1.Efficacy of the Envelope Method in Applying Polyglycolic Acid Sheets to Post-Endoscopic Submucosal Dissection Ulcers in Living Pigs
Hiroya SAKAGUCHI ; Toshitatsu TAKAO ; Yoshitaka TAKEGAWA ; Yuki KOGA ; Kazunori YAMANAKA ; Masataka SAGATA ; Shinwa TANAKA ; Yoshinori MORITA ; Takashi TOYONAGA ; Yuzo KODAMA
Clinical Endoscopy 2021;54(1):64-72
Background/Aims:
Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD) ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This study assessed the usefulness of the envelope-based delivery system with and against gravity in living pigs.
Methods:
PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelope methods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors were compared.
Results:
With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with the conventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional group had insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similar between the groups.
Conclusions
The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriately both with and against gravity in living pigs.
2.Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection.
Hiroya MIZUTANI ; Satoshi ONO ; Daisuke OHKI ; Chihiro TAKEUCHI ; Seiichi YAKABI ; Yosuke KATAOKA ; Itaru SAITO ; Yoshiki SAKAGUCHI ; Chihiro MINATSUKI ; Yosuke TSUJI ; Keiko NIIMI ; Shinya KODASHIMA ; Nobutake YAMAMICHI ; Mitsuhiro FUJISHIRO ; Kazuhiko KOIKE
Clinical Endoscopy 2017;50(6):562-568
Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world.
Asian Continental Ancestry Group
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Colorectal Neoplasms
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Humans
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Japan
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Methods
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Traction
3.Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum
Nobuaki IKEZAWA ; Takashi TOYONAGA ; Shinwa TANAKA ; Tetsuya YOSHIZAKI ; Toshitatsu TAKAO ; Hirofumi ABE ; Hiroya SAKAGUCHI ; Kazunori TSUDA ; Satoshi URAKAMI ; Tatsuya NAKAI ; Taku HARADA ; Kou MIURA ; Takahisa YAMASAKI ; Stuart KOSTALAS ; Yoshinori MORITA ; Yuzo KODAMA
Clinical Endoscopy 2022;55(3):417-425
Background/Aims:
Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD.
Methods:
D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed.
Results:
The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively.
Conclusions
D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.
4.Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy
Kei MATSUMOTO ; Shinwa TANAKA ; Takashi TOYONAGA ; Nobuaki IKEZAWA ; Mari NISHIO ; Masanao URAOKA ; Tomoatsu YOSHIHARA ; Hiroya SAKAGUCHI ; Hirofumi ABE ; Tetsuya YOSHIZAKI ; Madoka TAKAO ; Toshitatsu TAKAO ; Yoshinori MORITA ; Hiroshi YOKOZAKI ; Yuzo KODAMA
Clinical Endoscopy 2022;55(1):86-94
Background/Aims:
The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site.
Methods:
We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups.
Results:
The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group.
Conclusions
Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.
5.Clinical meaning of sarcopenia in patients undergoing endoscopic treatment
Hiroyuki HISADA ; Yosuke TSUJI ; Hikaru KURIBARA ; Ryohei MIYATA ; Kaori OSHIO ; Satoru MIZUTANI ; Hideki NAKAGAWA ; Rina CHO ; Nobuyuki SAKUMA ; Yuko MIURA ; Hiroya MIZUTANI ; Daisuke OHKI ; Seiichi YAKABI ; Yu TAKAHASHI ; Yoshiki SAKAGUCHI ; Naomi KAKUSHIMA ; Nobutake YAMAMICHI ; Mitsuhiro FUJISHIRO
Clinical Endoscopy 2024;57(4):446-453
With increasing global life expectancy, the significance of geriatric assessment parameters has increased. Sarcopenia is a crucial assessment parameter and is defined as the age-related loss of muscle mass and strength. Sarcopenia is widely acknowledged as a risk factor for postoperative complications in diverse advanced malignancies and has a detrimental effect on the long-term prognosis. While most studies have primarily concentrated on the correlation between sarcopenia and advanced cancer, more recent investigations have focused on the relationship between sarcopenia and early-stage cancer. Endoscopic submucosal dissection (ESD), which is less invasive than surgical intervention, is extensively employed in the management of early-stage cancer, although it is associated with complications such as bleeding and perforation. In recent years, several reports have revealed the adverse consequences of sarcopenia in patients with early-stage cancer undergoing ESD. This literature review briefly summarizes the recent studies on the association between sarcopenia and ESD.