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Risk factors of major intraoperative bleeding and postoperative bleeding associated with Endoscopic submucosal dissection for gastric neoplasms

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Chinese Medical Journal 2022年第3期135卷 309-316页

作者： Shanshan Xu Ningli Chai Xiaowei Tang Enqiang Linghu Shasha Wang Nankai University School of Medicine Nankai UniversityTianjin 300071China Department of Gastroenterology and Hepatology The First Medical Center of Chinese People's Liberation Army General HospitalBeijing 100853China

Background:endoscopic resection bleeding(ERB)classification was proposed by the authors’team to evaluate the severity of intraoperative bleeding(IB)during Endoscopic submucosal dissection(ESD).This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB(MIB)and postoperative bleeding(PB)associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital.All patients were divided into the non-MIB group(including ERB-0,ERB-controlled 1[ERB-c1],and ERB-c2)and the MIB group(including ERB-c3 and ERB-uncontrolled[ERB-unc])according to the ERB classification.Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients,773(57.95%)had ERB-0,477(35.76%)had ERB-c1,77(5.77%)had ERB-c2,7(0.52%)had ERB-c3,and no patients had ERB-unc.The rate of PB in patients with IB classifications of ERB-0,ERB-c1,ERB-c2,and ERB-c3 were 2.20%(17/773),3.35%(16/477),9.09%(7/77),and 2/7,respectively.In multivariate analysis,proximal location(odds ratio[OR]:1.488;95%confidence interval[CI]:1.045-3.645;P=0.047)was the only significant risk factor of MIB.Chronic kidney disease(CKD)(OR:7.844;95%CI:1.637-37.583;P=0.010)and MIB(ERB-c3)(OR:13.932;95%CI:2.585-74.794;P=0.002)were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB.Additionally,CKD and MIB(ERB-c3)were independent risk factors of PB.More attention should be paid to these high-risk patients for MIB and PB.

关键词： endoscopic resection bleeding classification Endoscopic submucosal dissection Gastric neoplasms

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Regression of gastric Endoscopic submucosal dissection induced polypoid nodular scar after Helicobacter pylori eradication:A case report

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World Journal of Clinical Cases 2022年第34期10卷 12793-12798页

作者： Byung Chul Jin Ae Ri Ahn Seong-Hun Kim Seung Young Seo Department of Internal Medicine Jeonbuk National University Medical SchoolResearch Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University HospitalJeonju 54907South Korea Department of Pathology Jeonbuk National University Medical SchoolResearch Institute of Clinical Medicine of Jeonbuk National UniversityBiomedical Research Institute of Jeonbuk National University Hospitaland Research Institute for Endocrine SciencesJeonju 56445South Korea

BACKGROUND Endoscopic submucosal dissection(ESD)is the treatment of choice for early gastric cancer and premalignant gastric dysplasia.In some cases,ESD induced ulcer heals as a polypoid nodular scar(PNS).These scars may make the physicians raise several clinical implications such as post-ESD neoplastic recurrence.CASE SUMMARY We described a case of gastric ESD induced PNS which is regressed after Helicobacter pylori(H.pylori)eradication.A 58-year-old male patient was referred to the outpatient clinic for evaluation and treatment of gastric low-grade dysplasia(LGD).ESD was performed.A PNS was developed at the ESD site.An endoscopic biopsy was done and there was no histological evidence of remnant tumor or recurrence but a hyperplastic mucosal change.The PNS showed increase in size in follow-up endoscopy,and the biopsy specimen demonstrated H.pylori infestation.H.pylori eradication was done and the PNS was regressed.CONCLUSION H.pylori eradication is considerable for the regression of PNS if H.pylori infesta tion is confirmed.

关键词： Polypoid nodular scar Helicobacter pylori Endoscopic submucosal dissection Case report

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Characteristics of metachronous gastric neoplasms after curative Endoscopic submucosal dissection for early gastric neoplasms

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Chinese Medical Journal 2021年第21期134卷 2603-2610页

作者： Shan-Shan Xu Ning-Li Chai Xiao-Wei Tang En-Qiang Linghu Sha-Sha Wang Bao Li Nankai University School of Medicine Nankai UniversityTianjin 300071China department of Gastroenterology and Hepatology The First Medical Center of Chinese People’s Liberation Army General HospitalBeijing 100853China

Background:With the wide application of Endoscopic submucosal dissection(ESD)for early gastric neoplasms,metachronous gastric neoplasms(MGN)have gradually become a concern.This study aimed to analyze the characteristics of MGN and evaluate the treatment and follow-up outcomes of MGN patients.Methods:A total of 814 patients were retrospectively enrolled.All these patients were treated by ESD for early gastric cancer or gastric dysplasia between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital.The risk factors for MGN were analyzed using Cox hazard proportional model.Moreover,the cumulative incidence,the correlation of initial lesions and MGN lesions,and the treatment and follow-up outcomes of MGN patients were analyzed.Results:A total of 4.5%(37/814)of patients had MGN after curative ESD.The 3-,5-,and 7-year cumulative incidences of MGN were 3.5%,5.1%,and 6.9%,respectively,and ultimately reaching a plateau of 11.3%at 99 months after ESD.There was no significant correlation between initial lesions and MGN lesions in terms of gross type(P=0.178),location(long axis:P=0.470;short axis:P=0.125),and histological type(P=0.832).Cox multivariable analysis found that initial multiplicity was the only independent risk factor of MGN(hazard ratio:4.3,95%confidence interval:2.0-9.4,Pendoscopic resection.During follow-up,two patients with MGN died of gastric cancer with lymph node metastasis.The disease-specific survival rate was significantly lower in patients with MGN than that in patients without MGN(94.6%vs.99.6%,P=0.006).Conclusions:The MGN rate gradually increased with follow-up time within 99 months after curative gastric ESD.Thus,regular and long-term surveillance endoscopy may be helpful,especially for patients with initial multiple neoplasms.

关键词： Metachronous gastric neoplasms Early gastric cancer Endoscopic submucosal dissection Characteristics Follow-up

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Giant myxofibrosarcoma of the esophagus treated by Endoscopic submucosal dissection:A case report

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World Journal of Clinical Cases 2023年第5期11卷 1094-1098页

作者： Xiao-Song Wang Cheng-Guang Zhao Hui-Ming Wang Xiao-Yan Wang Department of Digestive Diseases Suqian First People’s Hospital Affiliated to Nanjing Medical UniversitySuqian 223800Jiangsu ProvinceChina Department of Gastroenterology Suqian First People’s Hospital Affiliated to Nanjing Medical UniversitySuqian 223800Jiangsu ProvinceChina

BACKGROUND Myxofibrosarcoma(MFS)is a fibroblast-derived sarcoma that mainly occurs in subcutaneous tissue.MFS rarely occurs in the gastrointestinal tract,especially in the esophagus.CASE SUMMARY A 79-year-old male patient was admitted to our hospital for dysphagia for a week.Computed tomography and electronic gastroscopy showed that a giant mass was located 30 cm from the incisor and extended to the cardia.There was incomplete esophageal stenosis.endoscopic pathology showed spindle cell lesions,which were considered inflammatory myofibroblast like hyperplasia.Considering the strong demands of the patient and his family,and the fact that most inflammatory myofibroblast tumors are benign,we decided to perform Endoscopic submucosal dissection(ESD)even if the tumor size was giant(9.0 cm×3.0 cm).Postoperative pathological examination resulted in a final diagnosis of MFS.MFS rarely occurs in the gastrointestinal tract,especially in the esophagus.Surgical resection and local adjuvant radiotherapy are the first choices to improve the prognosis.This case report firstly described the ESD for esophageal giant MFS.It suggests that ESD may be an alternative treatment for primary esophageal MFS.CONCLUSION This case report for the first time describe the successful treatment of a giant esophageal MFS by ESD,suggesting that ESD may be an alternative treatment for primary esophageal MFS,especially in elderly high-risk patients with obvious dysphagia symptoms.

关键词： Endoscopic submucosal dissection Giant myxofibrosarcoma Esophagus Case report

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Role of second look endoscopy in Endoscopic submucosal dissection and peptic ulcer bleeding:Meta-analysis of randomized controlled trials

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World Journal of Gastrointestinal Endoscopy 2024年第4期16卷 214-226页

作者： Gowthami Sai Kogilathota Jagirdhar Jose Andres Perez Akshat Banga Rakhtan K Qasba Ruman K Qasba Harsha Pattnaik Muhammad Hussain Yatinder Bains Salim Surani Department of Medicine Saint Francis Health Science CenterNewarkNJ 07107United States Department of Medicine Saint Francis Health SystemsTulsaOK 74133United States Department of Internal Medicine Sawai Man Singh Medical CollegeJaipur 302004India Department of Medicine Green Life Medical College and HospitalDhaka 1205Bangladesh Department of Medicine Sher-i-kashmir Institute of Medical ScienceJammuSrinagar 190011India Department of Medicine Lady Hardinge Medical CollegeNew Delhi 110001India Department of Gastroenterology Saint Michaels Medical CenterNewarkNJ 07102United States Department of Medicine and Pharmacology Texas AM UniversityCollege StationTX 77843United States

BACKGROUND Second-look endoscopy(SLE)to prevent recurrent bleeding in patients with peptic ulcer disease(PUD)and those undergoing Endoscopic submucosal dissection(ESD)is routinely being performed.Conflicting evidence exists regarding efficacy,risk,benefit,and cost-effectiveness.AIM To identify the role and effectiveness of SLE in ESD and PUD,associated rebleeding and PUD-related outcomes like mortality,hospital length of stay,need for endoscopic or surgical intervention and blood transfusions.METHODS A systematic review of literature databases PubMed,Cochrane,and Embase was conducted from inception to January 5,2023.Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included.The study was conducted per PRISMA guidelines,and the protocol was registered in PROSPERO(ID CRD42023427555:).RevMan was used to perform meta-analysis,and Mantel-Haenszel Odds ratio(OR)were generated using random effect models.RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis,of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding.In ESD,the rates of rebleeding were 7%in the SLE group compared to 4.4%in the non-SLE group with OR 1.65,95%confidence intervals(CI)of 0.96 to 2.85;P=0.07,whereas it was 11%in the SLE group compared to 13%in the non-SLE group with OR 0.895%CI:0.50 to 1.29;P=0.36.The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01,95%CI:-0.22 to 0.25;P=0.91.In SLE vs non-SLE groups with PUD,the OR for endoscopic intervention was 0.29,95%CI:0.08 to 1.00;P=0.05 while it was OR 2.03,95%CI:0.95 to 4.33;P=0.07,for surgical intervention.The mean difference in the hospital length of stay was-3.57 d between the SLE and no SLE groups in PUD with 95%CI:-7.84 to 0.69;P=0.10,denoting an average of approximately 3 fewer days of hospital stay amon

关键词： Endoscopy Endoscopic submucosal dissection Peptic ulcer Gastrointestinal bleeding

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Early esophageal carcinomas in achalasia patient after Endoscopic submucosal dissection combined with peroral endoscopic myotomy:A case report

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World Journal of Clinical Cases 2023年第22期11卷 5407-5411页

作者： Bai-Quan An Chun-Xiao Wang Hai-Yan Zhang Jin-Dong Fu Department of Gastroenterology People’s Hospital of RizhaoRizhao 276800Shandong ProvinceChina Department of Hematology People’s Hospital of RizhaoRizhao 276800Shandong ProvinceChina

BACKGROUND Achalasia is associated with high risk of esophageal carcinoma.However,the optimal endoscopic surgery for patients with early esophageal carcinoma concomitant with achalasia remains unclear.CASE SUMMARY A combination of concurrent Endoscopic submucosal dissection(ESD)and modified peroral endoscopic myotomy(POEM)was performed on a 62-year-old male,who presented with multiple early esophageal carcinomas concomitant with achalasia.The patient exhibited an improvement in feeding obstruction,and presented no evidence of disease during the 3-year follow-up.CONCLUSION The combination of ESD and POEM is a feasible treatment modality for patients with early esophageal carcinoma concomitant with achalasia.

关键词： Achalasia Early esophageal carcinoma Endoscopic submucosal dissection Modified peroral endoscopic myotomy Case report

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Clinical outcomes of Clutch Cutter Endoscopic submucosal dissection for older patients with early gastric cancer

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World Journal of Gastrointestinal Oncology 2017年第10期9卷 416-422页

作者： Yoshihiro Otsuka Kazuya Akahoshi Kayoko Yasunaga Masaru Kubokawa Junya Gibo Shigeki Osada Kayo Tokumaru Kazuaki Miyamoto Takao Sato Yuki Shiratsuchi Masafumi Oya Hidenobu Koga Eikichi Ihara Kazuhiko Nakamura Department of Gastroenterology Aso Iizuka Hospital Diagnosis Procedure Combination Coding Management Office Aso Iizuka Hospital Department of Pathology Aso Iizuka Hospital Clinical Research Supportive Office Aso Iizuka Hospital Department of Medicine and Bioregulatory Science Graduate School of Medical SciencesKyushu University

AIM To evaluate the clinical outcome of Endoscopic submucosal dissection using the Clutch Cutter(ESDCC) in older patients. METHODS We reviewed 232 consecutive patients with early gastric cancer who underwent ESDCC between June 2010 and February 2014 at Aso Iizuka Hospital. We divided patients into two groups according to age: Older patients(> 80 years, n = 64) and non-older patients(≤ 80 years, n = 168). We retrospectively compared the prevalence rates of pre-existing comorbidities, anticoagulant therapy, en bloc resection, mean duration of hospitalization, incidence of ESDCC-related complications, change in performance status(PS) before and after ESDCC, and financial cost of admission. RESULTS The older group comprised 64 patients with a mean age of 84.1 years, and the non-older group comprised 168 patients with a mean age of 69.5 years. Older patients had significantly more pre-existing comorbidities than did non-older patients, specifically heart disease(P < 0.05). The en bloc resection rate in non-older patients was significantly higher than that in older patients(100% vs 95.3%, P = 0.02). There were no significant differences between the older and non-older groups in the incidence of ESDCC-related complications(i.e., postoperative bleeding and perforation) and the post-ESDCC change in PS. There were also no significant differences between the older and non-older groups in the mean duration of hospitalization(11.4 and 10.7 d, respectively) and financial cost of admission(657040 JPY and 574890 JPY, respectively).CONCLUSION ESDCC has a good clinical outcome in older patients.

关键词： Older patients Clutch Cutter Endoscopic submucosal dissection Early gastric cancer Financial cost Duration of hospitalization

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Perforation associated with Endoscopic submucosal dissection for duodenal neoplasm without a papillary portion

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World Journal of Gastrointestinal Surgery 2017年第7期9卷 161-166页

作者： Yasuhiro Matsuda Kazuki Sakamoto Naoki Kataoka Tomoyuki Yamaguchi Masafumi Tomita Shinichiro Makimoto Department of Surgery Kishiwada Tokushukai HospitalKishiwada CityOsaka 596-8522Japan

AIM To investigate predictors of perforation after endoscopic resection(ER) for duodenal neoplasms without a papillary portion.METHODS This was a single-center, retrospective, cohort study conducted between April 2003 and September 2014. A total of 54 patients(59 lesions) underwent endoscopic mucosal resection(EMR)(n = 36) and Endoscopic submucosal dissection(ESD)(n = 23). Clinical features, outcomes, and predictors of perforation were investigated.RESULTS Cases of perforation occurred in eight(13%) patients(95%CI: 4.7%-22.6%). Three ESD cases required sur-gical management because they could not be repaired by clipping. Delayed perforation occurred in two ESD cases, which required surgical management, although both patients underwent prophylactic clipping. All patients with perforation who required surgery had no postoperative complications and were discharged at anaverage of 13.2 d after ER. Perforation after ER showed a significant association with a tumor size greater than20 mm(P = 0.014) and ESD(P = 0.047).CONCLUSION ESD for duodenal neoplasms exceeding 20 mm may be associated with perforation. ESD alone is not recom-mended for tumor treatment, and LECS should be con-sidered as an alternative.

关键词： Duodenal neoplasm Endoscopic submucosal dissection Laparoscopic and endoscopic cooperative surgery

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Long-term outcomes of Endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection

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World Journal of Gastrointestinal Endoscopy 2024年第6期16卷 326-334页

作者： Jun Yong Bae Chang Beom Ryu Moon Sung Lee Kulwinder S Dua Internal Medicine and Digestive Disease Center Seoul Medical CenterSeoul 02053South Korea Internal Medicine and Digestive Disease Center and Research Institute Soon Chun Hyang University of School of MedicineBucheon 14584South Korea Department of Medicine Medical College of WisconsinMilwaukeeWI 53226United States

BACKGROUND Endoscopic submucosal dissection(ESD)for over 2 cm in size undifferentiated type(UD type)early gastric cancer(EGC)confined to the mucosa is not only challenging,but also long-term outcomes are not well known.AIM To evaluate the long-term outcomes of ESD done for UD type EGCs confined to the mucosa over 2 cm in size and compare the results with those where the lesions were less than 2 cm.METHODS 143 patients with UD type EGC confirmed on histology after ESD at a tertiary hospital were reviewed.Cases with synchronous and metachronous lesions and a case with emergency surgery after ESD were excluded.A total of 137 cases were enrolled.79 cases who underwent R0 resection were divided into 2 cm or less(group A)and over 2 cm(group B)in size.RESULTS Among 79 patients who underwent R0 resection,the number in group A and B were 51 and 28,respectively.The mean follow-up period(SD)was 79.71±45.42 months.There was a local recurrence in group A(1/51,2%)and group B(1/28,3.6%)respectively.This patient in group A underwent surgery while the patient in group B underwent repeated ESD with no further recurrences in both patients.There was no regional lymph node metastasis,distant metastasis,and deaths in both groups.With R0 resection strategy for ESD on lesions over 2 cm,20.4%(28/137)of patients were able to avoid surgery compared with expanded indication.CONCLUSION If R0 resection is achieved by ESD,UD type EGCs over 2 cm also showed good and similar clinical outcomes as compared to lesions less than 2 cm when followed for over 5 years.With R0 resection strategy,several patients can avoid surgery.

关键词： Undifferentiated type early gastric cancer Endoscopic submucosal dissection Long term outcomes Over 2 cm Early gastric cancer

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Construction and analysis of an ulcer risk prediction model after Endoscopic submucosal dissection for early gastric cancer

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World Journal of Gastrointestinal Oncology 2022年第9期14卷 1823-1832页

作者： San-Dong Gong Huan Li Yi-Bin Xie Xiao-Hui Wang Department of Gastroenterology Hainan Hospital of Chinese PLA General HospitalSanya 572013Hainan ProvinceChina Department of Gastroenterology Sixth Medical Center of Chinese PLA General HospitalBeijing 100048China Department of Pancreatic and Gastric Surgery National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021China

BACKGROUND Endoscopic submucosal dissection(ESD) has been widely used in the treatment of early gastric cancer(EGC). A personalized and effective prediction method for ESD with EGC is urgently needed.AIM To construct a risk prediction model for ulcers after ESD for EGC based on LASSO regression.METHODS A total of 196 patients with EGC who received ESD treatment were prospectively selected as the research subjects and followed up for one month. They were divided into an ulcer group and a non-ulcer group according to whether ulcers occurred. The general data, pathology, and endoscopic characteristics of the groups were compared, and the best risk predictor subsets were screened by LASSO regression and tenfold cross-validation. Multivariate logistic regression was applied to analyze the risk factors for ulcers after ESD in patients with EGC. A receiver operating characteristic(ROC) curve was used to estimate the predictive model performance.RESULTS One month after the operation, no patient was lost to follow-up. The incidence of ulcers was 20.41%(40/196)(ulcer group), and the incidence of no ulcers was 79.59%(156/196)(non-ulcer group). There were statistically significant differences in the course of disease, Helicobacter pylori infection history, smoking history, tumor number, clopidogrel medication history, lesion diameter, infiltration depth, convergent folds, and mucosal discoloration between the groups. Gray’s medication history, lesion diameter, convergent folds, and mucosal discoloration, which were the 4 nonzero regression coefficients, were screened by LASSO regression analysis. Further multivariate logistic analysis showed that lesion diameter [Odds ratios(OR) = 30.490, 95%CI: 8.584-108.294], convergent folds(OR = 3.860, 95%CI: 1.060-14.055), mucosal discoloration(OR = 3.191, 95%CI: 1.016-10.021), and history of clopidogrel(OR = 3.554, 95%CI: 1.009-12.515) were independent risk factors for ulcers after ESD in patients with EGC(P < 0.05). The ROC curve showed that the area under the curve of the risk predic

关键词： Endoscopic submucosal dissection Early gastric cancer endoscopic features Ulcer Model

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