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Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasias

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Abstract

Background

Superficial esophageal neoplasias resected in piecemeal manner with endoscopic mucosal resection (EMR) sometimes recur locally, and additional treatments need to be developed. Efficacy and safety of endoscopic submucosal dissection (ESD) for esophageal neoplasias are not sufficiently demonstrated, so we conducted a retrospective study to evaluate the efficacy and safety of ESD for superficial esophageal neoplasias.

Methods

Thirty-seven superficial esophageal neoplasias consisted of 34 squamous cell neoplasias and 3 columnar neoplasias in 35 patients were treated with ESD from May 2006 to July 2008. Patients were regularly followed up with endoscopy every 6 months, and with echoendoscope and computed tomography every year. Therapeutic efficacy, complications, and follow-up results were evaluated.

Results

The mean size of the resected neoplasias and that of the resected specimens were 22 mm (range 10–83 mm) and 41 mm (range 18–90 mm), respectively. The mean duration of the ESD procedures was 117 min (range 40–235 min). The overall rates of en bloc resection and of free margin resection were 100% (37/37) and 95% (35/37), respectively. The mean follow-up period of 19 months (range 7–32 months) revealed no local or distant recurrence. There were no complications such as bleeding or perforation in any case. In all nine cases, the strictures were successfully managed with prophylactic endoscopic balloon dilation.

Conclusions

ESD with a combination of small-caliber-tip transparent hood and flex knife is a safe endoscopic treatment for superficial esophageal neoplasias and enables large en bloc resection.

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References

  1. Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25:445–450

    Article  CAS  PubMed  Google Scholar 

  2. Inoue H, Tani M, Nagai K, Kawano T, Takeshita K, Endo M et al (1999) Treatment of esophageal and gastric tumors. Endoscopy 31:47–55

    Article  CAS  PubMed  Google Scholar 

  3. Gotoda T, Yanagisawa A, Sasako M, Ono H, Nakanishi Y, Shimoda T, Kato Y (2000) Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 3:219–225

    Article  PubMed  Google Scholar 

  4. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  CAS  PubMed  Google Scholar 

  5. Neuhaus H, Costamagna G, Deviere J, Fockens P, Ponchon T, Rosch T (2006) Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy 38:1016–1023

    Article  CAS  PubMed  Google Scholar 

  6. Mandard AM, Tourneux J, Gignoux M, Blanc L, Segol P, Mandard JC (1980) In situ carcinoma of the esophagus. Macroscopic study with particular reference to the Lugol test. Endoscopy 12:51–57

    Article  CAS  PubMed  Google Scholar 

  7. Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo S (2004) Narrow band imaging system with magnifying endoscopy for superficial esophageal lesion. Gastrointest Endosc 59:288–295

    Article  PubMed  Google Scholar 

  8. Goda K, Tajiri H, Ikegami M, Urashima M, Nakayoshi T, Kaise M (2007) Usefulness of magnifying endoscopy with narrow band imaging for the detection of specialized intestinal metaplasia in columnar-lined esophagus and Barrett’s adenocarcinoma. Gastrointest Endosc 65:36–46

    Article  PubMed  Google Scholar 

  9. Wolfsen HC, Crook JF, Krishna M, Achem SR, Devault KR, Bouras EP et al (2008) Prospective, controlled tandem endoscopy study of narrow band imaging for dysplasia detection in Barrett’s esophagus. Gastroenterology 135:24–31

    Article  PubMed  Google Scholar 

  10. Katada C, Muto M, Manabe T, Ohtsu A, Yoshida S (2005) Local recurrence of squamous-cell carcinoma of the esophagus after EMR. Gastrointest Endosc 61:219–225

    Article  PubMed  Google Scholar 

  11. Pech O, May A, Grossner L, Rabenstein T, Manner H, Huijsmans J et al (2007) Curative endoscopic therapy in patients with early esophageal squamous-cell carcinoma or high-grade intraepithelial neoplasia. Endoscopy 39:30–35

    Article  CAS  PubMed  Google Scholar 

  12. Tanabe S, Koizumi W, Higuchi K, Sasaki T, Nakatani K, Hanaoka N et al (2008) Clinical outcomes of endoscopic oblique aspiration mucosectomy for superficial esophageal cancer. Gastrointest Endosc 67:814–820

    Article  PubMed  Google Scholar 

  13. Inoue H, Honda T, Nagai K, Kawano T, Yoshino K, Takeshita K et al (1997) Ultra-high magnification endoscopic observation of carcinoma in situ of the esophagus. Dig Endosc 9:16–18

    Article  Google Scholar 

  14. Kumagai Y, Toi M, Inoue H (2002) Dynamism of tumour vasculature in the early phase of cancer progression: outcomes from oesophageal cancer research. Lancet Oncol 3:604–610

    Article  PubMed  Google Scholar 

  15. Endoscopic Classification Review Group (2005) Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37:570–578

    Article  Google Scholar 

  16. Yahagi N, Fujishiro M, Imagawa A, Kakushima N, Iguchi M, Omata M (2004) Endoscopic submucosal dissection for the reliable en bloc resection of colorectal mucosal tumors. Dig Endosc 16:89–92

    Article  Google Scholar 

  17. Yamamoto H, Kawata H, Sunada K, Sasaki A, Nakazawa K, Miyata T et al (2003) Successful en-bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood. Endoscopy 35:690–694

    Article  CAS  PubMed  Google Scholar 

  18. Yamamoto H, Yube T, Isoda N, Sato Y, Sekine Y, Higashizawa T et al (1999) A novel method of endoscopic mucosal resection using sodium hyaluronate. Gastrointest Endosc 50:251–256

    Article  CAS  PubMed  Google Scholar 

  19. Fujishiro M, Yahagi N, Kashimura K, Mizushima Y, Oka M, Matsuura T et al (2004) Different mixtures of sodium hyaluronate and their ability to create submucosal fluid cushions for endoscopic mucosal resection. Endoscopy 36:584–589

    Article  CAS  PubMed  Google Scholar 

  20. Stolte M (2003) The new Vienna classification of epithelia neoplasia of gastrointestinal tract: advantages and disadvantages. Virchows Arch 442:99–106

    PubMed  Google Scholar 

  21. Higuchi K, Tanabe S, Koizumi W, Sasaki T, Nakatani K, Saigenji K et al (2007) Expansion of the indications for endoscopic mucosal resection in patients with superficial esophageal carcinoma. Endoscopy 39:36–40

    Article  CAS  PubMed  Google Scholar 

  22. Natsugoe S, Baba M, Yoshinaga H, Kijima F, Shimada M, Shirao K et al (1998) Mucosal squamous cell carcinoma of the esophagus: a clinicopathologic study of 30 cases. Oncology 55:235–241

    Article  CAS  PubMed  Google Scholar 

  23. Tajima Y, Nakanishi Y, Ochiai A, Tachimori Y, Kato H, Watanabe H et al (2000) Histopathologic findings predicting lymph node metastasis and prognosis of patients with superficial esophageal carcinoma: analysis of 240 surgically resected tumors. Cancer 88:1285–1293

    Article  CAS  PubMed  Google Scholar 

  24. Stein HJ, Feith M, Mueller J, Werner M, Siewert JR (2000) Limited resection for early adenocarcinoma in Barrett’s esophagus. Ann Surg 232:733–742

    Article  CAS  PubMed  Google Scholar 

  25. Buskens CJ, Westerterp M, Lagarde SM, Bergman JJ, ten Kate FJ, van Lanschot JJ (2004) Prediction of appropriateness of local endoscopic treatment for high-grade dysplasia and early adenocarcinoma by EUS and histopathologic features. Gastrointest Endosc 60:703–710

    Article  PubMed  Google Scholar 

  26. Ishihara R, Iishi H, Uedo N, Takeuchi Y, Yamamoto S, Yamada T et al (2008) Comparison of EMR and endoscopic submucosal dissection for en bloc resection of early esophageal cancers in Japan. Gastrointest Endosc 68:1066–1072

    Article  PubMed  Google Scholar 

  27. Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M et al (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3:67–70

    Article  Google Scholar 

  28. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S et al (2006) Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 4:688–694

    Article  PubMed  Google Scholar 

  29. Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053

    Article  CAS  PubMed  Google Scholar 

  30. Roth JA, Putnam JB Jr (1994) Surgery for cancer of the esophagus. Semin Oncol 21:453–461

    CAS  PubMed  Google Scholar 

  31. Dimick JB, Goodney PP, Orringer MB, Birkmeyer JD (2005) Specialty training and mortality after esophageal cancer resection. Ann Thorac Surg 80:282–286

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors report that there are no disclosures relevant to this publication.

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Authors and Affiliations

  1. Department of Gastroenterology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan

    Naoki Ishii, Noriyuki Horiki, Toshiyuki Itoh, Masayo Uemura, Masataka Maruyama, Shoko Suzuki, Shino Uchida, Yusuke Izuka, Katsuyuki Fukuda & Yoshiyuki Fujita

  2. Integrated Clinical Education Center, Kyoto University Hospital, Kyoto, Japan

    Toshiyuki Itoh

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  1. Naoki Ishii
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  2. Noriyuki Horiki
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Correspondence to Naoki Ishii.

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Ishii, N., Horiki, N., Itoh, T. et al. Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife is a safe and effective treatment for superficial esophageal neoplasias. Surg Endosc 24, 335–342 (2010). https://doi.org/10.1007/s00464-009-0560-x

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  • DOI: https://doi.org/10.1007/s00464-009-0560-x

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