Project description:With the development of reliable endoscopic closure techniques and tools, endoscopic full-thickness resection (EFTR) is emerging as a therapeutic option for the treatment of subepithelial tumors and epithelial neoplasia with significant fibrosis. EFTR may be categorized as "exposed" and "nonexposed." In exposed EFTR, the full-thickness resection is undertaken with a tunneled or nontunneled technique, with subsequent closure of the defect. In nonexposed EFTR, a secure serosa-to-serosa apposition is achieved before full-thickness resection of the isolated lesion. This document reviews current techniques and devices used for EFTR and reviews clinical applications and outcomes.
Project description:Video 1Nonexposed endoscopic wall inversion surgery for local resection of microscopic residual tumor after endoscopic submucosal dissection.
Project description:Video 1Technique of submucosal tunneling and endoscopic resection for a postcricoid subepithelial esophageal tumor. After surface marking and submucosal elevation, the mucosa was incised. The subepithelial tumor was dissected from the mucosal aspect and enucleated from the muscle layer. En bloc resection was achieved with an intact capsule. The mucosal incision was closed with endoclips.
Project description:ObjectivesEndoscopic submucosal resection with band ligation (ESMR-L) and endoscopic submucosal dissection (ESD) are both standard endoscopic resection methods for rectal neuroendocrine tumors (NETs) <10 mm in size. However, there is no definitive consensus on which is better. Here, we compared the efficacy of ESMR-L and ESD for small rectal NETs.MethodsThis was a multicenter retrospective cohort study including 205 patients with rectal NETs who underwent ESMR-L or ESD. Treatment outcomes were compared by univariate analysis, multivariate analysis, and inverse probability treatment weighting (IPTW) using propensity scores. Subgroup analysis evaluated the impact of the endoscopist's experience on the technical outcome.ResultsEighty-nine patients were treated by ESMR-L and 116 by ESD. The R0 resection rate was not significantly different between the two (90% vs. 92%, p = 0.73). The procedure time of ESMR-L was significantly shorter than for ESD (17 min vs. 52 min, p < 0.01) and the hospitalization period was also significantly shorter (3 days vs. 5 days, p < 0.01). These results were confirmed by multivariate analysis and also after IPTW adjustment. The procedure time of ESD was significantly prolonged by a less-experienced endoscopist (49 min vs. 70 min, p = 0.02), but that of ESMR-L was not affected (17 min vs. 17 min, p = 0.27).ConclusionsFor small rectal NETs, both ESMR-L and ESD showed similar high complete resection rates. However, considering the shorter procedure time and shorter hospitalization period, ESMR-L is the more efficient treatment method, especially for less-experienced endoscopists.
Project description:Although some studies have compared the treatment outcomes between modified endoscopic mucosal resection (m-EMR) and endoscopic submucosal dissection (ESD) for rectal neuroendocrine tumors (NETs), the results are based on the experience of experts from a single high-volume center. This multicenter study aimed to compare the outcomes between m-EMR and ESD for rectal NETs, with emphasis on the operator's level. Data of patients with rectal NETs treated using m-EMR or ESD at seven institutions that included general hospitals in Japan were retrospectively reviewed. Patients treated using m-EMR and those treated using ESD were matched for age, sex, lesion size, lesion location, and operator level through propensity score matching. The treatment outcomes were compared between the two groups. In total 304 patients (m-EMR = 178, ESD = 126) were included, with 218 in the matched groups (m-EMR = 109, ESD = 109). The R0 resection rate was not significantly different between the two groups (90.0% vs. 82.3%, P = .221). However, the procedural time was significantly shorter for the m-EMR group than that for the ESD group (6 vs. 26 min, P < .001). No significant difference in adverse events was observed between the two groups (postprocedure bleeding rate: 5.5% vs. 2.8%, P = .335; perforation rate: 0.9% vs. 0.9%, P = 1.00). Subgroup analysis revealed that the R0 resection rate for the trainees was significantly higher in the m-EMR group than in the ESD group (87.9% vs. 64.5%, P = .017). m-EMR is the preferred technique for the treatment of rectal NETs and should be considered, particularly for the trainees.
Project description:A 56-year-old male patient was diagnosed with a submucosal tumor in the fundus of the stomach. The conventional operation method is endoscopic submucosal dissection. We present a case of rapid tumor resection without employing traditional endoscopic submucosal dissection instruments such as a mucotomy knife and endoscopic injection needle, resulting in substantial cost savings for the patients.