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Hiroya Sakaguchi,Toshitatsu Takao,Yoshitaka Takegawa,Yuki Koga,Kazunori Yamanaka,Masataka Sagata,Shinwa Tanaka,Yoshinori Morita,Takashi Toyonaga,Yuzo Kodama 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.1
Background/Aims: Application of polyglycolic acid (PGA) sheets using fibrin glue in post-endoscopic submucosal dissection (ESD)ulcers to prevent bleeding has been reported to be difficult with the conventional delivery method because of gravity. This studyassessed the usefulness of the envelope-based delivery system with and against gravity in living pigs. Methods: PGA sheets were applied on post-ESD ulcers with and against gravity six times each using the conventional and envelopemethods, respectively. The PGA sheet delivery time and the endoscopic and histological findings of the treated ulcer floors werecompared. Results: With gravity, the median PGA sheet application time was 1.00 (0.68–1.30) min/cm2 and 0.32 (0.18–0.52) min/cm2 with theconventional and envelope techniques (p=0.002), respectively, and against gravity, it was 1.20 (1.13–1.63) min/cm2 and 0.50 (0.39–0.58) min/cm2 (p=0.002), respectively. Against gravity, the endoscopic and histological findings revealed that the conventional grouphad insufficient fixation of the PGA sheets, but the envelope groups had sufficient fixation. The results with gravity were similarbetween the groups. Conclusions: The envelope method makes it possible to deliver PGA sheets to the stomach quickly and cover ulcers appropriatelyboth with and against gravity in living pigs.
Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection
Hiroya Mizutani,Satoshi Ono,Daisuke Ohki,Chihiro Takeuchi,Seiichi Yakabi,Yosuke Kataoka,Itaru Saito,Yoshiki Sakaguchi,Chihiro Minatsuki,Yosuke Tsuji,Keiko Niimi,Shinya Kodashima,Nobutake Yamamichi,Mit 대한소화기내시경학회 2017 Clinical Endoscopy Vol.50 No.6
Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world.
Nobuaki Ikezawa,Takashi Toyonaga,Shinwa Tanaka,Tetsuya Yoshizaki,Toshitatsu Takao,Hirofumi Abe,Hiroya Sakaguchi,Kazunori Tsuda,Satoshi Urakami,Tatsuya Nakai,Taku Harada,Kou Miura,Takahisa Yamasaki,Stu 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.3
Background/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicatedbecause of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. Theaim of this study was to evaluate the feasibility and safety of D-ESD. Methods: D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients whounderwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategywere analyzed. Results: The en bloc resection rate was 96.2%. The R0 and curative resection rates were 76.4% and 70.6% in strategy A and 88.9% and77.8% in strategy B, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforationcase required emergency surgery, but the other cases were managed conservatively. Conclusions: D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert handsbecause it requires highly skilled endoscopic techniques.
Kei Matsumoto,Shinwa Tanaka,Takashi Toyonaga,Nobuaki Ikezawa,Mari Nishio,Masanao Uraoka,Tomoatsu Yoshihara,Hiroya Sakaguchi,Hirofumi Abe,Tetsuya Yoshizaki,Madoka Takao,Toshitatsu Takao,Yoshinori Morit 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.1
Background/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Differentreconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomoticsite. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastriccancers at the anastomotic site. Methods: We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at theanastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups. Results: The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm;p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation timewas longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth IIgroup. Conclusions: Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with abackground of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involvedlonger operative times and more frequent bleeding episodes than that in patients without Billroth II.