Project description:Video 1Esophageal endoscopic submucosal dissection on post-endoscopic variceal ligation scars with injection under red dichromatic imaging.

| S-EPMC8645840 | biostudies-literature

Tissue retractor system-assisted endoscopic submucosal dissection of a large rectal tumor with significant fibrosis from direct tattooing.

Project description: Not available

| S-EPMC6362363 | biostudies-literature

Intraoperative bleeding model for swine gastric endoscopic submucosal dissection via heparinization.

Project description:Background and study aims: Live swine have a high degree of coagulation and aggregation and using them for training about how to manage intraoperative bleeding during endoscopic submucosal dissection (ESD) is unsatisfactory. This study aimed to identify the appropriate heparin dose in an intraoperative bleeding model and validate its applicability. Methods: First, we explored the dose of heparin required for a swine bleeding model in which the activated clotting time reached and maintained the upper limit of measurement (1500 s) after 10 minutes. Second, we compared intraoperative bleeding and hematoma frequency during ESD for 2-cm lesions between the heparinized bleeding model and control groups. Intraoperative bleeding was classified according to the Forrest classification. Results: The combination of a bolus (300 U/kg), continuous infusion (300 U/kg/h), and a bolus dose (150 U/kg) of heparin 10 minutes after the first infusion was identified as the dose for the bleeding model. Five ESDs were performed in each heparinized bleeding model and the control group. The median number of intraoperative bleeds was significantly higher in the heparinized model than in the control group (5 interquartile range [IQR] 4-7 vs. 3 [IQR 0-4, P = 0.028). All of the intraoperative bleeding events oozing (Forrest Ib) rather than spurting (Forrest Ia). The median number of hematomas was significantly higher in the heparinized model group than in the control group (3 [IQR 1-4] vs. 0 [IQR 0-1], P = 0.023). Conclusions: High doses of heparin significantly increased intraoperative bleeding and hematoma during swine ESD.

| S-EPMC11604307 | biostudies-literature

The suture pulley countertraction method for challenging rectal endoscopic submucosal dissection.

Project description: Not available

| S-EPMC7221288 | biostudies-literature

Comparison of endoscopic submucosal dissection and modified endoscopic mucosal resection for rectal neuroendocrine tumors.

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.

| S-EPMC11825951 | biostudies-literature

Bleeding After Gastric Endoscopic Submucosal Dissection Focused on Management of Xa Inhibitors.

Project description:PurposeThe use of direct oral Xa inhibitors (DXaIs) to prevent venothrombotic events is increasing. However, gastrointestinal bleeding, including that related to endoscopic resection, is a concern. In this study, we evaluated bleeding and coagulation times during the perioperative period of gastric endoscopic submucosal dissection (ESD).Materials and methodsPatients who consecutively underwent gastric ESD from August 2016 to December 2018 were analyzed. Bleeding rates were compared among the 3 groups (antiplatelet, DXaIs, and control). DXaI administration was discontinued on the day of the procedure. Prothrombin time (PT), activated partial thromboplastin time, and the ratio of inhibited thrombin generation (RITG), which was based on dilute PT, were determined before and after ESD.ResultsDuring the study period, 265 gastric ESDs were performed in 239 patients, where 23 and 50 patients received DXaIs and antiplatelets, respectively. Delayed bleeding occurred in 17 patients (7.4%) and 21 lesions (7.1%). The bleeding rate in the DXaI group was significantly higher than that in the other groups (30.4%, P<0.01), and the adjusted odds ratio of bleeding was 5.7 (95% confidence interval, 1.4-23.7; P=0.016). In patients using DXaIs, there was a significant (P=0.046) difference in the median RITG between bleeding cases (18.6%) and non-bleeding cases (3.8%).ConclusionsA one-day cessation of DXaIs was related to a high incidence of bleeding after gastric ESD, and monitoring of residual coagulation activity at trough levels might enable the predicted risk of delayed bleeding in patients using DXaIs.

| S-EPMC8980599 | biostudies-literature

Laparoscopy-assisted nonexposed endoscopic full-thickness resection for local resection after endoscopic submucosal dissection.

Project description:Video 1Nonexposed endoscopic wall inversion surgery for local resection of microscopic residual tumor after endoscopic submucosal dissection.

| S-EPMC11009435 | biostudies-literature

Double-tunneling butterfly method for endoscopic submucosal dissection of extensive rectal neoplasms.

Project description:Background and aimsEndoscopic submucosal dissection (ESD) is the preferred technique for en bloc resection of superficial colorectal neoplasms. Resection of extensive lesions with ESD can be challenging, owing to loss of orientation in the submucosal space. In this case series, we describe the double-tunneling (DoT) butterfly method for ESD of extensive rectal neoplasms.MethodsThe key feature of the DoT butterfly method is the creation of 2 tunnels that are transformed into bilateral flaps, leaving a submucosal septum between them.ResultsFour rectal neoplasms measuring (maximum diameter) 7 cm, 8 cm, 9 cm, and 18 cm, respectively, were resected in 4 patients by use of the DoT butterfly method. The lesions included recurrent adenoma (n = 1) and dysplasia (n = 1) in longstanding ulcerative colitis. Curative R0 resection was confirmed in all 4 cases. Histologic examination showed tubular adenomas with low-grade dysplasia in 1 of 4 patients and focal high-grade dysplasia in 3 of 4 patients. One patient experienced postprocedural bleeding that required endoscopic reintervention.ConclusionThe DoT butterfly method appears to be useful for the resection of extensive rectal neoplasms. A prospective study is required to assess whether these results can be reproduced in a large cohort of patients.

| S-EPMC7004922 | biostudies-literature

Comparison of endoscopic submucosal resection with ligation and endoscopic submucosal dissection for small rectal neuroendocrine tumors: A multicenter retrospective study.

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.

| S-EPMC9478042 | biostudies-literature

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