Advertisement

Surgical Endoscopy

, Volume 22, Issue 3, pp 777–783 | Cite as

Endoscopic submucosal dissection used for treating early neoplasia of the foregut using a combination of knives

  • P. W. Y. ChiuEmail author
  • K. F. Chan
  • Y. T. Lee
  • J. J. Y. Sung
  • J. Y. W. Lau
  • E. K. W. Ng
Dynamic Manuscript

Abstract

Background

Endoscopic submucosal dissection (ESD) has emerged as a novel technique for achieving en bloc resection for early esophageal or gastric carcinoma limited to the mucosa. The authors report their experience with a combination of various devices to treat early neoplasia of the foregut using the ESD technique.

Methods

In this prospective case series, ESD was performed for early esophageal or gastric carcinoma limited to the mucosa. These lesions were staged by endoscopic ultrasonography before resection. Magnifying endoscopy and chromoendoscopy were used to locate the tumor and define the margin. The resection was accomplished with submucosal dissection using the insulated tip knife, the hook knife, and the triangular tip knife. The resected specimen was examined systematically for the lateral and deep margins.

Results

From January 2004 to March 2006, ESD was performed to manage 30 cases of early gastric or esophageal carcinoma. For 29 of these patients, R0 resection was successfully achieved. The mean operating time was 84.6 min. One patient experienced reactionary hemorrhage 12 h after resection, which was controlled endoscopically. There was no perforation. Most of the circumferential mucosal incisions were performed using the insulated tip knife (76.6%), whereas submucosal dissection was accomplished with a combination of various knives. One of the specimens showed involvement of the lateral margin, whereas another patient had two areas of new early gastric cancer 6 months after the initial procedure. These patients received salvage laparoscopically assisted gastrectomy.

Conclusions

Endoscopic submucosal dissection to manage early neoplasia of the foregut can be achieved safely and effectively with a combination of knives.

Keywords

Early gastric cancer Endoscopic submucosal dissection Superficial esophageal neoplasia 

Notes

Acknowledgment

We express our deepest thanks to Professor Haruhiro Inoue, Digestive Disease Center, Showa University Northern Yokohama Hospital, for his guidance and training in performing endoscopic submucosal dissection. We also thank Olympus Co. Ltd., Hong Kong and Tokyo, Japan, for providing the instruments used to perform endoscopic submucosal dissection.

Supplementary material

Supplementary material

Supplementary material

References

  1. 1.
    Inoue H (2001) Endoscopic mucosal resection for the entire gastrointestinal mucosal lesions. Gastrointest Endosc Clin North Am 11:459–478Google Scholar
  2. 2.
    Inoue H, Takeshita K, Hori H, Muraoka Y, Yoneshirma H, Endo M (1993) Endoscopic mucosal resection with a cap-fitted panendoscope for esophagus, stomach, and colon mucosal lesions. Gastrointest Endosc 39:58–62PubMedCrossRefGoogle Scholar
  3. 3.
    Yanai H, Matsubara Y, Kawano T, Okamoto T, Hirano A, Nakamura Y, Nakamura H, Nishikawa J, Okita K (2004) Clinical impact of strip biopsy for early gastric cancer. Gastrointest Endosc 60:771–777PubMedCrossRefGoogle Scholar
  4. 4.
    Inoue H, Endo M (1990) Endoscopic esophageal mucosal resection using a transparent tube. Surg Endosc 4:198–201PubMedCrossRefGoogle Scholar
  5. 5.
    Makuuchi H, Yoshida T, Ell C (2004) Four-step endoscopic esophageal mucosal resection (EEMR) tube method of resection for early esophageal cancer. Endoscopy 36:1013–1018PubMedCrossRefGoogle Scholar
  6. 6.
    Kida M, Tanabe S, Saigenji K (2003) Endoscopic mucosal resection for gastric cancer: necessity of “incision and stripping method” and present status. Dig Endosc 15(Suppl):S15-S18CrossRefGoogle Scholar
  7. 7.
    Japanese Gastric Cancer Association (1998) Japanese classification of gastric carcinoma. 2nd English ed. Gastric Cancer 1:10–24PubMedCrossRefGoogle Scholar
  8. 8.
    Tanabe S, Koizumi W, Mitomi H (2002) Clinical outcome of endoscopic aspiration mucosectomy for early stage gastric cancer. Gastrointest Endosc 56:708–713PubMedCrossRefGoogle Scholar
  9. 9.
    Hamanak H, Gotoda T (2005) Endoscopic resection for early gastric cancer and future expectations. Dig Endosc 17:275–285CrossRefGoogle Scholar
  10. 10.
    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 3:219–225PubMedCrossRefGoogle Scholar
  11. 11.
    Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kanao H, Kawamura T, Yoshida S, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection in comparison to endoscopic mucosal resection for early gastric cancer. Gastrointest Endosc 64:877–883PubMedCrossRefGoogle Scholar
  12. 12.
    Yoshida T, Inoue H, Usui S, Satodate H, Fukami N, Kudo S (2004) Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc 59:288–295PubMedCrossRefGoogle Scholar
  13. 13.
    Yoshida T, Kawachi H, Sasajima K, Shiokawa A, Kudo S (2005) The clinical meaning of a nonstructural pattern in early gastric cancer on magnifying endoscopy. Gastrointest Endosc 62:48–54PubMedCrossRefGoogle Scholar
  14. 14.
    The Paris classification of superficial neoplastic lesions: esophagus, stomach, and colon. (2003) Gastrointest Endosc 58(Suppl 6):S3–S43Google Scholar
  15. 15.
    Update on the Paris classification of superficial neoplastic lesions in the digestive tract. (2005) Endoscopy 37:570–578Google Scholar
  16. 16.
    World Health Organization (2000) Pathology and genetics of tumors of the digestive system. In: Hamiltron SR, Aaltonen LA (eds) Classification of tumors. IARC Press, LyonGoogle Scholar
  17. 17.
    Hundahl SA, Menck HR, Mansour EG, Winchester DP (1997) The National Cancer Data Base report on gastric carcinoma. Cancer 80:2333–2341PubMedCrossRefGoogle Scholar
  18. 18.
    Fuchs CS, Mayer RJ (1995) Gastric carcinoma. N Engl J Med 333:32–41PubMedCrossRefGoogle Scholar
  19. 19.
    Muller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H (1990) Surgical therapy of esophageal carcinoma. Br J Surg 77:845–857PubMedCrossRefGoogle Scholar
  20. 20.
    Seto Y, Nagawa H, Muto T (1997) Results of extended lymph node dissection for gastric cancer cases with N2 lymph node metastasis. Int Surg 82:257–261PubMedGoogle Scholar
  21. 21.
    Everett SM, Axon AT (1997) Early gastric cancer in Europe. Gut 41:142–150PubMedCrossRefGoogle Scholar
  22. 22.
    Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229PubMedCrossRefGoogle Scholar
  23. 23.
    Roy Soetikno, Inoue H, Chang KJ (2000) Endoscopic mucosal resection: current concepts. Gastrointest Endosc Clin North Am 10:595–617Google Scholar
  24. 24.
    Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, Miyata Y (2005) Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol 3(7 Suppl 1):S67–S70PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • P. W. Y. Chiu
    • 1
    Email author
  • K. F. Chan
    • 2
  • Y. T. Lee
    • 3
  • J. J. Y. Sung
    • 3
  • J. Y. W. Lau
    • 1
  • E. K. W. Ng
    • 1
  1. 1.Institute of Digestive Disease, Department of SurgeryThe Chinese University of Hong KongShatinHong Kong
  2. 2.Department of Anatomical and Cellular PathologyThe Chinese University of Hong KongShatinHong Kong
  3. 3.Department of Medicine and TherapeuticsThe Chinese University of Hong KongShatinHong Kong

Personalised recommendations