The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
BACKGROUND The technical complexity and potential for complications associated with endoscopic submucosal dissection(ESD)pose limitations on the widespread use of this procedure for stage 1 rectal neuroendocrine tumor...BACKGROUND The technical complexity and potential for complications associated with endoscopic submucosal dissection(ESD)pose limitations on the widespread use of this procedure for stage 1 rectal neuroendocrine tumors(NETs),despite its high success rate in achieving complete resection(R0).AIM To examine the results of ESD and hybrid ESD,a simpler adaptation of the ESD technique,for stage 1 rectal NETs.METHODS Seventy-nine patients with 84 lesions of clinical stage 1 rectal NETs who received treatment at Sun Yat-sen University Cancer Center from January 2010 to June 2021 were reviewed retrospectively.RESULTS Sixty-one lesions in 58 patients were treated with ESD,while 23 in 21 patients were treated with hybrid ESD.The 84 rectal NETs had a median diameter of 8(5)mm(range,3-20 mm),with the median lesion size 8(5)mm for ESD and 8(4)mm for hybrid ESD(P=0.359).For ESD,the median duration of procedure was 46.00(14.00)minutes,while for hybrid ESD,it was 32.00(15.00)minutes(P<0.001).Both the ESD and hybrid ESD groups had identical rates of en bloc resection(100.00%vs 100.00%,P=1.000),R0 resection(86.89%vs 86.96%,P=1.000),perforation(1.64%vs 0.00%,P=1.000),and delayed bleeding(1.64%vs 4.35%,P=0.475).After a median of 27.50(30.00)months of observation,neither group had recurrence.CONCLUSION For endoscopic excision of stage 1 rectal NETs,both ESD and hybrid ESD were well tolerated and produced positive results,with similar efficacy and safety.展开更多
BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD....BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.展开更多
In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive ove...In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.展开更多
BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conver...BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conversational artificial intelligence(AI)tools like chat generative pretrained transformer(ChatGPT)are rapidly emerging as sources of medical information.AIM To evaluate ChatGPT’s reliability and usefulness regarding ESD and EMR for patients and healthcare professionals.METHODS In this study,30 specific questions related to ESD and EMR were identified.Then,these questions were repeatedly entered into ChatGPT,with two independent answers generated for each question.A Likert scale was used to rate the accuracy,completeness,and comprehensibility of the responses.Meanwhile,a binary category(high/Low)was used to evaluate each aspect of the two responses generated by ChatGPT and the response retrieved from Google.RESULTS By analyzing the average scores of the three raters,our findings indicated that the responses generated by ChatGPT received high ratings for accuracy(mean score of 5.14 out of 6),completeness(mean score of 2.34 out of 3),and comprehensibility(mean score of 2.96 out of 3).Kendall’s coefficients of concordance indicated good agreement among raters(all P<0.05).For the responses generated by Google,more than half were classified by experts as having low accuracy and low completeness.CONCLUSION ChatGPT provided accurate and reliable answers in response to questions about ESD and EMR.Future studies should address ChatGPT’s current limitations by incorporating more detailed and up-to-date medical information.This could establish AI chatbots as significant resource for both patients and health care professionals.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychologi...BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.展开更多
BACKGROUND Conventional reusable endoscopes have high disinfection costs because of their large size.In this study,we compared the effectiveness,safety,and operation performance of the portable disposable large-channe...BACKGROUND Conventional reusable endoscopes have high disinfection costs because of their large size.In this study,we compared the effectiveness,safety,and operation performance of the portable disposable large-channel endoscope that we developed with those of a conventional gastroscope in endoscopic submucosal dissection(ESD).AIM To compare two gastroscopes in ESD for effectiveness and safety.METHODS Ten Bama pigs were subjected to gastroscopy and ESD after general anesthesia.The experiment was completed by four experienced endoscopists.First,two endoscopists randomly selected the portable disposable large-channel or conventional gastroscope to complete gastroscopy procedures.The other two endoscopists assessed the quality of endoscopic images.After endoscopy,all of the endoscopists randomly used the portable disposable large-channel endoscope or the conventional gastroscope for ESD.Endoscopic operation performance,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,success rate of en bloc resection,muscular injury rate,and complications were compared between the endoscopes.RESULTS No significant differences in gastroscopy duration or in the integrity,sharpness,saturation,and brightness of the gastroscopic images were observed between the gastroscopes.For ESD,no significant differences in endoscopic operation performance,incision time,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,or success rate of en bloc resection were observed between the gastroscopes.Neither gastroscope caused muscular injury or treatment-related complica-tions.CONCLUSION The portable disposable large-channel endoscope can be used safely and effectively for gastroscopy and treatment.展开更多
Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bl...Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bloc resection of neoplastic lesions confined to the mucosa and submucosa,thereby preserving organ function and reducing the need for more radical surgical interventions.ESD provides diagnostic clarity and enhances patient survival rates when performed by skilled practitioners in the early stages of GI cancers such as esophageal,gastric,and colorectal carcinomas.This article examines the indications,procedural advancements,technical considerations,and outcomes associated with ESD in early GI cancers.The challenges and complications that can arise are also highlighted.Additionally,we discuss the evolving role of novel techniques and adjunctive therapies to improve safety and efficacy.As the field progresses,ESD remains a cornerstone in managing early GI cancers,offering patients a promising option for organ preservation and long-term survival.展开更多
Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside ...Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.展开更多
BACKGROUND The incidence of esophageal cancer is high,and its prognosis is poor.Endoscopic submucosal dissection(ESD)is an important,minimally invasive treatment for early esophageal cancer,but the risk of postoperati...BACKGROUND The incidence of esophageal cancer is high,and its prognosis is poor.Endoscopic submucosal dissection(ESD)is an important,minimally invasive treatment for early esophageal cancer,but the risk of postoperative bleeding affects its efficacy.AIM To explore risk factors of bleeding after ESD and evaluate the predictive value of a gradient boosting machine(GBM)model for postoperative bleeding.METHODS The clinical data of 178 early esophageal cancer patients who underwent ESD at the Affiliated Hospital of Xuzhou Medical University from October 2019 to October 2024 were analyzed retrospectively.Patients were divided into two groups(bleeding and non-bleeding).Univariate and multivariate logistic regression analyses identified risk factors for postoperative bleeding,leading to the construction of the GBM prediction model.The receiver operating characteristic(ROC)curve evaluated the predictive efficacy of the GBM model and bleeding after ESD trend from Japan(BEST-J)score.RESULTS Among 178 patients who received ESD treatment,29 cases(16.29%)had bleeding,and 149 cases(83.71%)had no bleeding.The average BEST-J score and the proportion of high-risk and extremely high-risk patients were higher in the bleeding group than in the non-bleeding group(P<0.05).Multivariate logistic regression analysis showed that tumor size≥3 cm,surgical bleeding,and Creactive protein(CRP)were independent risk factors for bleeding after ESD in patients with early esophageal cancer(P<0.05).The ROC curve showed that the area under the curve of the GBM prediction model based on the influencing factors was greater than that of the BEST-J score(0.818 vs 0.653,P<0.05).CONCLUSION The GBM prediction model based on tumor size≥3 cm,surgical bleeding,and high CRP levels is more effective than the BEST-J score at predicting bleeding after ESD.展开更多
Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic sub...Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this tec...BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.展开更多
BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoi...BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.展开更多
BACKGROUND Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract.In the early stage,most patients are asymptomatic;after the onset of symptoms,there is often no specifici...BACKGROUND Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract.In the early stage,most patients are asymptomatic;after the onset of symptoms,there is often no specificity regarding symptoms.CASE SUMMARY Here we report the endoscopic diagnosis and treatment of an adult patient with cystic lymphangioma of the ascending colon.One patient who came to our hospital with“dull pain in the left lower abdomen for 2 days”was initially misdiagnosed with a colon cyst according to endoscopy and then underwent endoscopic submucosal dissection.The final pathological results suggested cystic lymphangioma.One year later,no recurrence was found on re-examination via colonoscopy.CONCLUSION Cystic lymphangioma in the gastrointestinal tract rarely occurs in adults and is easily misdiagnosed or missed.Endoscopy,imaging,histology,and immunohistochemical staining are useful for diagnosis.Surgical resection is the preferred treatment.展开更多
BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma presents with various clinical presentations and endoscopic features.While gastric lesions are primarily assessed via endoscopic forceps biopsy,pathol...BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma presents with various clinical presentations and endoscopic features.While gastric lesions are primarily assessed via endoscopic forceps biopsy,pathological confirmation of MALT lymphoma is frequently challenging,with low detection rates commonly observed.CASE SUMMARY We describe a 61-year-old male patient with gastric MALT lymphoma due to intermittent abdominal discomfort lasting over six months.The initial endoscopic forceps biopsy was suggestive of gastric lymphoma.Confirmation of the MALT lymphoma diagnosis was ultimately obtained through a jumbo biopsy specimen harvested via endoscopic submucosal dissection(ESD).CONCLUSION We report a case of gastric MALT lymphoma diagnosed through ESD,highlighting its potential as a diagnostic tool when forceps biopsy yields negative or inconclusive results.展开更多
BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location ...BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.AIM To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.METHODS A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024.Patients were stratified into two groups based on tumor location:Group 1 included patients with tumors in the lower third of the stomach,while Group 2 included those with tumors in the middle or upper third.The following parameters were evaluated for each group:procedure duration,curative resection rate,en bloc resection rate,complete resection rate,incidence of complications,and depth of neoplastic invasion.RESULTS The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach(P=0.0011).En bloc resection rates for ESD in the distal and proximal stomach were 97.9%and 85.7%,respectively(P=0.0016),while complete resection rates were 93.9%and 73.4%,respectively(P=0.0002).Curative resection was achieved in 90.9%of distal lesions compared to 65.3%of proximal lesions(P=0.0001).Submucosal invasion was identified in 4.0%of distal lesions and 14.2%of proximal lesions(P=0.013).CONCLUSION ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach,independent of lesion size and histopathological characteristics.Additionally,proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.展开更多
BACKGROUND Early gastric cancer(EGC)or precancerous lesions(PCLs)are generally small tumors and carry a diminished chance of nodal infiltration.Thus far,very few studies have examined how endoscopic submucosal dissect...BACKGROUND Early gastric cancer(EGC)or precancerous lesions(PCLs)are generally small tumors and carry a diminished chance of nodal infiltration.Thus far,very few studies have examined how endoscopic submucosal dissection(ESD)affects postoperative recovery and complications in such patients.AIM To evaluate the influence of ESD on postoperative recovery and complications in patients with EGC or PCL.METHODS The study population included patients with EGC and PCL admitted to The First People’s Hospital of Fuyang District between December 2022 and December 2024,who were divided into the research(n=65)and control(n=55)groups if they underwent ESD and laparoscopic radical gastrectomy,respectively.Therapeutic outcomes(en bloc and curative resection rates),surgical parameters(incision length,intraoperative bleeding,and operative duration),postoperative recovery indices(time to first ambulation/flatus/first oral intake,and hospital stay duration),complications(infection,outflow obstruction,bleeding,and perforation),and tumor markers[carcinoembryonic antigen(CEA)and carbohydrate antigen(CA)125/19-9]were comparatively evaluated.RESULTS Compared with the control group,the research group achieved a significantly higher en bloc resection rate but a notably lower curative resection rate.Additionally,the research group demonstrated shorter incision lengths,reduced intraoperative bleeding,and shorter operative duration.Regarding postoperative recovery,the research group demonstrated earlier ambulation,faster bowel function restoration,quicker oral intake resumption,and shorter hospital stays.Furthermore,an evidently lower overall complication rate was recorded in the research group,as well as markedly reduced postoperative CEA,CA125,and CA19-9 concentrations.CONCLUSION When performed for EGC and PCLs,ESD demonstrates advantages such as higher en bloc resection(although lower curative resection rates),surgical trauma minimization,shortened operative duration,and faster recovery.Moreover,it is effective in reducing serum tumor marker levels while maintaining favorable safety.展开更多
BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy o...BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.展开更多
BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding a...BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.展开更多
BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted end...BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.展开更多
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
基金Supported by the National Natural Science Foundation of China,No.82403973.
文摘BACKGROUND The technical complexity and potential for complications associated with endoscopic submucosal dissection(ESD)pose limitations on the widespread use of this procedure for stage 1 rectal neuroendocrine tumors(NETs),despite its high success rate in achieving complete resection(R0).AIM To examine the results of ESD and hybrid ESD,a simpler adaptation of the ESD technique,for stage 1 rectal NETs.METHODS Seventy-nine patients with 84 lesions of clinical stage 1 rectal NETs who received treatment at Sun Yat-sen University Cancer Center from January 2010 to June 2021 were reviewed retrospectively.RESULTS Sixty-one lesions in 58 patients were treated with ESD,while 23 in 21 patients were treated with hybrid ESD.The 84 rectal NETs had a median diameter of 8(5)mm(range,3-20 mm),with the median lesion size 8(5)mm for ESD and 8(4)mm for hybrid ESD(P=0.359).For ESD,the median duration of procedure was 46.00(14.00)minutes,while for hybrid ESD,it was 32.00(15.00)minutes(P<0.001).Both the ESD and hybrid ESD groups had identical rates of en bloc resection(100.00%vs 100.00%,P=1.000),R0 resection(86.89%vs 86.96%,P=1.000),perforation(1.64%vs 0.00%,P=1.000),and delayed bleeding(1.64%vs 4.35%,P=0.475).After a median of 27.50(30.00)months of observation,neither group had recurrence.CONCLUSION For endoscopic excision of stage 1 rectal NETs,both ESD and hybrid ESD were well tolerated and produced positive results,with similar efficacy and safety.
基金Supported by Science and Technology Department of Sichuan Province,No.2020YFS0376National Natural Science Foundation of China,No.81900599Science and Technology Program of Hospital of TCM,Southwest Medical University,No.2022-CXTD-01.
文摘BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.
文摘In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.
基金Supported by Ningbo Top Medical and Health Research Program,No.2023020612the Ningbo Leading Medical&Healthy Discipline Project,No.2022-S04+1 种基金the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission,No.2022KY315Ningbo Science and Technology Public Welfare Project,No.2023S133.
文摘BACKGROUND With the rising use of endoscopic submucosal dissection(ESD)and endoscopic mucosal resection(EMR),patients are increasingly questioning various aspects of these endoscopic procedures.At the same time,conversational artificial intelligence(AI)tools like chat generative pretrained transformer(ChatGPT)are rapidly emerging as sources of medical information.AIM To evaluate ChatGPT’s reliability and usefulness regarding ESD and EMR for patients and healthcare professionals.METHODS In this study,30 specific questions related to ESD and EMR were identified.Then,these questions were repeatedly entered into ChatGPT,with two independent answers generated for each question.A Likert scale was used to rate the accuracy,completeness,and comprehensibility of the responses.Meanwhile,a binary category(high/Low)was used to evaluate each aspect of the two responses generated by ChatGPT and the response retrieved from Google.RESULTS By analyzing the average scores of the three raters,our findings indicated that the responses generated by ChatGPT received high ratings for accuracy(mean score of 5.14 out of 6),completeness(mean score of 2.34 out of 3),and comprehensibility(mean score of 2.96 out of 3).Kendall’s coefficients of concordance indicated good agreement among raters(all P<0.05).For the responses generated by Google,more than half were classified by experts as having low accuracy and low completeness.CONCLUSION ChatGPT provided accurate and reliable answers in response to questions about ESD and EMR.Future studies should address ChatGPT’s current limitations by incorporating more detailed and up-to-date medical information.This could establish AI chatbots as significant resource for both patients and health care professionals.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)has become a widely accepted,minimally invasive treatment for gastrointestinal submucosal tumors.It has been reported that humanistic nursing care with graded psychological interventions can effectively enhance patients’physical activity in patients,reduce postoperative complications,and improve their postoperative quality of life.AIM To investigate the effects of combining humanistic care with graded psychological support on nursing satisfaction and quality of life in patients undergoing ESD for gastrointestinal submucosal tumors.METHODS A retrospective analysis was conducted on the clinical data of 180 patients who underwent ESD surgery for gastrointestinal submucosal tumors at our hospital between March 2021 and February 2023.Patients were allocated into groups based on the nursing care they received:The control group,which received routine care(n=90),and the observation group,which was subjected to humanistic nursing care in combination with graded psychological support(n=90).Patient anxiety and depression were assessed using the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Quality of life was evaluated using the shortform 36 health survey,and additional indications such as time to first food intake,surgery duration,length of hospital stay,nursing satisfaction,and adverse reactions were also recorded.Data was analyzed using SPSS22.0,with t-tests employed for continuous variables andχ2 tests for categorical data.RESULTS Patients in the observation group experienced significantly shorter times to first postoperative meal,surgery,and hospital stay compared to the control group.After the intervention,the SAS score of the observation group was 43.17±5.68,and the SDS score was 41.57±6.52,both significantly lower than those of the control group,with SAS score of 52.38±5.21 and SDS score of 51.23±8.25.In addition,the observation group scored significantly higher in daily living,physical function,psychological well-being,and social functioning(80.01±6.39,83.59±6.89,81.69±5.34,and 85.23±6.05,respectively).Moreover,the observation group also exhibited higher satisfaction and selfefficacy scores and a lower incidence of adverse reactions compared to the control group(P<0.05).CONCLUSION For patients undergoing ESD for gastrointestinal submucosal tumors,humanistic nursing care in combination with graded psychological nursing care significantly shorten the times to first postoperative meal,surgery,and hospital stay,effectively alleviates anxiety and depression,improves quality of life and nursing satisfaction,and mitigate the incidence of adverse reactions.
文摘BACKGROUND Conventional reusable endoscopes have high disinfection costs because of their large size.In this study,we compared the effectiveness,safety,and operation performance of the portable disposable large-channel endoscope that we developed with those of a conventional gastroscope in endoscopic submucosal dissection(ESD).AIM To compare two gastroscopes in ESD for effectiveness and safety.METHODS Ten Bama pigs were subjected to gastroscopy and ESD after general anesthesia.The experiment was completed by four experienced endoscopists.First,two endoscopists randomly selected the portable disposable large-channel or conventional gastroscope to complete gastroscopy procedures.The other two endoscopists assessed the quality of endoscopic images.After endoscopy,all of the endoscopists randomly used the portable disposable large-channel endoscope or the conventional gastroscope for ESD.Endoscopic operation performance,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,success rate of en bloc resection,muscular injury rate,and complications were compared between the endoscopes.RESULTS No significant differences in gastroscopy duration or in the integrity,sharpness,saturation,and brightness of the gastroscopic images were observed between the gastroscopes.For ESD,no significant differences in endoscopic operation performance,incision time,submucosal dissection time,total procedure time,total submucosal injection volume,specimen size,or success rate of en bloc resection were observed between the gastroscopes.Neither gastroscope caused muscular injury or treatment-related complica-tions.CONCLUSION The portable disposable large-channel endoscope can be used safely and effectively for gastroscopy and treatment.
文摘Endoscopic submucosal dissection(ESD)has emerged as a pivotal therapeutic modality for early gastrointestinal(GI)cancers,providing a minimally invasive approach with curative potential.This technique enables the en bloc resection of neoplastic lesions confined to the mucosa and submucosa,thereby preserving organ function and reducing the need for more radical surgical interventions.ESD provides diagnostic clarity and enhances patient survival rates when performed by skilled practitioners in the early stages of GI cancers such as esophageal,gastric,and colorectal carcinomas.This article examines the indications,procedural advancements,technical considerations,and outcomes associated with ESD in early GI cancers.The challenges and complications that can arise are also highlighted.Additionally,we discuss the evolving role of novel techniques and adjunctive therapies to improve safety and efficacy.As the field progresses,ESD remains a cornerstone in managing early GI cancers,offering patients a promising option for organ preservation and long-term survival.
文摘Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.
文摘BACKGROUND The incidence of esophageal cancer is high,and its prognosis is poor.Endoscopic submucosal dissection(ESD)is an important,minimally invasive treatment for early esophageal cancer,but the risk of postoperative bleeding affects its efficacy.AIM To explore risk factors of bleeding after ESD and evaluate the predictive value of a gradient boosting machine(GBM)model for postoperative bleeding.METHODS The clinical data of 178 early esophageal cancer patients who underwent ESD at the Affiliated Hospital of Xuzhou Medical University from October 2019 to October 2024 were analyzed retrospectively.Patients were divided into two groups(bleeding and non-bleeding).Univariate and multivariate logistic regression analyses identified risk factors for postoperative bleeding,leading to the construction of the GBM prediction model.The receiver operating characteristic(ROC)curve evaluated the predictive efficacy of the GBM model and bleeding after ESD trend from Japan(BEST-J)score.RESULTS Among 178 patients who received ESD treatment,29 cases(16.29%)had bleeding,and 149 cases(83.71%)had no bleeding.The average BEST-J score and the proportion of high-risk and extremely high-risk patients were higher in the bleeding group than in the non-bleeding group(P<0.05).Multivariate logistic regression analysis showed that tumor size≥3 cm,surgical bleeding,and Creactive protein(CRP)were independent risk factors for bleeding after ESD in patients with early esophageal cancer(P<0.05).The ROC curve showed that the area under the curve of the GBM prediction model based on the influencing factors was greater than that of the BEST-J score(0.818 vs 0.653,P<0.05).CONCLUSION The GBM prediction model based on tumor size≥3 cm,surgical bleeding,and high CRP levels is more effective than the BEST-J score at predicting bleeding after ESD.
文摘Objective:Esophageal carcinoma(EC)is a primary global health concern,ranking as the eighth most common cancer and the sixth leading cause of cancer-related mortality.Endoscopic mucosal resection(EMR)and endoscopic submucosal dissection(ESD)are widely used to manage early-stage EC and Barrett’s esophagus.However,their comparative efficacyand safety remain debated.This study aims to systematically compare the safety and efficacyof ESD and EMR in the treatment of early EC and Barrett’s esophagus.Methods:A systematic review and meta-analysis were conducted following the PRISMA 2020 guidelines.Databases,including MEDLINE(via PubMed),Google Scholar,and the Cochrane Library were searched for studies published up to October 2024.Twenty-two studies involving 3309 patients(1425 with ESD and 1884 with EMR)met the inclusion criteria.The outcomes assessed included en bloc resection,R0 resection,curative resection,local recurrence,bleeding,perforation,and stricture formation.Risk ratios(RR)with 95%CIs were calculated via a random-effects model via RevMan 5.4.Results:ESD significantlyoutperformed EMR in en bloc resection(RR=2.22,95%CI:1.69–2.90;p<0.001),R0 resection(RR=1.93,95%CI:1.28–2.91;p=0.002),and curative resection rates(RR=2.29,95%CI:1.52–3.46;p<0.001).ESD was associated with lower local recurrence in patients with squamous cell carcinoma(SCC)(RR=0.13,95%CI:0.06–0.30;p<0.001),whereas recurrence was greater in patients with Barrett’s esophagus(RR=1.67,95%CI:1.30–2.14;p<0.001).No significant difference was observed in bleeding rates;however,ESD was associated with a greater risk of perforation(RR=2.94,95%CI:1.31–6.60;p=0.009).Conclusion:ESD is more effective than EMR in achieving complete and curative resections for early EC and SCC,particularly for lesions>20 mm.However,it has a higher complication rate,especially perforation.Careful patient selection and procedural expertise are essential when choosing between the two techniques.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)is considered one of the effective and minimally invasive methods for managing lateral spreading tumors of the intestine.However,with the widespread adoption of this technique,the incidence of complications is expected to increase.The most common complications of ESD are hemorrhage and perforation.Rare cases of obstruction after colorectal ESD have been reported,which are often easily misdiagnosed.Therefore,clinicians should maintain heightened awareness of this complication.CASE SUMMARY We report the case of a 50-year-old male who developed bowel obstruction following ESD.On the second day after the procedure,the patient presented with fever and a mild left lower abdominal pain.Physical examination revealed tenderness and rebound tenderness in the left lower quadrant.Plain abdominal radiographs demonstrated air-fluid levels and dilatation of the proximal bowel.The patient continued to fast and was treated with intravenous antibiotics.On the third postoperative day,he developed abdominal distension in the lower abdomen and vomited approximately 200 mL of greenish-yellow fluid,with no bowel movement for two days after the procedure.A diagnosis of obstruction after ESD was made.Continuous gastrointestinal decompression was initiated on the fourth day,resulting in symptomatic improvement.Follow-up abdominal radiographs showed marked improvement in the obstruction compared with prior imaging.The patient resumed oral intake and was discharged uneventfully on the eighth postoperative day.CONCLUSION Acute intestinal obstruction after ESD is a rare complication.Delayed diagnosis or misdiagnosis may be life-threatening.Clinicians should be vigilant for this condition following ESD.
基金Supported by the Japan Society for the Promotion of Science Grant-in-Aid for Scientific Research,No.23K11902.
文摘BACKGROUND The early acquisition of skills required to perform hemostasis during endoscopy may be hindered by the lack of tools that allow assessments of the operator’s viewpoint.Understanding the operator’s viewpoint may facilitate the skills.AIM To evaluate the effects of a training system using operator gaze patterns during gastric endoscopic submucosal dissection(ESD)on hemostasis.METHODS An eye-tracking system was developed to record the operator’s viewpoints during gastric ESD,displaying the viewpoint as a circle.In phase 1,videos of three trainees’viewpoints were recorded.After reviewing these,trainees were recorded again in phase 2.The videos from both phases were retrospectively reviewed,and short clips were created to evaluate the hemostasis skills.Outcome measures included the time to recognize the bleeding point,the time to complete hemostasis,and the number of coagulation attempts.RESULTS Eight cases treated with ESD were reviewed,and 10 video clips of hemostasis were created.The time required to recognize the bleeding point during phase 2 was significantly shorter than that during phase 1(8.3±4.1 seconds vs 23.1±19.2 seconds;P=0.049).The time required to complete hemostasis during phase 1 and that during phase 2 were not significantly different(15.4±6.8 seconds vs 31.9±21.7 seconds;P=0.056).Significantly fewer coagulation attempts were performed during phase 2(1.8±0.7 vs 3.2±1.0;P=0.004).CONCLUSION Short-term training did not reduce hemostasis completion time but significantly improved bleeding point recognition and reduced coagulation attempts.Learning from the operator’s viewpoint can facilitate acquiring hemostasis skills during ESD.
文摘BACKGROUND Cystic lymphangioma is a rare hamartoma that is especially found in the adult gastrointestinal tract.In the early stage,most patients are asymptomatic;after the onset of symptoms,there is often no specificity regarding symptoms.CASE SUMMARY Here we report the endoscopic diagnosis and treatment of an adult patient with cystic lymphangioma of the ascending colon.One patient who came to our hospital with“dull pain in the left lower abdomen for 2 days”was initially misdiagnosed with a colon cyst according to endoscopy and then underwent endoscopic submucosal dissection.The final pathological results suggested cystic lymphangioma.One year later,no recurrence was found on re-examination via colonoscopy.CONCLUSION Cystic lymphangioma in the gastrointestinal tract rarely occurs in adults and is easily misdiagnosed or missed.Endoscopy,imaging,histology,and immunohistochemical staining are useful for diagnosis.Surgical resection is the preferred treatment.
基金Supported by the Hebei Natural Science Foundation,No.H2023206912.
文摘BACKGROUND Gastric mucosa-associated lymphoid tissue(MALT)lymphoma presents with various clinical presentations and endoscopic features.While gastric lesions are primarily assessed via endoscopic forceps biopsy,pathological confirmation of MALT lymphoma is frequently challenging,with low detection rates commonly observed.CASE SUMMARY We describe a 61-year-old male patient with gastric MALT lymphoma due to intermittent abdominal discomfort lasting over six months.The initial endoscopic forceps biopsy was suggestive of gastric lymphoma.Confirmation of the MALT lymphoma diagnosis was ultimately obtained through a jumbo biopsy specimen harvested via endoscopic submucosal dissection(ESD).CONCLUSION We report a case of gastric MALT lymphoma diagnosed through ESD,highlighting its potential as a diagnostic tool when forceps biopsy yields negative or inconclusive results.
文摘BACKGROUND The location of gastric neoplasms can influence the level of technical difficulty and performance of endoscopic submucosal dissection(ESD).There are few studies that analyze the influence of tumor location in the stomach on ESD outcomes.AIM To compare the clinical efficacy and safety of ESD in the proximal vs distal stomach.METHODS A retrospective analysis was conducted on patients admitted in chronological order who received gastric ESD between 2009 and 2024.Patients were stratified into two groups based on tumor location:Group 1 included patients with tumors in the lower third of the stomach,while Group 2 included those with tumors in the middle or upper third.The following parameters were evaluated for each group:procedure duration,curative resection rate,en bloc resection rate,complete resection rate,incidence of complications,and depth of neoplastic invasion.RESULTS The mean procedure time was 97.07 minutes for lesions located in the distal stomach and 129.08 minutes for those in the proximal stomach(P=0.0011).En bloc resection rates for ESD in the distal and proximal stomach were 97.9%and 85.7%,respectively(P=0.0016),while complete resection rates were 93.9%and 73.4%,respectively(P=0.0002).Curative resection was achieved in 90.9%of distal lesions compared to 65.3%of proximal lesions(P=0.0001).Submucosal invasion was identified in 4.0%of distal lesions and 14.2%of proximal lesions(P=0.013).CONCLUSION ESD performed in the proximal stomach requires a longer procedural time compared to ESD in the distal stomach,independent of lesion size and histopathological characteristics.Additionally,proximal gastric ESD is associated with reduced clinical efficacy and increased incidence of submucosal invasion.
文摘BACKGROUND Early gastric cancer(EGC)or precancerous lesions(PCLs)are generally small tumors and carry a diminished chance of nodal infiltration.Thus far,very few studies have examined how endoscopic submucosal dissection(ESD)affects postoperative recovery and complications in such patients.AIM To evaluate the influence of ESD on postoperative recovery and complications in patients with EGC or PCL.METHODS The study population included patients with EGC and PCL admitted to The First People’s Hospital of Fuyang District between December 2022 and December 2024,who were divided into the research(n=65)and control(n=55)groups if they underwent ESD and laparoscopic radical gastrectomy,respectively.Therapeutic outcomes(en bloc and curative resection rates),surgical parameters(incision length,intraoperative bleeding,and operative duration),postoperative recovery indices(time to first ambulation/flatus/first oral intake,and hospital stay duration),complications(infection,outflow obstruction,bleeding,and perforation),and tumor markers[carcinoembryonic antigen(CEA)and carbohydrate antigen(CA)125/19-9]were comparatively evaluated.RESULTS Compared with the control group,the research group achieved a significantly higher en bloc resection rate but a notably lower curative resection rate.Additionally,the research group demonstrated shorter incision lengths,reduced intraoperative bleeding,and shorter operative duration.Regarding postoperative recovery,the research group demonstrated earlier ambulation,faster bowel function restoration,quicker oral intake resumption,and shorter hospital stays.Furthermore,an evidently lower overall complication rate was recorded in the research group,as well as markedly reduced postoperative CEA,CA125,and CA19-9 concentrations.CONCLUSION When performed for EGC and PCLs,ESD demonstrates advantages such as higher en bloc resection(although lower curative resection rates),surgical trauma minimization,shortened operative duration,and faster recovery.Moreover,it is effective in reducing serum tumor marker levels while maintaining favorable safety.
基金Supported by the Basic and Applied Basic Research Foundation of Guangzhou,No.202201011331the National Natural Science Foundation of China,No.82373118the Natural Science Foundation of Guangdong Province,No.2023A1515010828.
文摘BACKGROUND Stage 1 rectal neuroendocrine tumors(NETs)are best treated with endoscopic submucosal dissection(ESD)or transanal endoscopic microsurgery(TEM)for local resection.AIM To investigate the safety and efficacy of ESD and TEM for local resection of stage 1 rectal NETs.METHODS This retrospective observational analysis included patients with clinical stage 1 rectal NETs(cT1N0M0,less than 20 mm)who underwent ESD or TEM.The ESD and TEM groups were matched to ensure that they had comparable lesion sizes,lesion locations,and pathological grades.We assessed the differences between groups in terms of en bloc resection rate,R0 resection rate,adverse event rate,recurrence rate,and hospital stay and cost.RESULTS Totally,128 Lesions(ESD=84;TEM=44)were included,with 58 Lesions within the matched groups(ESD=29;TEM=29).Both the ESD and TEM groups had identical en bloc resection(100.0%vs 100.0%,P=1.000),R0 resection(82.8%vs 96.6%,P=0.194),adverse event(0.0%vs 6.9%,P=0.491),and recurrence(0.0%vs 3.4%,P=1.000)rates.Nevertheless,the median hospital stay[ESD:5.5(4.5-6.0)vs TEM:10.0(7.0-12.0)days;P<0.001],and cost[ESD:11.6(9.8-12.6)vs TEM:20.9(17.0-25.1)kilo-China Yuan,P<0.001]were remarkably shorter and less for ESD.CONCLUSION Both ESD and TEM were well-tolerated and yielded favorable outcomes for the local removal of clinical stage 1 rectal NETs.ESD exhibits shorter hospital stay and fewer costs than TEM.
文摘BACKGROUND Early anal canal cancer is frequently treated with endoscopic submucosal dis-section(ESD)to preserve anal function.However,if the lesion is in the anal canal,then significant difficulties such as bleeding and challenges associated with scope manipulation can arise.CASE SUMMARY A 70-year-old woman undergoing follow-up after transverse colon cancer surgery was diagnosed with anal canal cancer extending to the dentate line.The patient underwent a combination of ESD and transanal resection(TAR).The specimen was excised in pieces,which resulted in difficulty performing the pathological evaluation of the margins,especially on the anal side where TAR was performed and severe crushing was observed.Careful follow-up was performed,and local recurrence was observed 3 years postoperatively.Because the patient had super-ficial cancer without lymph node metastasis,local resection was performed again.The second treatment attempt was improved as follows:(1)TAR and ESD were performed appropriately based on the situation by the same physician;(2)A needle scalpel was used during TAR to prevent tissue crushing;and(3)The lesion borders were marked using ESD techniques before treatment.Complete resection was performed without complications.CONCLUSION Anal canal lesions can be safely and reliably removed when ESD and TAR are used appropriately.
基金Supported by Fujian Province National Key Clinical Specialty Construction Project(Minwei Medical Policy Letter),No.[2023]1594.
文摘BACKGROUND Conventional endoscopic submucosal dissection(c-ESD)is a widely used technique for rectal neuroendocrine tumors(NETs),but it poses certain challenges.To address these,we developed a pretraction-assisted endoscopic submucosal dissection(p-ESD)technique.AIM To compare the efficacy and safety of p-ESD and c-ESD for rectal NETs.METHODS This retrospective study included consecutive patients with rectal NETs measuring less than 15 mm who underwent either p-ESD or c-ESD at Fujian Medical University Union Hospital between January 2019 and December 2023.The study aimed to evaluate differences in dissection time,en bloc resection rate,R0 resection rate,and adverse event rates between the p-ESD and c-ESD groups.RESULTS In total,103 patients were enrolled(49 in the p-ESD group and 54 in the c-ESD group).The p-ESD group exhibited a significantly shorter median dissection time(9.3 minutes vs 14.9 minutes;P<0.001)and a higher R0 resection rate(100%vs 88.9%;P=0.028),while en bloc resection rates were comparable.Rates of minor intraoperative bleeding(10.2%vs 25.9%;P=0.040)and major intraoperative bleeding(4.1%vs 18.5%;P=0.030)were lower in the p-ESD group.No muscularis propria injuries occurred in the p-ESD group vs 16.7%in the c-ESD group(P=0.003).Other adverse events did not differ significantly.CONCLUSION p-ESD is safe and effective for treating rectal NETs.Compared with c-ESD,it is technically easier,requires less dissection time,achieves higher R0 resection rates,reduces intraoperative bleeding,and lowers the risk of muscularis propria injury.
