• Journal of Gastric Cancer
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• v.11 no.3
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• pp.146-154
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• 2011

Endoscopic resection has been accepted as a curative modality for early gastric cancer (EGC). Since conventional endoscopic mucosal resection (EMR) has been introduced, many improvements in endoscopic accessories and techniques have been achieved. Recently, endoscopic submucosal dissection (ESD) using various electrosurgical knives has been performed for complete resection of EGC and enables complete resection of EGC, which is difficult to completely resect in the era of conventional EMR. Currently, ESD is accepted as the standard method for endoscopic resection of EGC in indicated cases. In this review, the history of endoscopic treatment for EGC, overall ESD procedures, and indications and clinical results of endoscopic treatment will be presented.

• Journal of Digestive Cancer Research
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• v.10 no.1
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• pp.16-21
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• 2022

Diagnosis of gastric subepithelial tumors (SETs) is sometimes difficult with conventional endoscopy or tissue sampling with standard biopsy, so non-invasive imaging modalities such as endoscopic ultrasound (EUS) and computed tomography are used to evaluate the characteristics of SETs features (size, location, originating layer, echogenicity, shape). However imaging modalities alone is not able to distinguish among all types of SETs, so histology is the gold standard for obtaining the final diagnosis. For tissue sampling, mucosal cutting biopsy and mucosal incision-assisted biopsy and EUS-guided fine-needle aspiration or biopsy (EUS-FNA or EUS-FNB) is commonly recommended. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are used for resection of SETs involving the mucosal and superficial submucosal layers, could not treat adequately and safely the SETs involving the deep mucosa and muscularis propria. Submucosal tunneling endoscopic resection (STER) and endoscopic full-thickness resection (EFTR) is used as a therapeutic option for the treatment of SETs with the development of reliable endoscopic closure techniques and tools.

• Clinical Endoscopy
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• v.56 no.4
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• pp.423-432
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• 2023

Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

• Clinical Endoscopy
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• v.56 no.5
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• pp.613-622
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) is currently considered the first-line treatment for the eradication of superficial neoplasms of the esophagus in Eastern countries. However, in the West, particularly in Latin America, the experience with esophageal ESD is still limited because of the high technical complexity required for its execution. This study aimed to present the results of the clinical application of ESD to manage superficial esophageal neoplasms in a Latin American center in over 100 consecutive cases. Methods: This retrospective study included consecutive patients who underwent endoscopic ESD for superficial esophageal neoplasms between 2009 and 2022. The following clinical outcomes were assessed: en bloc, complete, and curative resection rates, local recurrence, adverse events, and procedure-related mortality. Results: Esophageal ESD was performed mainly for squamous cell carcinoma (66.6%), high-grade intraepithelial neoplasia (17.1%), and adenocarcinoma (11.4%). En bloc and complete resection rates were 96.2% and 81.0%, respectively. The curative resection rate was 64.8%. Adverse events occurred in six cases (5.7%). Endoscopic follow-up was performed for an average period of 29.7 months. Conclusions: ESD performed by trained operators is feasible, safe, and clinically effective for managing superficial neoplastic lesions of the esophagus in Latin America.

• Journal of Gastric Cancer
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• v.20 no.4
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• pp.345-354
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• 2020

Early detection of gastric cancer is crucial because the survival rate can be improved through curative treatment. Although surgery and gastrectomy with lymph node dissection remain as the gold standard for curative treatment, early gastric cancer (EGC) with negligible risk of lymph node metastasis can be treated with endoscopic resection (ER), such as endoscopic submucosal dissection. Among gastric cancers, undifferentiated-type cancer is distinguished from differentiated-type cancer in various aspects in terms of clinical features and pathophysiology. The undifferentiated-type cancer is also known to be associated with an aggressive behavior and a poor prognosis. Therefore, the indication of ER for undifferentiated EGC is limited compared with differentiated-type. Recent studies have reported that ER for undifferentiated EGC is safe and shows favorable short- and long-term outcomes. However, it is necessary to understand the details of the research results and to selectively accept them. In this review, we aimed to evaluate the current practice guidelines and the short-term and long-term outcomes of ER for undifferentiated type EGC.

• Journal of Chest Surgery
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• v.53 no.4
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• pp.172-177
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• 2020

Superficial esophageal neoplasms (SENs) are being diagnosed increasingly frequently due to the screening endoscopy and advances in endoscopic techniques. Endoscopic resection (ER) is a relatively noninvasive treatment method with low morbidity and mortality that provides excellent oncologic outcomes. Endoscopic submucosal dissection is associated with higher rates of en bloc, complete and curative resections and lower rates of local recurrence than endoscopic mucosal resection. The most serious complication of ER is stricture, the treatment and prevention of which are crucial to maintain the patient's quality of life. ER for SEN is feasible, effective, and safe and can be considered a first-line treatment for SENs in which it is technically feasible.

• Journal of Gastric Cancer
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• v.13 no.2
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• pp.93-97
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• 2013

Purpose: Endoscopic submucosal dissection has recently been practiced on a differentiated type of early gastric cancer. However, there is no clear evidence for endoscopic treatments of signet ring cell carcinoma. The aim of this study is to identify the predictive clinicopathological factors for lymph node metastasis in signet ring cell carcinoma for assisting endoscopic submucosal dissection trials. Materials and Methods: A total of 186 patients with early signet ring cell carcinoma who underwent radical curative gastrectomy between January 2001 and September 2009 were enrolled in this study. Retrospective reviews of their medical records are being conducted. Several clinicopathologic factors were being investigated in order to identify predictive factors for lymph nodes metastasis: age, gender, tumor size, type of operation, tumor location, gross type, ulceration, Lauren's classification, depth of invasion, and lymphatic invasion. Results: The lymph node metastasis rate for signet ring cell carcinoma was 4.3% (n=8). Of the 186 lesions with early signet ring cell carcinoma, 91 (48.9%) tumors were larger than 15 mm in size and 40 (21.5%) showed submucosal invasions in the resection specimens. In multivariate analysis, only the lymphatic invasion (P<0.0001) showed an association with lymph node metastasis. To evaluate cutoff values for tumor sizes in the presence of lymph node metastasis, early signet ring cell carcinomas with lymphatic invasions were excluded. In the absence of lymphatic invasion, mucosal cancer with tumor sizes <15 mm had no lymph node metastasis. Conclusions: Endoscopic submucosal dissection can be performed on patients with early signet ring cell carcinoma limited to the mucosa and less than 15 mm.

• Journal of Korean Clinical Nursing Research
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• v.24 no.2
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• pp.147-158
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• 2018

Purpose: This study was conducted to identify the effects of educational video program delivered using Tablet PC on physical discomfort, uncertainty, state anxiety, and nursing education satisfaction among early gastric cancer patients undergoing endoscopic submucosal dissection. Methods: The study design was nonequivalent control group pretest-posttest design. The subjects were 60 patients who were hospitalized to undergo endoscopic submucosal dissection. The experimental group watched educational video using Tablet PC (n=30) and the control group received only the usual education (n=30). The collected data were analyzed using independent t-test to examine study hypothesis. Results: The level of physical discomfort (t=3.05, p=.003) and nursing education satisfaction (t=-2.20, p=.032) in the experimental group were significantly different from that of the control group. However, the level of uncertainty (t=-0.82, p=.418) and state anxiety (t=-1.69, p=.097) in the experimental group were not different from that of the control group. Conclusion: The study findings confirm that the educational video program delivered using Tablet PC as an effective intervention alleviating physical discomfort and improving satisfaction regarding nursing education among early gastric cancer patients undergoing endoscopic submucosal dissection. Based on the findings, we believe that the educational video program can be helpful in decreaseing physical discomfort, and it also can be utilized to improve nursing education satisfaction.

• Journal of Gastric Cancer
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• v.21 no.4
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• pp.426-438
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• 2021

Purpose: While the incidence of Barrett's neoplasia has been increasing in Western countries, the disease remains rare in Asian countries. Therefore, very few studies have investigated the endoscopic treatment for Barrett's neoplasia in Korea. Endoscopic submucosal dissection (ESD) enables en bloc and complete resection of gastrointestinal neoplastic lesions. This study aimed to evaluate the therapeutic outcomes of ESD for Barrett's neoplasia in a single center in Korea and to examine the predictive factors for incomplete resection. Materials and Methods: We conducted a retrospective observational study of 18 patients who underwent ESD for superficial Barrett's neoplasia (dysplasia and early cancer) between January 2010 and December 2019 at Pusan National University Hospital. The therapeutic outcomes of ESD and procedure-related complications were analyzed. Results: En bloc resection, complete resection, and curative resection were performed in 94%, 72%, and 61% of patients, respectively. Histopathology (submucosal or deeper invasion of the tumor) was a significant predictive factor for incomplete resection (P=0.047). Procedure-related bleeding and stenosis were not observed, whereas perforation occurred in one case. During the median follow-up period of 12 months (range, 6-74 months), local recurrence occurred in 2 patients with incomplete resection, one patient underwent repeat ESD, and the other patient received concurrent chemoradiotherapy. The 3-year overall and disease-specific survival rates were 73% and 93%, respectively. Conclusions: ESD seems to be an effective and safe treatment for superficial Barrett's neoplasia in Korea. Nevertheless, the suitability of ESD for Barrett's cancer cases should be determined considering the high risk of deep submucosal invasion.

• Clinical Endoscopy
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• v.56 no.6
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• pp.769-777
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal tumors (SNADETs) is associated with a high rate of en bloc resection. However, the technique for ESD remains challenging. Recent studies have demonstrated the effectiveness of S-O clips in colonic and gastric ESD. We evaluated the efficacy and safety of duodenal ESD using an S-O clip for SNADETs. Methods: Consecutive patients who underwent ESD for SNADETs between January 2011 and December 2021 were retrospectively enrolled. Propensity score matching analysis was used to compare patients who underwent duodenal ESD with the S-O clip (S-O group) and those who underwent conventional ESD (control group). Intraoperative perforation rate was the primary outcome, while procedure time and R0 resection rate were the secondary outcomes. Results: After propensity score matching, 16 pairs were created: 43 and 17 in the S-O and control groups, respectively. The intraoperative perforation rate in the S-O group was significantly lower than that in the control group (p=0.033). A significant difference was observed in the procedure time between the S-O and control groups (39±9 vs. 82±30 minutes, respectively; p=0.003). Conclusions: The S-O clip reduced the intraoperative perforation rate and procedure time, which may be useful and effective in duodenal ESD.