Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer.

Endoscopic submucosal dissection (ESD) has been utilized as an alternative treatment to endoscopic mucosal resection for superficial esophageal cancer. We aimed to evaluate the complications associated with esophageal ESD and elucidate predictive factors for post-ESD stenosis. The study enrolled a total of 42 lesions of superficial esophageal cancer in 33 consecutive patients who underwent ESD in our department. We retrospectively reviewed ESD-associated complications and comparatively analyzed regional and technical factors between cases with and without post-ESD stenosis. The regional factors included location, endoscopic appearance, longitudinal and circumferential tumor sizes, depth of invasion, and lymphatic and vessel invasion. The technical factors included longitudinal and circumferential sizes of mucosal defects, muscle disclosure and cleavage, perforation, and en bloc resection. Esophageal stenosis was defined when a standard endoscope (9.8 mm in diameter) failed to pass through the stenosis. The results showed no cases of delayed bleeding, three cases of insidious perforation (7.1%), two cases of endoscopically confirmed perforation followed by mediastinitis (4.8%), and seven cases of esophageal stenosis (16.7%). Monovalent analysis indicated that the longitudinal and circumferential sizes of the tumor and mucosal defect were significant predictive factors for post-ESD stenosis (P < 0.005). Receiver operating characteristic analysis showed the highest sensitivity and specificity for a circumferential mucosal defect size of more than 71% (100 and 97.1%, respectively), followed by a circumferential tumor size of more than 59% (85.7 and 97.1%, respectively). It is of note that the success rate of en bloc resection was 95.2%, and balloon dilatation was effective for clinical symptoms in all seven patients with post-ESD stenosis. In conclusion, the most frequent complication with ESD was esophageal stenosis, for which the sizes of the tumor and mucosal defect were significant predictive factors. Although ESD enables large en bloc resection of esophageal cancer, practically, in cases with a lesion more than half of the circumference, great care must be taken because of the high risk of post-ESD stenosis.

Evaluation of endoscopic and histopathological features of serrated adenoma of the colon.

BACKGROUND AND STUDY AIMS: The aim of this study was to reveal the clinical features of serrated colonic adenoma by investigating its endoscopic features using a magnifying videoscope. MATERIALS AND METHODS: 68 colorectal serrated adenomas presented for colonoscopic examination were included in this study. A magnifying videoscope with a zoom ranging from x 1 to x 100 magnification was employed to observe the pit patterns of colonic lesions, and 39 of the serrated adenoma specimens were evaluated using this. Some pit patterns appeared as elongated oval and stellar-like orifices of the crypts; we termed these type which was detected III(SA) patterns. Other pit patterns showed a flower petal-like or pineal form, and this was termed a type IV(SA) pit pattern. RESULTS: In the entire sample of serrated adenomas, 53 were of the protruded type, and 15 were superficial, for a protruded/superficial ratio of 3.5 : 1. The protruded type of serrated adenoma predominated in the distal portion. The superficial type was preferentially located in the proximal portion of the colon (P < 0.0001). Among the 13 superficial types in which the magnifying videoscope was used, all 13 showed the type III(SA) basic pit pattern. In these serrated adenomas of the superficial type, an additional IV(SA) pit pattern was found in 23.1% (3/13), which was detected in 53.8% (14/26) in the protruded type. Small serrated adenomas measuring less than 10 mm in diameter were preferentially mild to moderate atypia (odd's ratio = 15.9, P = 0.0216). CONCLUSION: The pit pattern may prove useful for the endoscopic diagnosis of serrated adenoma. Furthermore, endoscopic treatment is indicated for serrated adenoma; in particular those of 10 mm or more in diameter should be treated because of the possibility of high-grade glandular intraepithelial neoplasia.

Evaluation of endoscopic mucosal resection for laterally spreading rectal tumors.

BACKGROUND AND STUDY AIMS: We undertook this retrospective study to evaluate the frequency and prognosis of endoscopic treatment of laterally spreading tumors (LSTs) in the rectum. The recurrence rate for lesions of the lower rectum was compared with that of the upper rectum. PATIENTS AND METHODS: During the period from July 1989 to June 2002, a total of 1237 rectal tumors were detected. LSTs accounted for 6.9 % (85/1237) of all rectal tumors. A total of 224 tumors of the lower rectum were detected among the 1237 rectal tumors. LSTs accounted for 16.1 % (36/224) of all the lower rectal tumors. From 85 LST lesions, 67 were evaluated for their prognosis after endoscopic mucosal resection (EMR). Patients whose LSTs had been resected were followed up by endoscopy at the following frequencies: once 15 (22.4 %); twice (more than 1 year), 20 (29.9 %); three times (more than 3 years), 21(31.3 %); and four times or more (more than 5 years), 11 (16.4 %). RESULTS: A total of 67 patients with endoscopically treated LSTs were followed up by endoscopy. We observed recurrences in two lesions of the upper rectum (2/38, 5.3 %) and five lesions of the lower rectum (5/29, 17.2 %) (P = 0.2364); all seven lesions were resected piecemeal. LSTs whose horizontal margin reached the pectinate line frequently recurred in the lower rectum, at a rate of 80 % (4/5). However, all patients were completely cured by additional endoscopic resections, the greatest number of treatments being four. CONCLUSION: For early detection of recurrence and successful endoscopic cure, further colonoscopic examination within a few months after the first treatment is necessary.