The ethical review boards of Okayama University Hospital and Tsuyama Chuo Hospital approved this retrospective chart review and analysis of the procedural data used in this study.
Endoscopic Submucosal Dissection
It involves separating the lesion from the underlying muscle layer using an endoscopic knife, allowing for en bloc resection and improved pathological assessment.
This technique offers higher rates of en bloc and complete resection compared to conventional endoscopic mucosal resection, enhancing the potential for curative treatment and reducing the risk of recurrence.
Effective Endoscopic Submucosal Dissection requires specialized training and equipment, as well as careful patient selection to optimize outcomes.
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The ethical review boards of Okayama University Hospital and Tsuyama Chuo Hospital approved this retrospective chart review and analysis of the procedural data used in this study.
The internal part of each intervening part between the crypts had a profile resembling an ellipse (
Flow chart of patient throughput. NET neuroendocrine tumor, EMR endoscopic mucosal resection, EMR-P EMR with circumferential precutting, ESD endoscopic submucosal dissection, ASEMR anchored snare-tip EMR, EMR-C cap-assisted EMR.
White-light imaging (WLI) endoscopy data from gastric lesions with pathological confirmation were retrieved from the database of Chuncheon Sacred Heart hospital in JPEG format, with a minimum resolution of 640 × 480 pixels. Images with poor quality or low resolution disabling their proper classification (defocusing, artifacts, shadowing, etc.) were excluded, as previously described [19 (link)]. Eventually, a total of 2899 images from 846 patients were included in the study. This study was approved by the Institutional Review Board of Chuncheon Sacred Heart Hospital (number: 2018-07-003), and was conducted in accordance with the Declaration of Helsinki. IRB approval number: 2018-07-003.
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For patients who will enroll in autologous blood group, the tattooing will be performed at 24–48 hours before the surgery. When the lesion is identified by endoscopy, the patient’s peripheral venous blood will be collected using a 10 ml simple syringe without heparin preparation. Immediately after blood sampling, 2–3 ml of autologous blood will be injected submucosally at the distal side and proximal side of the lesion (about 2 cm below and above the border of the lesion) using a conventional endoscopic needle without submucosal injection of normal saline. The tattooing with autologous blood will consider to be invisible if both distal and proximal spots was not identified. For those receiving autologous blood localization, the case will be applied intraoperative colonoscopy if the autologous blood tattoo will not be identified or inaccurate in the laparoscopic colectomy.
For patients who will enroll in intraoperative colonoscopy group, the patient will be placed in the modified lithotomy position under general anesthesia with endotracheal intubation. The legs will be opened and positioned in padded stirrups to facilitate the insertion and manipulation of the colonoscope during the operation. After routine laparoscopic exploration, CO2-insufflated intraoperative colonoscopy will be performed using a flexible videocolonoscope. Upstream small bowel clamping will be applied before intraoperative colonoscopy. During intraoperative colonoscopy, CO2 pneumoperitoneum will be maintained by the insufflator so that the laparoscope could guide the colonoscope effectively.
After lesion will be identified, a standard laparoscopic colectomy will be performed by two experienced surgeons who has more than 20 years of experience in colorectal surgery with more than 200 cases per year for all enrolled patients. All abdominal operation of laparoscopy will be videotaped. Anastomosis will be performed using the instrumental method. The specimen will be pulled out through a small median incision under the xiphoid (about 3–8 cm).
For those receiving laparoscopic colectomy, the case will be required to be converted to open surgery if one of the following happens: severe or life-threatening intraoperative complications such as intra-abdominal massive haemorrhage, severe organ damage, or other technical or instrumental factors that require a conversion to open surgery.
Flowchart of the study sample. SGN, superficial gastric neoplasm; ESD, endoscopic submucosal dissection; CWL-ESD, clip with line-assisted endoscopic submucosal dissection; SLC-ESD; spring and loop with clip-assisted endoscopic submucosal dissection
The procedure of clip with line-assisted endoscopic submucosal dissection (CWL-ESD).
Spring and loop with clip (SLC; S–O clip; Zeon Medical, Tokyo, Japan)-assisted endoscopic submucosal dissection (SLC-ESD).
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More about "Endoscopic Submucosal Dissection"
This advanced endoscopic technique involves separating the lesion from the underlying muscle layer using specialized endoscopic knives, such as the DualKnife, GIF-H260Z, Flush Knife, GIF-Q260J, GIF-H260, GIF-Q260, KD-650L, and Hook knife, allowing for en bloc resection and improved pathological assessment.
Compared to conventional Endoscopic Mucosal Resection (EMR), ESD offers higher rates of en bloc and complete resection, enhancing the potential for curative treatment and reducing the risk of recurrence.
ESD requires specialized training and equipment, as well as careful patient selection to optimize outcomes.
The VIO300D electrosurgical unit is often used in conjunction with these endoscopic tools to facilitate the ESD procedure.
The benefits of ESD include the ability to precisely remove lesions while preserving the surrounding healthy tissue, leading to better long-term outcomes for patients.
This technique is particularly useful for the management of early-stage gastrointestinal cancers, such as those found in the esophagus, stomach, and colorectum.
With advancements in endoscopic technology and techniques, ESD has become an increasingly important option for minimally invasive cancer treatment.