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Feasibility and safety of endoscopic submucosal dissection for lower rectal tumors with hemorrhoids

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World Journal of Gastroenterology 2016年第27期22卷 6268-6275页

作者： shinwa tanaka Takashi Toyonaga Yoshinori Morita Namiko Hoshi Tsukasa Ishida Yoshiko Ohara Tetsuya Yoshizaki Fumiaki Kawara Eiji Umegaki Takeshi Azuma Department of Endoscopy Kobe University Hospital Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University

AIM: To evaluate the feasibility and safety of endoscopic submucosal dissection(ESD) for lower rectal lesions with ***: The outcome of ESD for 23 lesions with hemorrhoids(hemorrhoid group) was compared with that of 48 lesions without hemorrhoids extending to the dentate line(non-hemorrhoid group) during the same study period. RESULTS: Median operation times(ranges) in the hemorrhoid and non-hemorrhoid groups were 121(51-390) and 130(28-540) min. The en bloc resection rate and the curative resection rate in the hemorrhoid group were 96% and 83%, and they were 100% and 90% in the non-hemorrhoid group, respectively. In terms of adverse events, perforation and postoperative bleeding did not occur in both groups. In terms of the clinical course of hemorrhoids after ESD, the rate of complete recovery of hemorrhoids after ESD in lesions with resection of more than 90% was significantly higher than that in lesions with resection of less than 90%.CONCLUSION: ESD on lower rectal lesions with hemorrhoids could be performed safely, similarly to that on rectal lesions extending to the dentate line without hemorrhoids. In addition, all hemorrhoids after ESD improved to various degrees, depending on the resection range.

关键词： Endoscopic submucosal dissection Rectum Hemorrhoid Outcome Bleeding

Usefulness of a novel slim type Flush Knife-BT over conventional Flush Knife-BT in esophageal endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第9期23卷 1657-1665页

作者： Yoshiko Ohara Takashi Toyonaga Namiko Hoshi shinwa tanaka Shinichi Baba Hiroshi Takihara Fumiaki Kawara Tsukasa Ishida Yoshinori Morita Eiji Umegaki Takeshi Azuma Division of Gastroenterology Department of Internal MedicineGraduate School of MedicineKobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

To investigated the usefulness of a novel slim type ball-tipped FlushKnife (FlushKnife-BTS) over ball-tipped FlushKnife (FlushKnife-BT) in functional experiments and clinical *** order to evaluate the functionality of FlushKnife-BTS, water aspiration speed, resistance to knife insertion through the scope, and waterjet flushing speed were compared between FlushKnife-BTS and BT. In clinical practice, esophageal endoscopic submucosal dissection (ESD) performed using FlushKnife-BTS or BT by an experienced endoscopist between October 2015 and January 2016 were retrospectively reviewed. The treatment speed and frequency of removing and reinserting the knife to aspirate fluid and air during ESD sessions were *** experiments revealed that water aspiration speed by the endoscope equipped with a 2.8-mm working channel with FlushKnife-BTS was 7.7-fold faster than that with conventional FlushKnife-BT. Resistance to knife insertion inside the scope with a 2.8-mm working channel was reduced by 40% with FlushKnife-BTS. The waterjet flushing speed was faster with the use of FlushKnife-BT. In clinical practice, a comparison of 6 and 7 ESD using FlushKnife-BT and BTS, respectively, revealed that the median treatment speed was 25.5 mm2/min (range 19.6-30.3) in the BT group and 44.2 mm2/min (range 15.5-55.4) in the BTS group (P = 0.0633). However, the median treatment speed was significantly faster with FlushKnife-BTS when the resection size was larger than 1000 m2 (n = 4, median 24.2 mm2/min, range 19.6-27.7 vs n = 4, median 47.4 mm2/min, range 44.2-55.4, P = 0.0209). The frequency of knife replacement was less in the BTS group (median 1.76 times in one hour, range 0-5.45) than in the BT group (7.02 times in one hour, range 4.23-15) (P = 0.0065).CONCLUSIONOur results indicate that FlushKnife-BTS enhances the performance of ESD, particularly for large lesions, by improving air and fluid aspirat

关键词： Endoscopic submucosal dissection Novel slim type ball-tipped FlushKnife Ball-tipped FlushKnife Resistance to knife insertion Water aspiration speed

Gastric plexiform fibromyxoma resected by endoscopic submucosal dissection after observation of chronological changes:A case report

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World Journal of Gastrointestinal Oncology 2017年第6期9卷 263-267页

作者： Fumiaki Kawara shinwa tanaka Takashi Yamasaki Yoshinori Morita Yoshiko Ohara Yoshihiro Okabe Namiko Hoshi Takashi Toyonaga Eiji Umegaki Hiroshi Yokozaki Takanori Hirose Takeshi Azuma Division of Gastroenterology Department of Internal MedicineKobe University Graduate School of Medicine Division of Pathology Department of PathologyKobe University Graduate School of Medicine Department of Diagnostic Pathology Hyogo Cancer Center

A 66-year-old man was diagnosed with a gastric submucosal tumor. Endoscopic ultrasound(EUS) revealed an iso/hypoechoic mass in the third layer. No malignant cells were detected in a histological examination. Yearly follow-up endoscopy and EUS showed the slow growth of the tumor. Endoscopic submucosal dissection(ESD) was performed and a glistening tumor was resected. The lesion showed a multinodular plexiform growth pattern consisting of spindle cells with an abundant fibromyxoid stroma that was rich in small vessels. The tumor was diagnosed as plexiform fibromyxoma(PF) by immunohistochemistry. Although difficulties are associated with reaching a diagnosis preoperatively, chronological changes on EUS may contribute to the diagnosis of PF. ESD may also be useful in the diagnosis and treatment of PF.

关键词： Plexiform fibromyxoma Plexiform angiomyxoid myofibroblastic tumor Endoscopic ultrasound Endoscopic submucosal dissection Gastrointestinal stromal tumor

Efficacy of forced coagulation with low high-frequency power setting during endoscopic submucosal dissection

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World Journal of Gastroenterology 2017年第29期23卷 5422-5430页

作者： Tsukasa Ishida Takashi Toyonaga Yoshiko Ohara Tadao Nakashige Yasuaki Kitamura Ryusuke Ariyoshi Hiroshi Takihara Shinichi Baba Tetsuya Yoshizaki Fumiaki Kawara shinwa tanaka Yoshinori Morita Eiji Umegaki Namiko Hoshi Takeshi Azuma Division of Gastroenterology Department of Internal Medicine Graduate School of Medicine Kobe University Department of Endoscopy Kobe University Hospital Department of Endoscopy Kishiwada Tokushukai Hospital

To investigated the hemostatic ability of the S and F1-10 methods in clinical and ex vivo studies. METHODSThe hemostatic abilities of the two methods were analyzed retrospectively in all six gastric endoscopic submucosal dissection cases. The treated vessel diameter, compressed vessel frequency, and bleeding frequency after cutting the vessels were noted by the recorded videos. The coagulation mechanism of the two power settings was evaluated using the data recording program and histological examination on macro- and microscopic levels in the ex vivo experiments using porcine tissues. RESULTSF1-10 method showed a significantly better hemostatic ability for vessels ≥ 2 mm in diameter and a trend of overall better coagulation effect, evaluated by the bleeding rate after cutting the vessels. F1-10 method could sustain electrical current longer and effectively coagulate the tissue wider and deeper than the S method in the porcine model. CONCLUSIONF1-10 method is suggested to achieve a stronger hemostatic effect than the S method in clinical procedures and ex vivo models.

关键词： Endoscopic submucosal dissection Electrosurgery Endoknife Hemostatic effect The forced coagulation mode