Comparison of EMR and ESD in treatment of patients with neuroendocrine tumors of digestive tract / 中国内镜杂志

Objective To investigate the influence of EMR and ESD of endoscopic surgery on perioperative clinical parameters, complete resection rate and complications of patients with neuroendocrine tumors of digestive tract. Methods 40 patients with neuroendocrine tumors of digestive tract were chosen from June 2009 to June 2016 and randomly divided into 2 groups: A group (20 patients) with EMR and B group (20 patients) with ESD; and the operation time, the treatment cost, the lesion size, the lesion thickness, the complete resection of tumor, the negative rate of vertical margin and the complication incidence of the two groups were compared. Results The operation time and the treatment cost of B group were significant better than A group (P < 0.05). There was no significant difference in the lesion size and the lesion thickness between the two groups (P < 0.05). The completed resection rate of B group were significant higher than A group (P < 0.05). There was no significant difference in the negative rate of vertical margin between the two groups (P < 0.05). The complication incidence of B group were significant higher than A group (P < 0.05). Conclusion EMR and ESD of endoscopic surgery in the treatment of patients with neuroendocrine tumors of digestive tract possess the same clinical effects; EMR application can efficiently shorten the operation time and decrease the economic burden and ESD application maybe helpful to reduce the complication risk.

Analysis of endoscopic mucosal resection in treatment of 437 patients with colorectal polyps / 中国内镜杂志

Objectives To investigate the clinical, pathological and endoscopic characteristics of colorectal polyps treated by endoscopic mucosal resection (EMR), then evaluate its therapeutic effect and security, and analyze its significance in diagnosis and treatment. Methods Clinical and pathological data of 437 patients (687 lesions), who underwent EMR from August, 2014 to August, 2015 were collected. A retrospective analysis was made, and lesions were statistically analyzed by variables such as age, sex, endoscopic features and clinical and pathological characteristics, and so on, according to the group procedure of adenoma cancerization and 'high risk adenomas - low risk adenomas - non-adenoma polyps' to observe the curative effect and safety on EMR. Results 48.28% of the patients who received colonoscopy examines were detected with polyps, and 34.90% of them were operated EMR, including advanced adenomas, which were 17.08% of the total quantity. From non-adenoma to advanced adenoma, with a increasing possibility of carcinogenesis, the location of polyps are transferred from proximal colon to distal colon and lesions are readily to be pedunculated ones with a higher level of mucosal lobulation and other kinds of mucosal changing. The degeneration of the colorectum is associated with pedunculated polyps, distal colorectal polyps, the size (>1.0 cm), adenomas containing villous structures and mucosal lobulation. As for EMR treatment, the en bloc resection rate can reach as high as 99.70%, with a complication rate of 1.14%. Conclusions Some special characteristics can be found in the site and the endoscopic feature of advanced adenomas and degenerated adenomas. To polyps sizing in 0.5 ~ 3.0 cm, EMR with endoclips has a remarkable effect and a low complication incidence. It can reduce the process of colorectal adenoma degenerates to multiple colorectal adenocarcinoma, which can be regarded as an effective method to prevent and cure the colorectal carcinoma.

Comparison of EMR and ESD in treatment of patients with neuroendocrine tumors of digestive tract / 中国内镜杂志

Objective To investigate the influence of EMR and ESD of endoscopic surgery on perioperative clinical parameters, complete resection rate and complications of patients with neuroendocrine tumors of digestive tract. Methods 40 patients with neuroendocrine tumors of digestive tract were chosen from June 2009 to June 2016 and randomly divided into 2 groups: A group (20 patients) with EMR and B group (20 patients) with ESD; and the operation time, the treatment cost, the lesion size, the lesion thickness, the complete resection of tumor, the negative rate of vertical margin and the complication incidence of the two groups were compared. Results The operation time and the treatment cost of B group were significant better than A group (P < 0.05). There was no significant difference in the lesion size and the lesion thickness between the two groups (P < 0.05). The completed resection rate of B group were significant higher than A group (P < 0.05). There was no significant difference in the negative rate of vertical margin between the two groups (P < 0.05). The complication incidence of B group were significant higher than A group (P < 0.05). Conclusion EMR and ESD of endoscopic surgery in the treatment of patients with neuroendocrine tumors of digestive tract possess the same clinical effects; EMR application can efficiently shorten the operation time and decrease the economic burden and ESD application maybe helpful to reduce the complication risk.

Surgical Treatment for Patients Who Underwent Endoscopic Mucosal Resection (EMR)/Endoscopic Submucosal Dissection (ESD) of Early Gastric Cancer (EGC)

PURPOSE: To evaluate the necessity for additional surgical treatment after Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD), we analyzed the pathologic results of patients who underwent surgical treatment. METHODS: 140 consecutive patients underwent additional surgical treatment after EMR/ESD with en bloc resection between April 2005 and November 2009 at ASAN Medical Center. Additional surgical treatments were undergone for following conditions such as incomplete dissection (involvement of margin), undifferentiated-type histology (> or =2 cm) and submucosal cancer. RESULTS: One patient with deep margin involvement displayed advanced gastric cancer after gastrectomy. Three of 74 patients with clear resection margin were confirmed to have residual cancer at ESD site and 2 of 3 patients displayed advanced gastric cancer after surgery. In univariate analysis for metastasis of lymph node, deep submucosal invasion (over sm2 or 500microm) and the presence of lymphovascular invasion showed significant differences for lymph node metastasis. Especially, lymphovascular invasion was an important predictive factor for lymph node metastasis in multivariate analysis. In analysis for residual cancer, lateral margin involvement and large tumor (>3 cm) were risk factors. And, only lateral margin involvement showed significant risk in multivariate analysis. CONCLUSION: Although EMR/ESD were fully accomplished for resection margin, gastrectomy and lymph node dissection were positively necessary for patients with deepsubmucosal invasion (over sm2 or 500microm) and the presence of lymphovascular invasion to eliminate the possibility of residual cancer or more advanced gastric cancer or metastatic lymph nodes.

A Case of Gastric Perforation due to Endoscopic Mucosal Resection Managed by Detachable Snare and Hemoclips / 대한소화기내시경학회지

The detachable snare, by Pontecorvo and Pesce in 1986, was designed for the prevention of bleeding after endoscopic mucosal resection (EMR) of a polyp. It has been used widely for the ligation of large gastric or duodenal variceal bleeding, and even for the resection of a colon polyp. But detachable snare has been rarely used in the treatment of gastric perforation after the EMR. Herein, we report a successful case of detachable snare application in the treatment of gastric perforation caused by EMR in a patient with gastric adenoma measuring 1.6x1.6 cm in size, along with the review of relevant literatures.

Iodine staining and P53 oncoprotein for the diagnosis of early esophageal cancer and precancerous lesion / 中华消化内镜杂志

Objective To explore the feasibility of Lugol's iodine staining in association with P53 oncoprotein test to detect early esophageal cancer and precancerous lesions through endoscopy. Methods Lugol's iodine was sprayed on esophageal mucosa under endoscopy in 78 patients with suspected early malignancy. Severe dysplasia which taken from unstained position by iodine were prepared immunohistochemically for P53 oncoprotein study. Then endoscopic mucosal resection (EMR) was performed to these severe dysplasia with P53 oncoprotein－ positive mucosa. Results There were 31 unstained areas (25 patients) including squamous cell carcinomas (n=3) and severe dysplasias (n=16). Expression of P53 was found in 7 severe dysplasia (43.8％ ),and 1 carcinoma in situ was found by EMR. Conclusion This modified method seemed feasible not only to detect early esophageal cancer,but also to resect severe dysplasia mucosa selectively by EMR.

Laparoscopic Intra-Gastric Surgery

BACKGROUND: Endoscopic mucosal resection (EMR) is now in clinical use for the management of mucosal and submucosal tumors of the stomach (including early gastric cancer), but its use is limited by the size, depth, and the location of the tumor. METHODS: After the introduction of a new concept of laparoscopic intra-gastric surgery (L.I.G.S.) in which all trocars and surgical instruments are inserted directly into the gastric cavity to perform the resection of mucosal or submucosal lesions of the stomach by Dr. Ohashi, sixteen patients with a mucosal or a submucosal tumor in the posterior wall of the stomach have been successfully treated by L.I.G.S. in our hospital since 1995. RESULTS: 2 patients with early gastric cancer, 9 with a leiomyoma, and 5 with polyps. Twelve (87.5%) of the tumors were located in the antrum and 4 (12.5%) in the body. L.I.G.S. was successfully done on 14 patients (93%) with conversion to a minilaparotomy in 1 patient. The leiomyoma located in the lesser curvature was treated by L.I.G.S. through an anterior gastrotomy using hand suturing. The operationg time was about 100-160 minutes for the L.I.G.S., 120 minutes in the conversion case, and 180 minutes in the L.I.G.S. through an anterior gastrotomy. Postoperative pain was negligible in all cases, and the patients were discharged uneventfully six to seven days after surgery. The follow-up period was 1 to 37 months, and there were no recurrences. The important points of this approach are confirmation of the location of the tumor by both gastrofiberscopy and laparoscopy, excluding the determination of regional lymph node metastasis by endoscopic ultrasonography, and proper selection of the trocar sites. CONCLUSION: We conclude that L.I.G.S. is technically feasible, safe, and useful for a mucosal or a submucosal tumor in the posterior wall of the stomach and that it should be considered as a viable alternative to endoscopic mucosal resection and conventional gastric resection.

Endoscopic Mucosal Resection for Premalignant Lesions and Early Gastric Cancer / 대한내과학회지

OBJECTIVES: Gastrectomy with lymph node dissec tion is the standard treatment for early gastric can cer(EGC). However, patients who have high risks demand modifications in surgical treatment for EGC. Recently, endoscopic mucosal resection(EMR) has become accepted in many institutions as a treatment for cancerous mucosal lesions of the stomach. Thus we investigated the efficacy and safety of EMR prospectively in the patients with EGC who have high risks in surgery and those with premalignant lesions. METHOD: Twenty-five patients were treated with EMR, thirteen were EGC and twelve were premalignant lesions such as tubular adenoma, severe dysplasia. We used standard snare method and endoscopic mucosal resection using a band ligation kits(EMRL). RESULTS: The complete resection rate at the first step of EMR was 100%(12/12) in premalignant lesions, 76.9%(10/13) in EGC. Of three EGC resected incomple tely at the first step, one patient was treated by surgery and two patients underwent the third step of EMR. The final complete resection rate was 92%(23/25) and it was 100%(12/12) in the premalignant lesions, 84.6%(11/13) in EGC. The final complete resection rate in according to the methods was 100%(5/5) by standard snare method, 75%(6/8) by EMRL. As pathologic results, all cases of EGC were limited to the mucosa. No serious complications such as perforation, major bleeding were encountered. CONCLUSION: We consider that EMR is effective and safe in treatment of the patients with EGC who have high risks in surgery and those with premalignant lesions.