscopy Unit, Athens Medical Center, Faliron, Athens, Greece (Sotirios Georgopoulos)
| | - Dimitrios Christodoulou
- Gastroenterology Department, University of Ioannina, School of Medicine, Ioannina, Greece (Dimitrios Christodoulou)
| | | | - Konstantina Paraskeva
- Department of Gastroenterology, Konstantopoulion General Hospital, Athens, Greece (Konstantina Paraskeva)
| | | | | | | | - Zacharias Tsiamoulos
- GI Endoscopy East Kent University Hospitals Trust Senior Clinical Researcher, Imperial College, London St Mark's Hospital/Academic Institute, United Kingdom (Zacharias Tsiamoulos)
| | - Takataro Fukuhara
- Department of Molecular Genetics, Institute for Biomedical Science, Division of Gastroenterology and Hepatology, The Third Department of Internal Medicine, Kansai Medical University, Hirakata, Osaka, Japan (Takataro Fukuhara)
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Ohno-Higashi, Osaka-Sayama, Osaka, Japan, Faculty of Medicine, Kindai University (Yoriaki Komeda, Hiroshi Kashida)
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Ohno-Higashi, Osaka-Sayama, Osaka, Japan, Faculty of Medicine, Kindai University (Yoriaki Komeda, Hiroshi Kashida)
| |
Collapse
|
|
41
|
Neuhaus H. Early gastric cancer in super-agers: To treat or not to treat? Gastrointest Endosc 2017; 85:973-975. [PMID: 28411764 DOI: 10.1016/j.gie.2016.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 12/15/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Horst Neuhaus
- Department of Internal Medicine, Evangelisches Krankenhaus Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
|
42
|
Shiga H, Ohba R, Matsuhashi T, Jin M, Kuroha M, Endo K, Moroi R, Kayaba S, Iijima K. Feasibility of colorectal endoscopic submucosal dissection (ESD) carried out by endoscopists with no or little experience in gastric ESD. Dig Endosc 2017; 29 Suppl 2:58-65. [PMID: 28425662 DOI: 10.1111/den.12814] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/16/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Colorectal endoscopic submucosal dissection (ESD) is recommended to be carried out only by endoscopists with sufficient experience in gastric ESD. However, early gastric carcinoma is less common in Western countries than in Japan, and endoscopic maneuverability differs between the stomach and colorectum. We assessed the feasibility of colorectal ESD carried out by endoscopists with no or little experience in gastric ESD. METHODS We analyzed en bloc resection, R0 resection and perforation rates in 180 consecutive colorectal ESD carried out by three endoscopists who had no or <5 cases of experience in gastric ESD. We also identified factors associated with R0 resection failure. RESULTS Overall en bloc and R0 resection rates were 93.3% (168/180) and 82.2% (148/180), respectively. All 11 cases with perforation were treated endoscopically. Dividing 180 cases into three learning phases (early, middle, or late phases), the en bloc and R0 resection rates increased from 88.3% and 75.0% in the early phase to 98.3% and 88.3% in the late phase, respectively. Perforation rate also improved from 10.0% to 3.3%. Factors associated with R0 resection failure were location at junctions (odds ratio: 6.8, 95% CI: 1.9-27.5), preoperative factors reflecting fibrosis (5.8, 1.9-19.0), and late phase (0.2, 0.1-0.7). CONCLUSION Endoscopists without experience in gastric ESD carried out colorectal ESD safely. In the early and middle phases (≤40 cases), they should treat mainly rectal lesions but may also resect lesions in the colon avoiding flexures. Lesions located at junctions and those with preoperative factors reflecting fibrosis should be resected after completing 40 procedures.
Collapse
Affiliation(s)
- Hisashi Shiga
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Reina Ohba
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Mario Jin
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| | - Masatake Kuroha
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Katsuya Endo
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rintaro Moroi
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Shoichi Kayaba
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan
| | - Katsunori Iijima
- Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
|
43
|
Spychalski M, Koptas W, Zelga P, Dziki A. Role of endoscopic submucosal dissection in treatment of rectal gastroenteropancreatic neuroendocrine neoplasms. PRZEGLAD GASTROENTEROLOGICZNY 2017; 12:17-21. [PMID: 28337231 PMCID: PMC5360662 DOI: 10.5114/pg.2016.64635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 12/24/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A significant rise in incidence of rectal gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) has been observed in the last decade. Most detected gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are well differentiated and less than 2 cm in diameter. Endoscopic submucosal dissection (ESD) is a new method for endoscopic treatment of such tumors, difficult to resect by conventional endoscopic techniques and thus subject to surgical treatment. AIM To present the results of the endoscopic treatment of GEP NET tumors in the rectum using ESD in single academic center. MATERIAL AND METHODS From June 2013 to April 2014, 4 cases of GEP-NET in the rectum were treated by ESD in our center. Effectiveness of dissection, complications and tumor recurrence after 3 months of treatment were then retrospectively investigated. RESULTS The group contained 2 patients with primary rectal GEP-NET (1 male, 1 female; age range: 48-60 years) and 2 with scars after incomplete polypectomy of rectal GEP-NET (1 male, 1 female; 61-65 years). Primary rectal GEP-NET diameters were 0.6 cm and 1.5 cm. Scar resection specimen diameters were 0.7 cm and 1 cm. Mean resection time was 28 min. The en bloc resection rate was 100% (2 of 2) and the histologically complete resection was confirmed in both cases. No foci of neuroendocrine neoplasia were reported in dissected scars. No complications were observed. After 3 months, 3 patients underwent follow-up colonoscopy - no local recurrence was reported. CONCLUSIONS Endoscopic submucosal dissection of rectal GEP-NET should be recommended as a treatment of choice when dealing with lesions over 1 cm in diameter without invasion of the muscle layer. Due to technical difficulties, performing this procedure should be reserved for centers with appropriately trained endoscopic staff.
Collapse
Affiliation(s)
- Michał Spychalski
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Włodzimierz Koptas
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Piotr Zelga
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| |
Collapse
|
|
44
|
Jacques J, Legros R, Charissoux A, Mesturoux L, Couquet CY, Carrier P, Tabouret T, Valgueblasse V, Debette-Gratien M, Le-Sidaner A, Loustaud-Ratti V, Sautereau D. A local structured training program with live pigs allows performing ESD along the gastrointestinal tract with results close to those of Japanese experts. Dig Liver Dis 2016; 48:1457-1462. [PMID: 27590842 DOI: 10.1016/j.dld.2016.08.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/12/2016] [Accepted: 08/08/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The high specific skill needed by ESD limit its widespread use in Europe and animal training is recommended in Europe to improve the results of ESD that are far from Japanese at present. We create a local training program using live pigs as models, along with our human cases, to provide continuous exposure to the technique. METHODS Between February 2013 and December 2015, two young operators performed 55 pig gastric ESDs in parallel with 62 human cases for large superficial cancerous lesions. The number and training dates of pig cases were adapted to those of the human cases to achieve continuous exposure to ESD cases. RESULTS The en bloc, R0, and curative resection rates were 100%, 85.5% (53/62), and 77.5% (48/62), respectively with no recurrence observed during the one year follow up. There was no statistically significant difference in terms of the R0 or curative resection rates among ESDs performed during 2013-2015 (R0: 80% vs. 86.6% vs. 86.4%; Curative: 80% vs. 86.6% vs. 73%). CONCLUSION A local structured training program using live pig models was used to train endoscopists for ESD in humans with high safety and efficiency, similar to results published by Japanese experts.
Collapse
Affiliation(s)
- Jérémie Jacques
- Hepato-Gastro-Enterology Department, University Hospital, Limoges, France.
| | - Romain Legros
- Hepato-Gastro-Enterology Department, University Hospital, Limoges, France.
| | | | | | | | - Paul Carrier
- Hepato-Gastro-Enterology Department, University Hospital, Limoges, France.
| | - Tessa Tabouret
- Hepato-Gastro-Enterology Department, University Hospital, Limoges, France.
| | | | | | - Anne Le-Sidaner
- Hepato-Gastro-Enterology Department, University Hospital, Limoges, France.
| | | | - Denis Sautereau
- Hepato-Gastro-Enterology Department, University Hospital, Limoges, France.
| |
Collapse
|
|
45
|
Chen MJ, Wang HY, Chang CW, Lin CC, Chen CJ, Chu CH, Wang TE, Shih SC. A novel artificial tissue simulator for endoscopic submucosal resection training - a pilot study. BMC Gastroenterol 2016; 16:112. [PMID: 27612455 PMCID: PMC5018178 DOI: 10.1186/s12876-016-0529-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/26/2016] [Indexed: 12/14/2022] Open
Abstract
Background We developed a novel artificial simulator for endoscopic submucosal dissection (ESD) as a bridge between instructional videos and animal tissue training and aimed to evaluate the feasibility of using an artificial tissue model in ESD training. Methods Eight gastroenterology fellows from one medical center were enrolled in this ESD training program. Before and after the simulator training, attendees indicated on a 5-point scale the degree of difficulty in performing the following procedures: lesion marking, mucosal pre-cutting, circumferential incision, submucosal dissection, and hemostasis. After the simulator training, the participants completed a questionnaire regarding their opinions on the degree of realism and the feasibility of using this model for training. Results After watching an instructional video, attendees felt that the most difficult techniques were submucosal dissection and hemostasis. After using the artificial tissue simulator model, the attendees felt more confident in performing performing lesion marking (p = 0.026) and submucosal dissection (p = 0.037). However, they still felt that hemostasis was the most difficult techniques to master. Overall, the attendees thought the simulator was realistic in simulated lesion marking and its use was feasible for simulated lesion marking and submucosal dissection. Conclusion Our pilot study shows the feasibility of using a novel artificial tissue in performing ESD and we believe that the artificial tissue simulator acts well as a bridge between instructional videos and animal model training. The model is reusable and inexpensive, and could disseminate the techniques of the ESD more easily and quickly.
Collapse
Affiliation(s)
- Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,Clinical Skills Training Center, Department of Medical Education, MacKay Memorial Hospital, Taipei Campus, Taipei, Taiwan.,MacKay Medical College, New Taipei City, Taiwan
| | - Horng-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei City, Taiwan
| | - Chen-Wang Chang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,Clinical Skills Training Center, Department of Medical Education, MacKay Memorial Hospital, Taipei Campus, Taipei, Taiwan.,MacKay Medical College, New Taipei City, Taiwan
| | - Ching-Chung Lin
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,Clinical Skills Training Center, Department of Medical Education, MacKay Memorial Hospital, Taipei Campus, Taipei, Taiwan.,MacKay Medical College, New Taipei City, Taiwan
| | - Chih-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,Clinical Skills Training Center, Department of Medical Education, MacKay Memorial Hospital, Taipei Campus, Taipei, Taiwan.,MacKay Medical College, New Taipei City, Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei City, Taiwan
| | - Tsang-En Wang
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan.,MacKay Medical College, New Taipei City, Taiwan
| | - Shou-Chuan Shih
- Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei Campus, No. 92, Sec. 2, Chungshan North Road, Taipei, Taiwan. .,MacKay Medical College, New Taipei City, Taiwan.
| |
Collapse
|
|
46
|
Saunders BP, Tsiamoulos ZP. Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps. Nat Rev Gastroenterol Hepatol 2016; 13:486-96. [PMID: 27353401 DOI: 10.1038/nrgastro.2016.96] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR.
Collapse
Affiliation(s)
- Brian P Saunders
- Imperial College, London, Wolfson Unit for Endoscopy, St Mark's Academic Institute, Watford Road, Harrow HA1 3UJ, UK
| | - Zacharias P Tsiamoulos
- Imperial College, London, Wolfson Unit for Endoscopy, St Mark's Academic Institute, Watford Road, Harrow HA1 3UJ, UK
| |
Collapse
|
|
47
|
Barret M, Lepilliez V, Coumaros D, Chaussade S, Leblanc S, Ponchon T, Fumex F, Chabrun E, Bauret P, Cellier C, Coron E, Bichard P, Bulois P, Charachon A, Rahmi G, Bellon S, Lerhun M, Arpurt JP, Koch S, Napoleon B, Vaillant E, Esch A, Farhat S, Robin F, Kaddour N, Prat F. The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey. United European Gastroenterol J 2016; 5:45-53. [PMID: 28405321 DOI: 10.1177/2050640616644392] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/20/2016] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time. MATERIAL AND METHODS All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow-up data were recorded. The results obtained over three years were compared to previously published data covering the 2008-2010 period. RESULTS Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010-2013 vs 32.1 ± 21 for 2008-2010 (p = 0.004). En bloc resection improved from 77.1% to 91.7% (p < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% (p = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 (p < 0.0001), with bleeding decreasing from 11.2% to 4.7% (p = 0.01) and perforations from 18.1% to 8.1% (p = 0.002) over time. No procedure-related mortality was recorded. CONCLUSIONS In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.
Collapse
Affiliation(s)
- Maximilien Barret
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Vincent Lepilliez
- Edouard Herriot Hospital, Lyon, France; Jean Mermoz Hospital, Lyon, France
| | | | | | - Sarah Leblanc
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
| | | | | | | | | | | | | | | | | | - Antoine Charachon
- Henri Mondor Hospital, Creteil, France, and Princess Grace Hospital, Monaco
| | | | | | | | | | | | | | | | - Anouk Esch
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
| | | | | | | | - Frédéric Prat
- Cochin Hospital, Paris, France; Paris Descartes University, Paris, France
| | | |
Collapse
|
|
48
|
Affiliation(s)
- Pierre H. Deprez
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium,Corresponding author Pierre H. Deprez Head of Hepato-GI DptProfesseur Clinique OrdinaireHepato-gastroenterologyCliniques universitaires Saint-LucUniversité Catholique de LouvainAve Hippocrate 101200 BrusselsBelgium+3227642849+3227648927
| |
Collapse
|
|
49
|
van der Wiel SE, Küttner Magalhães R, Rocha Gonçalves CR, Dinis-Ribeiro M, Bruno MJ, Koch AD. Simulator training in gastrointestinal endoscopy - From basic training to advanced endoscopic procedures. Best Pract Res Clin Gastroenterol 2016; 30:375-87. [PMID: 27345646 DOI: 10.1016/j.bpg.2016.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/14/2016] [Accepted: 04/28/2016] [Indexed: 02/06/2023]
Abstract
Simulator-based gastrointestinal endoscopy training has gained acceptance over the last decades and has been extensively studied. Several types of simulators have been validated and it has been demonstrated that the use of simulators in the early training setting accelerates the learning curve in acquiring basic skills. Current GI endoscopy simulators lack the degree of realism that would be necessary to provide training to achieve full competency or to be applicable in certification. Virtual Reality and mechanical simulators are commonly used in basic flexible endoscopy training, whereas ex vivo and in vivo models are used in training the most advanced endoscopic procedures. Validated models for the training of more routine therapeutic interventions like polypectomy, EMR, stenting and haemostasis are lacking or scarce and developments in these areas should be encouraged.
Collapse
Affiliation(s)
- S E van der Wiel
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - R Küttner Magalhães
- Department of Gastroenterology, Santo António Hospital, Porto Hospital Center, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal.
| | - Carla Rolanda Rocha Gonçalves
- Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal; Department of Gastroenterology, Hospital Braga, Portugal.
| | - M Dinis-Ribeiro
- Department of Gastroenterology, Portugese Oncology Institute of Porto, Rua Dr. Bernardino de Almeida, 4200-072 Porto, Portugal; CIDES/CINTESIS, Porto Faculty of Medicine, Portugal.
| | - M J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| | - A D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
| |
Collapse
|
|
50
|
Abstract
OPINION STATEMENT Early gastric cancer (EGC), defined as being confined to the submucosa, is a curable condition. In recent years, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely applied to subgroups of mucosal cancers, thereby avoiding the burden of operation while preserving gastric function. However, it can be difficult to identify mucosal cancers, which often evade detection due to their flat shapes without ulceration. Proper preparation to clean the mucosal surface, detailed systematic observation of the entire stomach, and the use of high-resolution systems for both endoscopies equipped with image-enhanced modality and monitors would facilitate the detection of such lesions. It is also critical to evaluate the resected specimen to confirm completeness of resection (tumor-free lateral and vertical margins as well as the absence of lymphatic and vascular invasion). If the resection is incomplete, further treatment is usually recommended-further endoscopic resection for patients with positive lateral margins or surgery for patients with positive vertical margins or with lymphatic or vascular involvement. The five-year survival for endoscopically resected EGC is excellent-and comparable to that of surgical therapy. Since most gastric cancers are caused by Helicobacter pylori, this infection should be tested for routinely. If a patient is H. pylori-positive, eradication is recommended, as heterotopic, metachronous recurrence of EGC is subsequently reduced. Importantly, basic principles for early diagnosis and endoscopic treatment of EGC can be applied to neoplasms arising in other parts of the gut, such as the esophagus and colon, and would be beneficial for patients through preserving organ function and minimizing operative intervention.
Collapse
Affiliation(s)
- Kentaro Sugano
- Department of Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| |
Collapse
|