The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection
Background and study aims Severe fibrosis poses a challenge in colorectal endoscopic submucosal dissection (ESD). Recently, the pocket-creation method (PCM) has been developed for overcoming various difficulties of ESD. A specific tapered hood is used for adequate traction in the PCM, and endoscopic...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Georg Thieme Verlag KG
2018-08-01
|
| Series: | Endoscopy International Open |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/a-0593-5818 |
| _version_ | 1818379449254543360 |
|---|---|
| author | Naohisa Yoshida Yuji Naito Ritsu Yasuda Takaaki Murakami Ryohei Hirose Kiyoshi Ogiso Yutaka Inada Hideyuki Konishi Rafiz Abdul Rani Mitsuo Kishimoto Eiichi Konishi Masayoshi Nakanishi Yoshito Itoh |
| author_facet | Naohisa Yoshida Yuji Naito Ritsu Yasuda Takaaki Murakami Ryohei Hirose Kiyoshi Ogiso Yutaka Inada Hideyuki Konishi Rafiz Abdul Rani Mitsuo Kishimoto Eiichi Konishi Masayoshi Nakanishi Yoshito Itoh |
| author_sort | Naohisa Yoshida |
| collection | DOAJ |
| description | Background and study aims Severe fibrosis poses a challenge in colorectal endoscopic submucosal dissection (ESD). Recently, the pocket-creation method (PCM) has been developed for overcoming various difficulties of ESD. A specific tapered hood is used for adequate traction in the PCM, and endoscopic operability becomes stable in the pocket. In this study, we investigated the efficacy of the PCM in ESD for cases with severe fibrosis.
Patients and methods We retrospectively reviewed 1000 consecutive colorectal ESD cases (April 2006 to January 2017). Since 2016, the PCM was performed in 58 cases. The indications for ESD included (1) tumors ≥ 20 mm in size diagnosed as intramucosal cancer or high-grade dysplasia and part of T1a cancer using magnifying endoscopic examinations and (2) tumors that appeared impossible to resect with endoscopic mucosal resection because of suspected fibrosis. We identified 120 cases with severe fibrosis and compared them to cases without severe fibrosis. Additionally, the 120 severe fibrosis cases were divided into the PCM and non-PCM groups. En bloc resection, procedure time, discontinuation, and complications were analyzed between these 2 groups.
Results Among all 1000 ESDs, severe fibrosis and discontinuation rates were 12.0 % (120 cases) and 1.8 % (18 cases), respectively. Regarding the comparison between cases with severe fibrosis and with no severe fibrosis, there were significant differences about en bloc resection rate (78.3 % vs. 95.7 %, P < 0.001), discontinuance rate (12.5 % vs. 0.3 %, P < 0.001), and perforation rate (8.3 % vs. 2.6 %, P = 0.001). Among the 120 cases with severe fibrosis, 21 and 99 cases were in the PCM and non-PCM groups, respectively. The PCM group had a higher en bloc resection rate (95.2 vs. 74.7, P = 0.03), a shorter mean procedure time (min) (79.6 ± 26.5 vs. 118.8 ± 71.0, P = 0.001), and no cases of discontinuation. An analysis of the interobserver agreement for the diagnosis of severe fibrosis among the 3 endoscopists showed kappa values of > 0.6.
Conclusions In cases with severe fibrosis, the PCM with ESD improved en bloc resection rates and shortened the procedure time compared to the conventional non-PCM method. Additionally, the PCM reduced the discontinuation rate. |
| first_indexed | 2024-12-14T02:02:58Z |
| format | Article |
| id | doaj.art-ae6046f1d81543daab88a046a457b66f |
| institution | Directory Open Access Journal |
| issn | 2364-3722 2196-9736 |
| language | English |
| last_indexed | 2024-12-14T02:02:58Z |
| publishDate | 2018-08-01 |
| publisher | Georg Thieme Verlag KG |
| record_format | Article |
| series | Endoscopy International Open |
| spelling | doaj.art-ae6046f1d81543daab88a046a457b66f2022-12-21T23:20:58ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362018-08-010608E975E98310.1055/a-0593-5818The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissectionNaohisa Yoshida0Yuji Naito1Ritsu Yasuda2Takaaki Murakami3Ryohei Hirose4Kiyoshi Ogiso5Yutaka Inada6Hideyuki Konishi7Rafiz Abdul Rani8Mitsuo Kishimoto9Eiichi Konishi10Masayoshi Nakanishi11Yoshito Itoh12Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanGastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, MalaysiaDepartment of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan Department of Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanDepartment of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, JapanBackground and study aims Severe fibrosis poses a challenge in colorectal endoscopic submucosal dissection (ESD). Recently, the pocket-creation method (PCM) has been developed for overcoming various difficulties of ESD. A specific tapered hood is used for adequate traction in the PCM, and endoscopic operability becomes stable in the pocket. In this study, we investigated the efficacy of the PCM in ESD for cases with severe fibrosis. Patients and methods We retrospectively reviewed 1000 consecutive colorectal ESD cases (April 2006 to January 2017). Since 2016, the PCM was performed in 58 cases. The indications for ESD included (1) tumors ≥ 20 mm in size diagnosed as intramucosal cancer or high-grade dysplasia and part of T1a cancer using magnifying endoscopic examinations and (2) tumors that appeared impossible to resect with endoscopic mucosal resection because of suspected fibrosis. We identified 120 cases with severe fibrosis and compared them to cases without severe fibrosis. Additionally, the 120 severe fibrosis cases were divided into the PCM and non-PCM groups. En bloc resection, procedure time, discontinuation, and complications were analyzed between these 2 groups. Results Among all 1000 ESDs, severe fibrosis and discontinuation rates were 12.0 % (120 cases) and 1.8 % (18 cases), respectively. Regarding the comparison between cases with severe fibrosis and with no severe fibrosis, there were significant differences about en bloc resection rate (78.3 % vs. 95.7 %, P < 0.001), discontinuance rate (12.5 % vs. 0.3 %, P < 0.001), and perforation rate (8.3 % vs. 2.6 %, P = 0.001). Among the 120 cases with severe fibrosis, 21 and 99 cases were in the PCM and non-PCM groups, respectively. The PCM group had a higher en bloc resection rate (95.2 vs. 74.7, P = 0.03), a shorter mean procedure time (min) (79.6 ± 26.5 vs. 118.8 ± 71.0, P = 0.001), and no cases of discontinuation. An analysis of the interobserver agreement for the diagnosis of severe fibrosis among the 3 endoscopists showed kappa values of > 0.6. Conclusions In cases with severe fibrosis, the PCM with ESD improved en bloc resection rates and shortened the procedure time compared to the conventional non-PCM method. Additionally, the PCM reduced the discontinuation rate.http://www.thieme-connect.de/DOI/DOI?10.1055/a-0593-5818 |
| spellingShingle | Naohisa Yoshida Yuji Naito Ritsu Yasuda Takaaki Murakami Ryohei Hirose Kiyoshi Ogiso Yutaka Inada Hideyuki Konishi Rafiz Abdul Rani Mitsuo Kishimoto Eiichi Konishi Masayoshi Nakanishi Yoshito Itoh The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection Endoscopy International Open |
| title | The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection |
| title_full | The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection |
| title_fullStr | The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection |
| title_full_unstemmed | The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection |
| title_short | The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection |
| title_sort | efficacy of the pocket creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/a-0593-5818 |
| work_keys_str_mv | AT naohisayoshida theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT yujinaito theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT ritsuyasuda theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT takaakimurakami theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT ryoheihirose theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT kiyoshiogiso theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT yutakainada theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT hideyukikonishi theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT rafizabdulrani theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT mitsuokishimoto theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT eiichikonishi theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT masayoshinakanishi theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT yoshitoitoh theefficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT naohisayoshida efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT yujinaito efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT ritsuyasuda efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT takaakimurakami efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT ryoheihirose efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT kiyoshiogiso efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT yutakainada efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT hideyukikonishi efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT rafizabdulrani efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT mitsuokishimoto efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT eiichikonishi efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT masayoshinakanishi efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection AT yoshitoitoh efficacyofthepocketcreationmethodforcaseswithseverefibrosisincolorectalendoscopicsubmucosaldissection |