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Post-polypectomy surveillance: the present and the future
Masau Sekiguchi,Takahisa Matsuda,Kinichi Hotta,Yutaka Saito 대한소화기내시경학회 2022 Clinical Endoscopy Vol.55 No.4
An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition,the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, andpatient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major internationalguidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommendedrisk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or nosurveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previousguidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopyscreening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratifiedpost-polectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-upafter the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines,are warranted.
Metachronous Gastric Cancer Following Curative Endoscopic Resection of Early Gastric Cancer
Seiichiro Abe,Ichiro Oda,Takeyoshi Minagawa,Masau Sekiguchi,Satoru Nonaka,Haruhisa Suzuki,Shigetaka Yoshinaga,Amit Bhatt,Yutaka Saito 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.3
This review article summarizes knowledge about metachronous gastric cancer (MGC) occurring after curative endoscopic resection (ER)of early gastric cancer (EGC), treatment outcomes of patients who developed MGC, and efficacy of Helicobacter pylori eradication toprevent MGC. The incidence of MGC following curative ER increases over time and is higher than in patients undergoing gastrectomy. Increasing age and multifocal EGC are independent risk factors for developing MGC. An MGC following curative ER is usually a small(<20 mm) and differentiated intramucosal cancer. Most MGC lesions are found at an early stage on semiannual or annual surveillanceendoscopy and are successfully treated by further ER, with excellent long-term outcomes. Eradication of H. pylori may reduce the riskof MGC following ER of EGC, but further prospective studies with long-term outcomes are required. Surveillance endoscopy followinggastric ER should be continued indefinitely, due to the risk of MGC even after successful H. pylori eradication. Risk stratification andtailored endoscopic surveillance schedules need to be developed.
Endoscopic Resection of Undifferentiated Early Gastric Cancer
Seiichiro Abe,Yuichiro Hirai,Mai Ego Makiguchi,Masau Sekiguchi,Satoru Nonaka,Haruhisa Suzuki,Shigetaka Yoshinaga,Yutaka Saito 대한위암학회 2023 Journal of gastric cancer Vol.23 No.1
Endoscopic resection (ER) is widely performed for early gastric cancer (EGC) with a negligible risk of lymph node metastasis (LNM) in Eastern Asian countries. In particular, endoscopic submucosal dissection (ESD) leads to a high en bloc resection rate, enabling accurate pathological evaluation. As undifferentiated EGC (UD-EGC) is known to result in a higher incidence of LNM and infiltrative growth than differentiated EGC (D-EGC), the indications for ER are limited compared with those for D-EGC. Previously, clinical staging as intramucosal UD-EGC ≤2 cm, without ulceration, was presented as ‘weakly recommended’ or ‘expanded indications’ for ER in the guidelines of the United States, Europe, Korea, and Japan. Based on promising long-term outcomes from a prospective multicenter study by the Japan Clinical Oncology Group (JCOG) 1009/1010, the status of this indication has expanded and is now considered ‘absolute indications’ in the latest Japanese guidelines published in 2021. In this study, which comprised 275 patients with UD-EGC (cT1a, ≤2 cm, without ulceration) treated with ESD, the 5-year overall survival (OS) was 99.3% (95% confidence interval, 97.1%–99.8%), which was higher than the threshold 5-year OS (89.9%). Currently, the levels of evidence grades and recommendations for ER of UD-EGC differ among Japan, Korea, and Western countries. Therefore, a further discussion is warranted to generalize the indications for ER of UD-EGC in countries besides Japan.
Efficacy of Current Traction Techniques for Endoscopic Submucosal Dissection
Seiichiro Abe,Shih Yea Sylvia Wu,Mai Ego,Hiroyuki Takamaru,Masau Sekiguchi,Masayoshi Yamada,Satoru Nonaka,Taku Sakamoto,Haruhisa Suzuki,Shigetaka Yoshinaga,Takahisa Matsuda,Ichiro Oda,Yutaka Saito 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.6
This systematic review aimed to assess the efficacy of the current approach to tissue traction during the endoscopic submucosal dissection (ESD) of superficial esophageal cancer, early gastric cancer, and colorectal neoplasms. We performed a systematic electronic literature search of articles published in PubMed and selected comparative studies to investigate the treatment outcomes of tractionassisted versus conventional ESD. Using the keywords, we retrieved 381 articles, including five eligible articles on the esophagus, 13 on the stomach, and 12 on the colorectum. A total of seven randomized controlled trials and 23 retrospective studies were identified. Clip line traction and submucosal tunneling were effective in reducing the procedural time during esophageal ESD. The efficacy of traction methods in gastric ESD varied in terms of the devices and strategies used depending on the lesion location and degree of submucosal fibrosis. Several prospective and retrospective studies utilized traction devices without the need to reinsert the colonoscope. When pocket creation is included, the traction devices and methods effectively shorten the procedural time during colorectal ESD. Although the efficacy is dependent on the organ and tumor locations, several traction techniques have been demonstrated to be efficacious in facilitating ESD by maintaining satisfactory traction during dissection.
Kazuya Inoki,Seiichiro Abe,Yusaku Tanaka,Koji Yamamoto,Daisuke Hihara,Ryoji Ichijima,Yukihiro Nakatani,Hsin- Yu Chen,Hiroyuki Takamaru,Masau Sekiguchi,Masayoshi Yamada,Taku Sakamoto,Satoru Nonaka,Haru 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.3
Background/Aims: Probe-based confocal laser endomicroscopy (pCLE) requires the administration of intravenous (IV) fluorescein. This study aimed to determine the optimal dose of IV fluorescein for both upper and lower gastrointestinal (GI) tract pCLE. Methods: Patients 20 to 79 years old with gastric high-grade dysplasia (HGD) or colorectal neoplasms (CRNs) were enrolled in thestudy. The dose de-escalation method was employed with five levels. The primary endpoint of the study was the determination ofthe optimal dose of IV fluorescein for pCLE of the GI tract. The reduced dose was determined based on off-line reviews by threeendoscopists. An insufficient dose of fluorescein was defined as the dose of fluorescein with which the pCLE images were notdeemed to be visible. If all three endoscopists determined that the tissue structure was visible, the doses were de-escalated. Results: A total of 12 patients with gastric HGD and 12 patients with CRNs were enrolled in the study. Doses were de-escalated to0.5 mg/kg of fluorescein for both non-neoplastic duodenal and colorectal mucosa. All gastric HGD or CRNs were visible with pCLEwith IV fluorescein at 0.5 mg/kg. Conclusions: In the present study, pCLE with IV fluorescein 0.5 mg/kg was adequate to visualize the magnified structure of both theupper and lower GI tract.