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Long-Term Outcomes of Using Endoscopic Submucosal Dissection to Treat Early Gastric Cancer
Toshihiro Nishizawa,Naohisa Yahagi 거트앤리버 소화기연관학회협의회 2018 Gut and Liver Vol.12 No.2
Endoscopic submucosal dissection (ESD) is becoming the main procedure for the resection of early gastric cancer (EGC). The absolute indications for treating EGC with endoscopic resection were established by the Japanese Gastric Cancer Association and have been generally accepted. However, the absolute indications for treating EGC are rather strict, and expanded indications have been developed. Many studies have reported favorable long-term outcomes for patients who received curative resection for the expanded indication. ESD preserves the stomach, thereby improving patients’ quality of life compared to surgery; however, a generally higher incidence of metachronous gastric cancer has been reported after ESD for EGC. Therefore, clinicians must pay careful attention during surveillance endoscopy, even after a curative ESD.
( Mitsuhiro Fujishiro ),( Shinya Kodashima ),( Satoshi Ono ),( Osamu Goto ),( Nobutake Yamamichi ),( Naohisa Yahagi ),( Koji Kashimura ),( Toyokazu Matsuura ),( Mikitaka Iguchi ),( Masashi Oka ),( Mas 대한소화기학회 2008 Gut and Liver Vol.2 No.2
Background/Aims: There have been several reports of thermal injury induced by argon plasma coagulation (APC) in animal models, but no follow-up studies have revealed the actual thermal injury. Methods: APC was performed on the stomachs of two living minipigs with and without prior submucosal injection of normal saline. The power and argon gas flow were set to 60 watts and 2 L/min, respectively, and pulse durations of 5, 10, and 20 seconds were used. One of the minipigs was killed immediately thereafter and the other was killed 1 week later. Results: The minipig killed immediately showed only subtle differences between noninjected and injected injuries under all the conditions, and the usefulness of prior submucosal injection was not obvious. However, the minipig killed 1 week later had a deep ulcer extending to the deeper muscle layer at the noninjected site where APC had been applied for 20 seconds, whereas tissue injury of the injected site was limited to the submucosal layer. Conclusions: Unexpected tissue damage can occur even using a short-duration APC. Prior submucosal injection for APC might be a safer alternative technique, especially in a thinner and narrower gut wall.
Dirk W. Schölvinck,Osamu Goto,Jacques J. G. H. M. Bergman,Naohisa Yahagi,Bas L. A. M. Weusten 대한소화기내시경학회 2015 Clinical Endoscopy Vol.48 No.3
Background/Aims: To investigate whether the EndoLifter (Olympus), a counter-traction device facilitating submucosal dissection, can accelerate endoscopic submucosal dissection (ESD). Methods: Two endoscopists (novice/expert in ESD) performed 64 ESDs (artificial 3-cm lesions) in 16 ex vivo pig stomachs: per stomach, two at the posterior wall (forward approach) and two at the lesser curvature (retroflex approach). Per approach, one lesion was dissected with (EL+) and one without (EL–) the EndoLifter. The submucosal dissection time (SDT), corrected for specimen size, and the influence of ESD experience on EndoLifter usefulness were assessed. Results: En bloc resection rate was 98.4%. In the forward approach, the median SDT was shorter with the EndoLifter (0.56 min/cm2 vs. 0.91 min/cm2), although not significantly (p=0.09). The ESD-experienced endoscopist benefitted more from the EndoLifter (0.45 [EL+] min/cm2 vs. 0.68 [EL–] min/cm2, p=0.07) than the ESD-inexperienced endoscopist (0.77 [EL+] min/cm2 vs. 1.01 [EL–] min/cm2, p=0.48). In the retroflex approach, the median SDTs were 1.06 (EL+) and 0.48 (EL–) min/cm2 (p=0.16). The EndoLifter did not shorten the SDT for the ESD-experienced endoscopist (0.68 [EL+] min/cm2 vs. 0.68 [EL–] min/cm2, p=0.78), whereas the ESD-inexperienced endoscopist seemed hindered (1.65 [EL+] min/cm2 vs. 0.38 [EL–] min/cm2, p=0.03). Conclusions: In gastric ESD, the EndoLifter, in trend, shortens SDTs in the forward, but not in the retroflex approach. Given the low numbers in this study, a type II error cannot be excluded.
BRIEF COMMUNICATION : Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy
Hiromitsu Soma,Naoteru Miyata,Shigenari Hozawa,Hajime Higuchi,Yoshiyuki Yamagishi,Yuji Nakamura,Keita Saeki,Kaori Kameyama,Yohei Masugi,Naohisa Yahagi,Takanori Kanai 대한소화기학회 2015 Gut and Liver Vol.9 No.5
Kaoru Takabayashi,Naoki Hosoe,Motohiko Kato,Yukie Hayashi,Ryoichi Miyanaga,Kosaku Nanki,Kayoko Fukuhara,Yohei Mikami,Shinta Mizuno,Tomohisa Sujino,Makoto Mutaguchi,Makoto Naganuma,Naohisa Yahagi,Haruh 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.5
Background/Aims: The evaluation of small bowel lesions of Crohn’s disease (CD) using balloon-assisted enteroscopy (BAE) is crucial because mucosal healing is associated with a good prognosis. However, BAE procedures are invasive, requiring sedation or analgesia to reduce the patient’s pain. This study evaluated the clinical usefulness of a novel ultrathin single-balloon enteroscopy (SBE) procedure for CD. Methods: This single-center retrospective study included 102 CD patients who underwent trans-anal SBE between January 2012 and May 2018. Of these patients, 82 underwent enteroscopy using conventional SBE, while 20 underwent ultrathin SBE. Patients were analyzed using propensity score matching, with 20 patients per group. The median duration of the examination, terminal ileum intubation rate, median cecum intubation time, median insertion depth, adverse events, and sedated dose in each group were compared. Results: Before propensity score matching, the conventional SBE group had a larger number of surgical history patients than the ultrathin SBE group (p=0.05). After matching, the two groups did not significantly differ clinically. There were no significant differences in the mean duration of the examination, cecum intubation time, or terminal ileal intubation rate between ultrathin SBE and conventional SBE. The mean insertion depth of ultrathin SBE tended to be deeper than that of conventional SBE (p=0.09). The use of ultrathin SBE also reduced the sedative dose during needed for enteroscopy compared with conventional SBE (p=0.005). Conclusions: Novel ultrathin SBE may be less painful for CD patients than conventional SBE.