Endoscopic submucosal dissection for superficial pharyngeal carcinoma using transnasal endoscope.
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ABSTRACT:
SUBMITTER: Kikuchi D
PROVIDER: S-EPMC7859500 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
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Endoscopic submucosal dissection for superficial pharyngeal carcinoma using transnasal endoscope.
Kikuchi Daisuke D Tanaka Masami M Suzuki Yugo Y Takeda Hidehiko H Hoteya Shu S
VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy 20201213 2
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Project description:ObjectivesEndoscopic treatment of superficial pharyngeal carcinomas includes endoscopic submucosal dissection (ESD; usually performed by endoscopists), and endoscopic laryngo-pharyngeal surgery (ELPS; primarily performed by otolaryngologists). Few studies have compared the efficacy of the two techniques in treating superficial pharyngeal carcinomas. In this study, we compared the outcomes of these two techniques to determine the advantages.MethodsWe retrospectively examined the short- and long-term outcomes of 93 consecutive patients with superficial pharyngeal carcinoma who either underwent an ESD or ELPS between August 2008 and December 2021.ResultsThere were 35 lesions among 29 patients and 93 lesions among 71 patients in the ESD and ELPS groups, respectively. The ELPS group had a significantly shorter procedure time (121.2 ± 97.4 min vs. 54.7 ± 40.2 min, p<0.01), greater procedure speed (0.10 ± 0.06 min/min vs. 0.30 ± 0.23 min/min, p<0.01), and less laryngeal edema than that of the ESD group. There were no significant differences in the 3-year overall, relapse-free, or disease-specific survival rates between the two groups. Intervention with ESD during ELPS was most commonly required when it was difficult to secure the visual field.ConclusionsThere were no differences in batch resection rates or long-term prognoses between the two groups; nevertheless, the ELPS group had a shorter treatment time and less laryngeal edema than the ESD group. However, the treatment of narrow areas, such as the esophageal inlet patch, is a technical limitation of ELPS; thus, ELPS should be combined with ESD techniques.
| S-EPMC11391100 | biostudies-literature
Project description:Background and aimsIntraoperative perforation is a major adverse event of endoscopic submucosal dissection (ESD). To avoid perforation, it is important for the endoscope to approach the portion to be resected carefully and to ensure that the knife can approach the submucosa at an angle parallel to the muscle layer. The multibending endoscope has 2 bends at its tip and may facilitate the ESD procedure. To the best of our knowledge, very few studies have reported the use of the multibending endoscope during gastric ESD. The aim of this study was, therefore, to introduce the usefulness of the multibending endoscope for gastric ESD.MethodsWe report 2 cases of early gastric cancer in which ESD was performed using a multibending endoscope.ResultsUnlike conventional single-bending endoscopes that have only 1 moveable part, the multibending endoscope allowed difficult areas to be approached more easily. Small adjustments could be made to the upward or downward angle of both the first and the second bending sections of the endoscope. This ensured that the knife would approach the submucosa at an angle parallel to the muscle layer. In patient 1, initially the conventional endoscope was used, but it became more difficult to approach the site, and paradoxic movement occurred. When the conventional endoscope was changed to the multibending endoscope, the ESD procedure became safer and more efficient. Another ESD using the multibending endoscope was performed successfully without any adverse events.ConclusionsThe use of a multibending endoscope for ESD will enable safer and faster treatment of patients.
| S-EPMC6895728 | biostudies-literature
Project description:BackgroundEndoscopic submucosal dissection (ESD) is a representative treatment modality for early gastric neoplasms. However, the learning curve for beginners performing ESD using a multibending endoscope has not been introduced.ObjectiveThis study aimed to evaluate the learning curves of operators undergoing intensive training using a multibending endoscope.DesignThis was a retrospective single center study.MethodsWe retrospectively analyzed data of over 1500 consecutive gastric ESDs performed by two operators using a multibending endoscope. A change-point analysis with 50 cases of moving average speeds was used to determine the new target resection speed. Cumulative sum (CUSUM) analysis was used to identify the cases required for proficiency in ESD. Risk-adjusted CUSUM (RA-CUSUM) analysis was performed for each operator after adjusting for confounding factors influencing the resection speed.ResultsIn total, 1491 cases were enrolled, with early gastric cancer accounting for 43.2% (n = 644). Overall, the en bloc resection, R0 resection, and curability rates were 97.7%, 96.0%, and 92.3%, respectively. The mean resection speed was 19.8 cm2/h. Because both operators surpassed the commonly used benchmark resection speed of 9 cm2/h in the first 50-case block, we established a new target benchmark of 17.9 cm2/h in the change-point analysis. CUSUM analysis indicated that performing 166 cases overall was required to achieve the benchmark, with the 2 operators needing 153 and 69 cases to meet this target speed after RA-CUSUM analysis.ConclusionUsing a multibending endoscope for gastric ESD can help beginners achieve safe and excellent outcomes. These findings will serve as a useful guide for beginners attempting to use a multibending endoscope.
| S-EPMC11831642 | biostudies-literature
Project description:Esophageal endoscopic submucosal dissection (ESD) can be a curative treatment for superficial esophageal squamous cell carcinoma (SESCC). However, it is unclear whether the development of metachronous recurrence after ESD may be explained based on several risk factors. This study aimed to assess the incidence and the risk factors of metachronous recurrence of SESCC after ESD. This retrospective analysis was conducted at Samsung Medical Center, Seoul, Korea, from April 2007 to May 2018. Two hundred and fifty-three SESCC patients treated with ESD were followed using surveillance endoscopy after the procedure. Risk factors for metachronous esophageal SCC were analyzed using the Kaplan-Meier method and Cox's proportional hazards model. Metachronous esophageal SCCs were found in 21 (8.3%) of the 253 patients. Six patients (2.4%) with extraesophageal recurrence such as lymph node metastasis confirmed by imaging were excluded from patients with metachronous recurrence and data were censored from the recurrence date. Univariate analysis revealed that the presence of many (>10) irregularly shaped multiform Lugol-voiding lesions (LVLs) around the main lesion, margin of the main LVL, and tumor differentiation were risk factors for the development of metachronous cancer. Multivariate analysis also revealed that many (>10) LVLs (hazard ratio [HR], 6.32; 95% confidence interval [CI], 1.62-24.72; p = 0.047) and unclear or spiculated margin of the main LVL (HR, 6.51; 95% CI, 1.44-29.42; p = 0.029) were associated with the risk of metachronous recurrence. Metachronous esophageal SCC develops in patients treated with ESD for SESCC. A risk assessment is important for surveillance before and after ESD for SESCC. Number of LVLs and tumor edge type are associated with an increased risk of metachronous cancer in SESCC. Patients will benefit from careful endoscopic surveillance when endoscopists pay attention to these tumor characteristics.
| S-EPMC7473781 | biostudies-literature
Project description:BackgroundColorectal endoscopic submucosal dissection is technically demanding, and the traction offered by gravity, cap, or clip-with-line during conventional endoscopic submucosal dissection remains unsatisfactory. Robotic systems are still under development and are expensive. We proposed double-scope endoscopic submucosal dissection with strong and adjustable traction offered by snaring the lesion with additional scope.ObjectiveThis study aimed to test the novel double-scope endoscopic submucosal dissection with snare-based traction.DesignThis was a retrospective study that reviewed double-scope endoscopic submucosal dissection compared with matched conventional endoscopic submucosal dissection, and size, location, morphology, and pathology between groups were compared.SettingsThis study was conducted in a referral endoscopy center in a local hospital.PatientsThis study included patients with colorectal lesions receiving double-scope endoscopic submucosal dissection and matched conventional endoscopic submucosal dissection.Main outcome measuresThe pathological completeness, procedure time, and complications were analyzed.ResultsFifteen double-scope endoscopic submucosal dissection procedures, with 11 lesions located in the proximal colon with a median size of 40 mm, were performed. The median procedure time of double-scope endoscopic submucosal dissection was 32.45 (interquartile range, 16.03-38.20) minutes. The time required for second scope insertion was 2.57 (interquartile range, 0.95-6.75) minutes; for snaring, 3.03 (interquartile range, 2.12-6.62) minutes; and for actual endoscopic submucosal dissection, 28.23 (interquartile range, 7.90-37.00) minutes. All lesions were resected completely. No major complication was encountered. The procedure time was significantly shorter than that of 14 matched conventional endoscopic submucosal dissections (54.61 [interquartile range, 33.11-97.25] min; p = 0.021).LimitationsThis was a single-center, single-operator, retrospective case-controlled study with limited cases.ConclusionsThis study confirmed the feasibility of double-scope endoscopic submucosal dissection with snare-based traction to shorten procedure time and to simplify endoscopic submucosal dissection. Additional trials are required.
| S-EPMC9172887 | biostudies-literature
Project description:One of the challenges in performing endoscopic submucosal dissection (ESD) is the lack of counter traction during submucosal dissection. MASTER (Master and Slave Transluminal Endoscopic Robot) was designed to allow performance of complex endoluminal procedures using two arms with excellent control. This study aimed to compare the performance of ESD between endoscopists and novices using MASTER.This is a prospective study comparing the differences in performing ESD using MASTER in an ex vivo porcine stomach model among individuals with or without experience in surgery and endoscopy. Multiple standardized lesions of 20 mm(2) were pre-marked on an ex vivo porcine stomach. Each participant received basic training in controlling MASTER before the ESD procedure. The operative time and size of specimen obtained by each participant were noted.Nine individuals (three ESD expert endoscopists, three ESD non-expert endoscopists, and three non-clinician novices) participated in the experiment. All participants completed the ESD procedure for en bloc resection of standardized lesions using EndoMASTER without perforation. The mean times (mean ± SD) taken by ESD expert endoscopists, ESD non-expert endoscopists, and novices to complete Robotic ESD were 122 ± 58 s, 203 ± 150 s, and 561 ± 496 s, respectively. There was no statistically significant difference in the mean operative time to complete the ESD between the three groups (P = 0.242). When the performance of the six endoscopists was compared to that of the three novices, the endoscopists took an average of 162 ± 111 s to complete the ESD, while the non-clinicians required an average of 561 ± 496 s (P = 0.085).There was a trend to shorter operative time when comparing endoscopists to non-endoscopists in performing ESD using MASTER. The use of MASTER enabled the novice without endoscopy experience to complete the ESD procedure.
| S-EPMC4612240 | biostudies-other
Project description:Esophageal squamous cell carcinoma (ESCC) has a poor prognosis when diagnosed at an advanced stage, and early detection and treatment are essential to improve survival. However, intraobserver and interobserver variation make the diagnosis of superficial ESCC difficult, and suitable biomarkers are urgently needed. Here, we compared the microRNA (miRNA) expression profiles of superficial ESCC tissues and adjacent normal tissues obtained immediately before esophageal endoscopic submucosal dissection. We found that ESCC and normal tissues differed in their miRNA expression profiles. In particular, miR-21-5p and miR-146b-5p were significantly upregulated and miR-210-3p was significantly downregulated in tumor tissues compared with normal tissues. We also detected significant associations between miRNA expression and ESCC invasion depth and lymphovascular invasion. The same differential expression of miR-21-5p, miR-146b-5p, and miR-210-3p was detected in ESCC cell lines compared with normal esophageal epithelial cells in vitro. However, transfection of ESCC cells with miR-210-3p and miR-21-5p mimics or inhibitors had partial effects on cell proliferation and invasion in vitro. These results indicate that miRNA expression is significantly deregulated in superficial ESCC, and suggest that the potential contribution of differentially expressed miRNAs to the malignant phenotype should be further investigated.
| S-EPMC8124636 | biostudies-literature
Project description:AimTo identify the determinants of endoscopic submucosal dissection (ESD) operation time.MethodsThis investigation was conducted as a single-center, prospective study in which ESD was performed by the same endoscopist at the Chinese PLA General Hospital. A total of 173 patients underwent ESD operations performed by Dr. Lu from July 2007 to December 2011, and 183 lesions were enrolled. Patient gender, age, tumor location, gross type, tumor size, pathological type and adhesions were recorded prospectively. The order of treatment represented the experience of the operator. Univariate analysis and multivariate analysis were performed to evaluate the relationships between these factors and ESD procedure time.ResultsUnivariate analysis showed the ESD time was closely related to the gender (P = 0.0210), tumor size (P < 0.0001), location (P < 0.0001), gross type (P < 0.0001) and adhesion (P = 0.0010). The surgical proficiency level was associated with ESD time in unit area (P < 0.0001). Multivariate analysis revealed that the ESD time was positively correlated with tumor size (P < 0.0001), adhesion (P < 0.0001) and location (P < 0.0001), but negatively correlated with surgical proficiency level (P = 0.0046).ConclusionLarge tumor size, adjacency to the cardia, and adhesion are predictors of a long ESD time, whereas high surgical proficiency level predicts a short ESD time.
| S-EPMC3531687 | biostudies-literature
Project description:Opinion statementWith the widespread use of esophagogastroduodenoscopy in recent years, the detection rate of superficial non-ampullary duodenal epithelial tumors (SNADETs) is increasing. Most SNADETs are early-stage adenocarcinoma or benign conditions, including adenoma. Therefore, endoscopic resection is desirable from the perspective of quality of life. However, endoscopic resection for SNADETs has not yet been established. Endoscopic submucosal dissection (ESD) is the most promising method for the treatment of SNADETs, because ESD provides a high rate of en bloc resection and a low rate of recurrence regardless of the tumor size. However, the difficulty of the procedure and a high rate of severe adverse events including perforation and bleeding have become major problems. Various preventive countermeasures for adverse events, such as use of specific devices, endoscope stabilization methods, and endoscopic closure of the post-ESD ulcer using clips, are reported to reduce the risk of the adverse events of ESD for SNADETs. This article reviews and highlights the current state of ESD for SNADETs and new challenges towards safe and effective ESD.
| S-EPMC7588384 | biostudies-literature
Project description:IntroductionEndoscopic submucosal dissection (ESD) is a preferred treatment option for superficial esophageal squamous cell carcinoma (SESCC). However, only few studies compared long-term survival outcomes of ESD with surgery. This study compared the overall survival (OS), recurrence-free survival, and complication rates of ESD with those of surgery.MethodsWe reviewed patients who underwent ESD (n = 70) or surgery (n = 114) for SESCC at Seoul National University Hospital from 2011 to 2017. A propensity score-matched analysis was used to reduce selection bias. To increase the precision of our results interpretation, subgroups were analyzed according to the depth of tumor invasion.ResultsIn the matching study, the ESD group (n = 34) showed comparable survival outcomes with the surgery group (n = 34). The 5-year OS rates were 89.4% vs 87.8% for the ESD and the surgery groups, respectively; similarly, the 5-year recurrence-free survival rates were 90.9% and 91.6%, respectively. The ESD group showed a lower early major complication rate (2.9% [1 of 34] vs 23.5% [8 of 34], P < 0.001) and shorter hospital stay (median, 3.0 days vs 16.5 days, P < 0.001) than the surgery group. In the tumor in situ (Tis)-subgroup, ESD showed better OS than esophagectomy (P = 0.030). Between-group comparisons of survival outcomes in the T1a and T1b subgroups revealed no significant differences.DiscussionLong-term outcomes of ESD are comparable with surgery for patients with SESCC. For early major complications and duration of hospital stay, ESD was associated with better outcomes than radical surgery. These results support ESD as the preferred treatment option for SESCC.
| S-EPMC7386344 | biostudies-literature