Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer: initial experience of a western center

BACKGROUND: Endoscopic submucosal dissection is a new Japanese technique characterized by en-bloc resection of the entire lesion irrespective of size, with lower local recurrence when compared to endoscopic mucosal resection. OBJECTIVE: To evaluate the feasibility, early results and complications of the endoscopic submucosal dissection technique for treating early gastric and esophageal cancer at the Endoscopic Unit of Clinics Hospital and Cancer Institute of the São Paulo University. MATERIALS AND METHODS: Twenty patients underwent endoscopic resection using the endoscopic submucosal dissection technique for early gastric or esophageal cancer. The patients were evaluated prospectively as to the executability of the technique, the short-term results of the procedure and complications. RESULTS: Sixteen gastric adenocarcinoma lesions and six esophageal squamous carcinoma lesions were resected. In the stomach, the mean diameter of the lesions was 16.2 mm (0.6-3.5 mm). Eight lesions were type IIa + IIc, four were type IIa and four IIc, with thirteen being well differentiated and three undifferentiated. Regarding the degree of invasion, five were M2, seven were M3, two were Sm1 and one was Sm2. The mean duration of the procedures was 85 min (20-160 min). In the esophagus, all of the lesions were type IIb, with a mean diameter of 17.8 mm (6-30 mm). Regarding the degree of invasion, three were M1, one was M2, one was M3 and one was Sm1. All had free lateral and deep margins. The mean time of the procedure was 78 min (20-150 min). CONCLUSION: The endoscopic submucosal dissection technique was feasible in our service with a high success rate.

Ecopunção endoscópica no diagnóstico das massas mediastinais: análise de 25 casos / Echoendoscopy in the diagnosis of mediastinal masses: analysis of 25 cases

Introdução: A maioria das massas mediastinais é assintomática. Pela importância das estruturas vasculares e linfáticas da região, bem como o difícil acesso, a ecoendoscopia tornou-se importante aliado na caracterização de massas e obtenção de material para estudo histopatológico. Métodos: Realizou-se análise retrospectiva de ecoendoscopias do mediastino realizadas em 2005, no Serviço de Endoscopia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, e que apresentavam o diagnóstico de massa ou presença de linfonodos mediastinais. Em todos os pacientes procedeu-se a ecopunção com obtenção de microfragmentos. Resultados: Foram avaliados 25 pacientes, 10 (40%) homens e 15 (60%) mulheres, com idade média de 51,72 anos. Do total de exames, em 21 (84%) obteve-se diagnóstico histológico, diagnosticando-se neoplasia em 12 (48%), com seis (24%) lesões inflamatórias, das quais uma linfadenopatia reativa, em dois, antracose, uma necrase inespecífica e duas granulomatosas. Foram observados três (12%) casos com tecido normal. Em quatro (16%) casos o material foi insuficiente para o diagnóstico. Conclusão: A ecoendoscopia apresentou-se como método satisfatório na obtenção de material para análise histopatológica de massas mediastinais.