Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD ena... Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharma-cotherapy during the healing process are essential.展开更多
AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affilia...AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affiliated to The Catholic University of Korea.ESD was performed in 76 consecutive patients with gastric epithelial neoplasia by using the GTS(37 patients)or the hook knife plus coagrasper(HKC)(39 patients).The complete resection rate,complication rate,total time elapsed and elapsed time per square centimeter of the dissected specimen were analyzed between the GTS and HKC group.RESULTS:The mean age of the GTS group was 62.3±11.4 years and mean age of the HKC group was 65.6±10.1 years.Differentiated adenocarcinoma was found in32.4%in the GTS group and 33.3%in the HKC group.The procedures were performed without interruption in every case in both groups.The en bloc resection rates of both groups were 100%.The total time elapsed during the procedure was 44.54±21.72 min in the GTS group and 43.77±21.84 min in the HKC group(P=0.88)and the time elapsed per square centimeter of the resected lesion was 7.53±6.35 min/cm2in the GTS group and 6.92±5.93 min/cm2in the HKC group(P=0.66).The overall complication rate was not significantly different between the two groups.CONCLUSION:GTS is a safe and effective device for ESD compared with HKC.ESD can be performed with GTS alone,which can reduce the costs for ESD.展开更多
基金Supported by A Grant-in-Aid for Cancer Research from the Ministry of Health, Labor and Welfare of Japan, in part
文摘 Endoscopic submucosal dissection (ESD), an endoscopic procedure for the treatment of gastric epithelial neoplasia without lymph node metastases, spread rapidly, primarily in Japan, starting in the late 1990s. ESD enables en bloc resection of lesions that are difficult to resect using conventional endoscopic mucosal resection (EMR). However, in comparison to EMR, ESD requires a high level of endoscopic competence and a longer resection time. Thus, ESD is associated with a higher risk of adverse events, including intraoperative and postoperative bleeding and gastrointestinal perforation. In particular, because of a higher incidence of intraoperative bleeding with mucosal incision and submucosal dissection, which are distinctive endoscopic procedures in ESD, a strategy for endoscopic hemostasis, mainly by thermo-coagulation hemostasis using hemostatic forceps, is important. In addition, because of iatrogenic artificial ulcers that always form after ESD, endoscopic hemostasis and appropriate pharma-cotherapy during the healing process are essential.
基金Supported by Research grants from Korean Society of Gastrointestinal Endoscopy
文摘AIM:To evaluate the efficacy and safety of grasper type scissors(GTS)for endoscopic submucosal dissection(ESD)of gastric epithelial neoplasia.METHODS:The study was performed by 4 endoscopists in 4 institutions affiliated to The Catholic University of Korea.ESD was performed in 76 consecutive patients with gastric epithelial neoplasia by using the GTS(37 patients)or the hook knife plus coagrasper(HKC)(39 patients).The complete resection rate,complication rate,total time elapsed and elapsed time per square centimeter of the dissected specimen were analyzed between the GTS and HKC group.RESULTS:The mean age of the GTS group was 62.3±11.4 years and mean age of the HKC group was 65.6±10.1 years.Differentiated adenocarcinoma was found in32.4%in the GTS group and 33.3%in the HKC group.The procedures were performed without interruption in every case in both groups.The en bloc resection rates of both groups were 100%.The total time elapsed during the procedure was 44.54±21.72 min in the GTS group and 43.77±21.84 min in the HKC group(P=0.88)and the time elapsed per square centimeter of the resected lesion was 7.53±6.35 min/cm2in the GTS group and 6.92±5.93 min/cm2in the HKC group(P=0.66).The overall complication rate was not significantly different between the two groups.CONCLUSION:GTS is a safe and effective device for ESD compared with HKC.ESD can be performed with GTS alone,which can reduce the costs for ESD.
