BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract tumors.The assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and...BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract tumors.The assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and grasp the target tissue appropriately;therefore,the assistant’s skill may affect the technical outcomes of ESD-C.AIM To determine how assistant skill level affected the technical outcomes of gastric ESD-C using an ex vivo porcine training model.METHODS In this pilot study,mock lesions of 15-30 mm in diameter were created in the middle or lower third of the porcine stomach.A total of 32 ESD-C procedures were performed by 16 trainees.Each trainee operator performed two ESD-C procedures;one ESD-C was assisted by an expert(ESD-C-E),and the other was assisted by a non-expert(ESD-C-NE).The total procedure time of the ESD was set as the primary outcome,and en bloc resection rate,complete procedure rate,perforation rate,and each procedure time/speed for mucosal incision or submucosal dissection were set as the secondary outcomes.In addition,we investigated factors associated with the difficulty of ESD including incompletion of ESD procedure,a long procedure time(≥20 min)or intraoperative perforation.RESULTS The median total procedure time of the ESD-C-E was significantly shorter than that of the ESD-C-NE(12.9 min vs 21.9 min,P=0.001).The en bloc resection rate was 100%in both groups.Complete resection rates of the ESD-C-E and ESD-C-NE groups were 100%and 93.8%,respectively.No intraoperative perforation was observed in both groups.In the multivariate analysis,assistant skill was significantly associated with the difficulty of ESD,with the highest odds ratio of 16.5.CONCLUSION Assistance by an expert is an important factor when trainees perform ESD-C procedures.展开更多
Although endoscopy is a less invasive procedure than surgery,patients can experience pain without sedation.Patients expect reduced pain during endoscopies from effective and safe sedatives.Midazolam and propofol are u...Although endoscopy is a less invasive procedure than surgery,patients can experience pain without sedation.Patients expect reduced pain during endoscopies from effective and safe sedatives.Midazolam and propofol are used for endoscopic sedation in many countries and regions.Midazolam is a widely available benzodiazepine,and many clinical trials have shown it to be an effective sedative.However,patients who are sedated with midazolam require rest in the recovery room due to its relatively long half-life,and an antagonist such as flumazenil may need to be administered in cases of deep or prolonged sedation.Propofol is a short-acting sedative with a short half-life and a quick recovery time.Therefore,the use of propofol has been increasing.However,propofol has a narrow margin of safety and often induces adverse effects such as respiratory depression.Also,propofol has no specific antagonist,and should be administered by an anesthesiologist or an endoscopist familiar with anesthesia.Remimazolam,which is a novel ultra-short-acting benzodiazepine,has recently gained attention.Remimazolam has a short half-life and an antagonist.Both effective and safe sedation is desired in accordance with the increasing need for sedative endoscopies.Therefore,in this review each sedative is summarized.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is widely accepted for early gastric cancer(EGC)without lymph node metastasis,although ESD is challenging,even for small lesions,in the greater curvature(GC)of the upper...BACKGROUND Endoscopic submucosal dissection(ESD)is widely accepted for early gastric cancer(EGC)without lymph node metastasis,although ESD is challenging,even for small lesions,in the greater curvature(GC)of the upper(U)and middle(M)thirds of the stomach.Grasping forceps-assisted endoscopic resection(GF-ER)is a type of endoscopic mucosal resection that is performed via a double-channel endoscope.AIM To investigate the safety and efficacy of GF-ER vs ESD in the GC of the stomach’s U and M regions.METHODS We retrospectively reviewed the medical records of 506 patients who underwent ER of 522 EGC lesions in the stomach’s U and M regions in three institutions between January 2016 and May 2020.Nine lesions from eight patients who underwent GF-ER for EGC(the GF-ER group)were compared to 63 lesions from 63 patients who underwent ESD(the ESD group).We also performed a subgroup analysis of small lesions(≤10 mm)in 6 patients(7 lesions)from the GF-ER group and 20 patients(20 lesions)from the ESD group.RESULTS There were no statistically significant differences between the GF-ER and ESD groups in the en bloc resection rates(100%vs 100%)and the R0 resection rates(100%vs 98.4%).The median procedure time in the GF-ER group was shorter than that in the ESD group(4.0 min vs 55.0 min,P<0.01).There were no adverse events in the GF-ER group,although five perforations(8.0%)and 1 case of postoperative bleeding(1.6%)were observed in the ESD group.When we only considered lesions that were≤10 mm,the median procedure time in the GF-ER group was still shorter than that in the ESD group(4.0 min vs 35.0 min,P<0.01).There were no adverse events in the GF-ER group,although 1 case of perforation(1.6%)were observed in the ESD group.CONCLUSION These findings suggest that GF-ER may be an effective therapeutic option for small lesions in the GC of the stomach’s U and M regions.展开更多
文摘BACKGROUND A clutch cutter is a scissor-type knife used in endoscopic submucosal dissection(ESD)for gastrointestinal tract tumors.The assistant during the ESD using a clutch cutter(ESD-C)needs to rotate the device and grasp the target tissue appropriately;therefore,the assistant’s skill may affect the technical outcomes of ESD-C.AIM To determine how assistant skill level affected the technical outcomes of gastric ESD-C using an ex vivo porcine training model.METHODS In this pilot study,mock lesions of 15-30 mm in diameter were created in the middle or lower third of the porcine stomach.A total of 32 ESD-C procedures were performed by 16 trainees.Each trainee operator performed two ESD-C procedures;one ESD-C was assisted by an expert(ESD-C-E),and the other was assisted by a non-expert(ESD-C-NE).The total procedure time of the ESD was set as the primary outcome,and en bloc resection rate,complete procedure rate,perforation rate,and each procedure time/speed for mucosal incision or submucosal dissection were set as the secondary outcomes.In addition,we investigated factors associated with the difficulty of ESD including incompletion of ESD procedure,a long procedure time(≥20 min)or intraoperative perforation.RESULTS The median total procedure time of the ESD-C-E was significantly shorter than that of the ESD-C-NE(12.9 min vs 21.9 min,P=0.001).The en bloc resection rate was 100%in both groups.Complete resection rates of the ESD-C-E and ESD-C-NE groups were 100%and 93.8%,respectively.No intraoperative perforation was observed in both groups.In the multivariate analysis,assistant skill was significantly associated with the difficulty of ESD,with the highest odds ratio of 16.5.CONCLUSION Assistance by an expert is an important factor when trainees perform ESD-C procedures.
文摘Although endoscopy is a less invasive procedure than surgery,patients can experience pain without sedation.Patients expect reduced pain during endoscopies from effective and safe sedatives.Midazolam and propofol are used for endoscopic sedation in many countries and regions.Midazolam is a widely available benzodiazepine,and many clinical trials have shown it to be an effective sedative.However,patients who are sedated with midazolam require rest in the recovery room due to its relatively long half-life,and an antagonist such as flumazenil may need to be administered in cases of deep or prolonged sedation.Propofol is a short-acting sedative with a short half-life and a quick recovery time.Therefore,the use of propofol has been increasing.However,propofol has a narrow margin of safety and often induces adverse effects such as respiratory depression.Also,propofol has no specific antagonist,and should be administered by an anesthesiologist or an endoscopist familiar with anesthesia.Remimazolam,which is a novel ultra-short-acting benzodiazepine,has recently gained attention.Remimazolam has a short half-life and an antagonist.Both effective and safe sedation is desired in accordance with the increasing need for sedative endoscopies.Therefore,in this review each sedative is summarized.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is widely accepted for early gastric cancer(EGC)without lymph node metastasis,although ESD is challenging,even for small lesions,in the greater curvature(GC)of the upper(U)and middle(M)thirds of the stomach.Grasping forceps-assisted endoscopic resection(GF-ER)is a type of endoscopic mucosal resection that is performed via a double-channel endoscope.AIM To investigate the safety and efficacy of GF-ER vs ESD in the GC of the stomach’s U and M regions.METHODS We retrospectively reviewed the medical records of 506 patients who underwent ER of 522 EGC lesions in the stomach’s U and M regions in three institutions between January 2016 and May 2020.Nine lesions from eight patients who underwent GF-ER for EGC(the GF-ER group)were compared to 63 lesions from 63 patients who underwent ESD(the ESD group).We also performed a subgroup analysis of small lesions(≤10 mm)in 6 patients(7 lesions)from the GF-ER group and 20 patients(20 lesions)from the ESD group.RESULTS There were no statistically significant differences between the GF-ER and ESD groups in the en bloc resection rates(100%vs 100%)and the R0 resection rates(100%vs 98.4%).The median procedure time in the GF-ER group was shorter than that in the ESD group(4.0 min vs 55.0 min,P<0.01).There were no adverse events in the GF-ER group,although five perforations(8.0%)and 1 case of postoperative bleeding(1.6%)were observed in the ESD group.When we only considered lesions that were≤10 mm,the median procedure time in the GF-ER group was still shorter than that in the ESD group(4.0 min vs 35.0 min,P<0.01).There were no adverse events in the GF-ER group,although 1 case of perforation(1.6%)were observed in the ESD group.CONCLUSION These findings suggest that GF-ER may be an effective therapeutic option for small lesions in the GC of the stomach’s U and M regions.
