Short-term Prospective Questionnaire Study of Early Postoperative Quality of Life After Colorectal Endoscopic Submucosal Dissection.

BACKGROUND: Endoscopic submucosal dissection (ESD) has become popular as an alternative to laparoscopy-assisted colectomy (LAC) for early colorectal cancer. AIM: To validate postoperative quality of life (QOL) based on subjective symptoms of patients from questionnaire survey. METHODS: We prospectively enrolled patients planned to undergo ESD for adenoma or Tis/T1a cancer at our institution between December 2011 and January 2013. Controls were prospectively enrolled LAC patients diagnosed with T1b cancer. Patients answered questionnaire survey on QOL on postoperative day (POD) 1 and POD14. Questions were scored using visual analog scale (0 points = worst condition, 100 points = best condition) and were classified into six categories: health status, mental status (MeS), motor status (MoS), bodily painless, passage and anorectal function (PAF), and stress for the treatment. Total score was also calculated. We compared the median scores among categories using the Wilcoxon rank-sum test. RESULTS: A total of 82 ESDs and 41 LACs were included. Median score for the factors in questionnaire (POD1/POD14) in ESDs versus LACs for colonic lesion (rectal lesion) was as follows: MeS, 74/83 versus 54/73 (72/85 vs. 42/62); MoS, 98/96 versus 51/75 (95/90 vs. 66/67); PAF, 90/96 versus 80/80 (90/95 vs. 70/53); total score, 83/91 versus 58/75 (81/87 vs. 51/66). These items showed statistical significant differences between ESDs and LACs. CONCLUSIONS: Postoperative QOL and symptoms are significantly better on POD1 and POD14 following ESD compared with LAC.

Indications for and technical aspects of colorectal endoscopic submucosal dissection.

Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage.

Endoscopic submucosal dissection for early gastric cancer in the remnant stomach after gastrectomy.

BACKGROUND: Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line. OBJECTIVE: We evaluated clinical results including long-term outcomes to determine the feasibility and effectiveness of ESD for EGC in the remnant stomach of patients after gastrectomy. DESIGN: Retrospective study. SETTING: National Cancer Center Hospital, Tokyo, Japan. PATIENTS: We investigated patients undergoing ESD for EGC in the remnant stomach from 1997 to 2011. INTERVENTION ESD MAIN OUTCOME MEASUREMENTS: We examined the patient characteristics, endoscopic findings, technical results, adverse events, and histopathologic results including curability and evaluations of Helicobacter pylori gastritis in addition to the rates of local recurrence, metachronous gastric cancer, overall survival, and cause-specific survival. RESULTS: A total of 128 consecutive patients with 139 lesions had previously undergone 87 distal (68%), 25 proximal (19.5%) and 16 pylorus-preserving gastrectomies (12.5%). The median period from the original gastrectomy to the subsequent ESD for EGC in the remnant stomach was 5.7 years (range 0.6-51 years), the median tumor size was 13 mm (range 1-60 mm), and the median procedure time was 60 minutes (range 15-310 minutes). There were 131 en bloc resections (94%), with curative resections achieved for 109 lesions (78%); 22 lesions (16%) resulted in non-curative resections, and 8 lesions (6%) had only a horizontal margin positive or had inconclusive results. A total of 118 patients (92%) were assessed as H pylori gastritis-positive, with 7 patients (5%) negative. Adverse events included 2 cases of delayed bleeding (1.4%) and 2 perforations (1.4%), with 1 patient requiring emergency surgery. The 5-year overall and cause-specific survival rates were 87.3% and 100%, respectively, during a median follow-up period of 4.5 years (range 0-13.7 years), with no deaths from EGC in the remnant stomach. LIMITATIONS: Single-center, retrospective study. CONCLUSION: ESD for EGC in the remnant stomach of patients after gastrectomy was a feasible and effective therapeutic method and should become the standard treatment in such cases, based on the favorable long-term outcomes.

[A case of Diphyllobothrium nihonkaiense identified by virtual enterography and virtual enteroscopy].

In October 2007, a woman in her early 30s presented, complaining of worm discharge in her stool. We identified it as Diphyllobothrium nihonkaiense, and identified it by virtual enterography and virtual enteroscopy. It was treated by 1500 mg/day praziquantel orally. We think these methods, of pathology as well as capsule enteroscopy and enteroscopy, are useful for the searching of the small intestinal lesions. We hope these examinations will become more widespread with reference to these cases.