Gif q240

The endoscopic procedures were performed with a single-channel endoscope (GIF-Q240 or PCF-PQ260I; Olympus Medical Systems Co., Tokyo, Japan) or a double balloon sigmoid scope (EN-450T5/W; FUJIFILM, Saitama, Japan) by carbon dioxide insufflation. The choice of scope depended on the distance to the lesion.
EMR was indicated for small lesions (< 2 cm) or pedunculated lesions. Simple snarectomy was performed after the injection of 0.4% sodium hyaluronate solution (MucoUp; Johnson and Johnson K.K., Tokyo, Japan). The mucosa bulge is important for the safety of the procedure because the wall of the duodenum is thin. ESD was indicated for large lesions (≥ 2 cm) or flattened lesions. The ESD technique consisted of three steps. First, the periphery of the lesion was marked using a 2.0 mm short needle knife with a water jet function (Flush Knife, DK2618JB20; FUJIFILM, Saitama, Japan). Second, MucoUp was injected into the submucosal layer to achieve sufficient mucosal elevation. Third, a mucosal incision and submucosal dissection were performed with the Flush Knife (1.5 mm or 2.0 mm). Additionally, an electric current generator (VIO300D; ERBE, Tübingen, Germany) was used for hemostasis.
Prophylactic clipping using hemoclips (HX-110/610; Olympus Medical Systems Co.) was performed for mucosal defects after ER.

In the study group, patients with superficial ESCC who underwent circumferential or semi‐circumferential ESD were administered a systemic steroid. Oral prednisolone was administered at a dose of 30 mg/day on the third day after ESD, and then tapered gradually (30, 25, 20, 15, 10, and 5 mg for 14 days). EBD was applied whenever patients experienced persistent dysphagia to solids. Patients in the control group only received EBD after ESD when required.
Serial esophagoscopy with iodine staining was performed to assess for stenosis and tumor recurrence at one, three, six, and 12 months after ESD. Post‐ESD stricture was defined when patients complained of dysphagia or when a standard endoscope (GIF‐Q240; Olympus Medical Systems, Tokyo, Japan) could not be passed through the scar induced by ESD. In such cases, EBD was performed using an esophageal balloon dilation catheter (CRE Fixed Wire 15/16.5/18 mm, Boston Scientific Corporation, Boston, MA, USA), and dilation was repeated as necessary until the symptom was resolved.
Surveillance esophagoscopy was terminated if the patient remained free from stricture during the 12‐month follow‐up period and negative results were obtained on the last endoscopic examination.

Proton pump inhibitors were administered to all patients starting from the day of ESD for prevention of gastric acid reflux. We checked for chest pain and fever, and performed chest X-ray imaging and blood examinations on the following day to determine whether complications such as delayed bleeding and perforation had occurred. Esophagoscopy was performed to assess for stenosis at 1 month, 3 months, 6 months, and 1 year after ESD. Post-ESD stricture was defined as a patient complaint of dysphagia to soft solids or when a standard endoscope (GIF-Q240 or GIF-Q260J; Olympus) could not be passed through the ESD scar. EBD was performed with a balloon dilator (CRE Fixed Wire Balloon Dilators; Boston Scientific Japan Co., Tokyo, Japan) whenever a patient complained of dysphagia and was repeated on demand until the dysphagia resolved.

The ESD procedure was performed by five experienced endoscopists. Patients were sedated with intravenous injection of propofol or midazolam while monitoring of blood pressure, electrocardiography results, oxygen saturation, and bispectral index was performed during ESD. All ESDs were performed with an upper gastrointestinal endoscope (GIF-Q240 or GIF-Q260J; Olympus Medical Systems, Tokyo, Japan) that was fitted with a transparent hood (F-020, TOP Corporation, Tokyo, Japan). Carbon dioxide insufflation was used during ESD. An electrosurgical current was applied using a standard electrosurgical generator (VIO300 D or ICC200; ERBE, Tübingen, Germany) and a Hook knife (KD-260LR, Olympus) was used as an electrosurgical knife. The tumor margin was defined using a 1.25 % iodine solution and mucosal marking was performed circumferentially outside the tumor margin with the knife. Glycerol (10 % glycerin and 5 % fructose) was injected into the submucosa to elevate the lesion. Bleeding vessels were coagulated using monopolar Coagrasper Hemostatic Forceps (ED-410LR, Olympus). Resected specimens were extended on boards using pins, for fixation in 10 % formalin. Serial-step sections at 2-mm intervals were made after 24 hours, stained with hematoxylin and eosin, and evaluated by pathologists. Tumor size, depth of invasion, and horizontal and vertical margin involvement were evaluated.