ABSTRACT
Background and study aims A post-endoscopic submucosal dissection (ESD) scar is expected to look homogeneous, however, some patients develop benign polypoid nodule scar (PNS). Incidence of PNS is unknown, yet these scars have direct clinical implications because they may render evaluation of post-ESD neoplastic recurrence difficult. Therefore, we reviewed the clinical experience of 5 ESD referral centers and evaluated their PNS incidence and clinical management. Patients and methods This was a retrospective multicenter case series enrolling patients that underwent R0, curative gastric ESD from 2003 to 2015 in 5 academic centers. PNS was defined as ESD site nodularity with hyperplastic or regenerative tissue histology. Results A total of 2275 patients underwent gastric ESD with endoscopy control and 28 patients (18 men/10 women) developed PNS for overall incidence of 1.2â%. Incidence of PNS ranged from 0.15â% to 11.4â% between centers. All patients that developed PNS had primary neoplastic lesions located in the distal stomach. Considering only lesions situated in the antrum (nâ=â912), incidence of PNS was 3.1â%. After mean follow-up of 43 months (range 6â-â192), no malignant recurrence in the PNS has been identified. In five patients (17.8â%) PNS disappeared after a mean of 18 months. Conclusion PNS occurs exclusively after ESD in the distal stomach in approximately 3.1â% of patients. Although PNS appearance can be concerning, no malignant recurrence was observed after curative R0 resection. Therefore, PNS should be viewed as a benign alteration that does not require any type of intervention, other than endoscopic surveillance.
ABSTRACT
El carcinoma de células escamosas del esófago (CCE) tiene un mal pronóstico debido a que la detección ocurre generalmente en etapas avanzadas. Sin embargo, el desarrollo de la endoscopia de alta resolución con recursos de cromoscopia digital y con lugol ha favorecido el diagnóstico del CCE en estadios iniciales.En paralelo hubo un importante progreso de las técnicas endoscópicas para la resección endoluminal del tumor en bloque, a partir del desarrollo del procedimiento denominado disección endoscópica de la submucosa (DES). Estos avances han permitido la expansión de las indicaciones del tratamiento endoscópico mínimamente invasivo con potencial curativo en pacientes con CCE. El presente artículo de revisión tiene como objetivo principal contribuir a la comprensión de los avances recientes más importantes relacionados al manejo del CCE precoz de esófago. Como objetivo secundario se pretende ofrecer una revisión detallada de la técnica de la DES desarrollada por los expertos japoneses, a fi n de contribuir a la difusión de este concepto y a la incorporación de estas nuevas tecnologías en la endoscopia latinoamericana
Squamous cell carcinoma (SCC) of the esophagus has a poor prognosis because it is generally detected in its advanced stages. Recently however, the development of high resolution endoscopy with digital chromoscopy and Lugol favors diagnosis of SCC in its initial stages. This development was made parallel to development of important endoscopic techniques for endoluminal resectioning of tumors en bloque from endoscopic submucosal dissection (ESD). These advances have increased the indications for minimally invasive endoscopictreatment of SCC of the esophagus providing patients with the potential of a cure. This review article aims to provide an understanding of the most recent and most important advances related to management of early SCC of the esophagus. The secondary objective of this article is to provide a detailed review of the ESD technique developed by Japanese experts. Both objectives have the aim of contributing to the diffusion ofESD and these new technologies to Latin American endoscopy and their incorporation into Latin Americangastroenterological practice.
Subject(s)
Humans , Male , Adult , Female , Young Adult , Carcinoma , Dissection , EsophagusABSTRACT
Nos países ocidentais, o carcinoma de células escamosas de esôfago (CCE) geralmente é detectado em estágio avançado, quando as possibilidades de cura são remotas e o prognóstico reservado. Entretanto, nos anos recentes, ocorreu uma série de avanços na abordagem do CCE de esôfago, tais como a identificação dos grupos de risco para o surgimento desta neoplasia; o uso da endoscopia de alta resolução e cromoendoscopia com lugol favorecendo o diagnóstico do CCE em estágios iniciais; e o desenvolvimento de técnicas endoscópicas de ressecção tumoral endoluminal em monobloco denominada dissecção endoscópica de submucosa. Este progresso tem possibilitado a aplicação do tratamento endoscópico minimamente invasivo com potencial curativo em pacientes selecionados com CCE superficial de esôfago. O presente artigo de revisão, elaborado por um grupo multicêntrico internacional, tem como objetivo primário contribuir para o entendimento dos principais avanços recentes ocorridos no manejo do CCE precoce de esôfago. Como objetivo secundário, pretende propiciar uma revisão detalhada e minuciosa da estratégia técnica de DES desenvolvida pelos experts japoneses, de forma a colaborar para a difusão deste conceito e a incorporação destas tecnologias na Medicina Brasileira e Latino-americana.
Esophageal squamous cell cancer (ESCC) has a dismal prognosis mainly because its recognition in Western countries usually occurs in late stages, when the possibilities of cure are minimal. However, in recent years, several advances have been observed in the management of ESSC, such as the identification of high-risk patients, the use of high-resolution endoscopy and lugol chromoscopy favoring the diagnosis of early stage ESCC, and the development of endoluminal techniques of en-block tumor resection, namely endoscopic submucosal dissection (ESD). These factors have enabled the application of endoscopic minimally invasive curative interventions in selected patients with superficial ESCC. This review article, designed by a multicenter international group, has the primary objective to provide a comprehensive overview of the most important recent advances in the management of ESCC. Secondarily it intends to provide a detailed and practical description of the technical approach to ESD in order to facilitate the dissemination of this concept and the incorporation of this new technologies in Brazil and in Latin-America.
Subject(s)
Female , Humans , Male , Esophageal Neoplasms/pathology , Esophageal Neoplasms/surgery , Early Diagnosis , Esophagoscopy , Neoplasm StagingABSTRACT
Las nuevas tecnologías de imagen con endoscopios de alta resolución y el uso de cromoscopia asociado al entrenamiento de los endoscopistas han permitido detectar lesiones neoplásicas de esófago en estadios iniciales. Estos avances resultaron en la expansión de las indicaciones del tratamiento endoscópico curativo en pacientes con carcinoma de células escamosas de esófago. En los últimos años se ha desarrollado en Japón técnicas para la resección endoluminal en bloque de los tumores gastrointestinales precoces, procedimiento denominado disección endoscópica de la submucosa (DES). Inicialmente la DES fue utilizada para tratamiento de tumores gástricos, y apenas más recientemente esta técnica pasó a ser aplicada para tumores de esófago y colorectales.El presente artículo de revisión presenta una descripción detallada de la DES en el manejo de las neoplasias superficiales de esófago, a fin de contribuir para la difusión de este concepto y la incorporación de este procedimiento en Latinoamérica.Endoscopic treatment of early esophageal squamous carcinoma by the endoscopic submucosal disection.
The development of high-resolution endoscopes with chromoendoscopy and the education of endoscopists have enabled the detection of early stage esophageal squamous-cell carcinoma (ESCC). Moreover, in recent years there has been an important progress in the management of early gastrointestinal neoplastic lesions after the development in Japan of endoluminal techniques for en-block tumor resection, namely endoscopic submucosal dissection (ESD). The combination of these factors facilitated the expansion of indications for endoscopic minimally invasive curative interventions in selected patients with superficial ESCC. This review article presents a comprehensive overview and detailed description of the ESD procedure for treatment of ESCC in order to facilitate the dissemination of this concept and the incorporation of this new technique in Latin-America.
Subject(s)
Humans , Male , Female , Carcinoma, Squamous Cell , Endoscopy , Esophageal Neoplasms/diagnosis , Esophageal Neoplasms/drug therapy , Esophageal Neoplasms , Diagnostic Imaging , Dissection , Gastrointestinal DiseasesABSTRACT
El tratamiento del cáncer gástrico temprano ha experimentado cambios revolucionarios en las décadas desde la aparición del tratamiento endoscópico. En la actualidad, la mayoría de estas lesiones tempranas son tratados con disección endoscópica de la submucosa (ESD). Debido a la excelente programa de detección implementado en Japón casi la mitad de todos los casos de cáncer gástrico no se tratan con la EDS. El objetivo de este artículo de revisión es facilitar el uso de esta técnica por endoscopistas latinoamericanos y así beneficiar a nuestros pacientes. Para ello ofrecemos una descripción detallada de la EDS, mostrar el estado actual de las indicaciones de esta técnica, y explicar las limitaciones de esta técnica. Este estudio fue realizado por endoscopistas entrenados en la EDS en Japón y bajo la supervisión de un endoscopista experto japonés (TT) que se habían realizado más de 4.000 con disección endoscópica de la submucosa a partir de principios de 2012.
The treatment of early gastric cancer has undergone revolutionary changes in the decades since the advent of endoscopic management. Currently, most of these early lesions are treated with endoscopic submucosal dissection (ESD). Due to the excellent screening program implemented in Japan almost half of all cases of gastric cancer there are treated with ESD. The aim of this review article is to facilitate the use of this technique by Latin American endoscopists and thus benefit our patients. To this end we provide a detailed description of ESD, show the current state of indications for this technique, and explain the limitations of this technique. This study was conducted by endoscopists trained in ESD in Japan and supervised by an expert Japanese endoscopist (TT) who had performed more than 4,000 with endoscopic submucosal dissections as of the beginning of 2012.
Subject(s)
Humans , Male , Female , Adult , Dissection , Stomach NeoplasmsABSTRACT
Esophageal squamous cell cancer (ESCC) has a dismal prognosis mainly because its recognition in Western countries usually occurs in late stages, when the possibilities of cure are minimal. However, in recent years, several advances have been observed in the management of ESSC, such as the identification of high-risk patients, the use of high-resolution endoscopy and lugol chromoscopy favoring the diagnosis of early stage ESCC, and the development of endoluminal techniques of en-block tumor resection, namely endoscopic submucosal dissection (ESD). These factors have enabled the application of endoscopic minimally invasive curative interventions in selected patients with superficial ESCC. This review article, designed by a multicenter international group, has the primary objective to provide a comprehensive overview of the most important recent advances in the management of ESCC. Secondarily it intends to provide a detailed and practical description of the technical approach to ESD in order to facilitate the dissemination of this concept and the incorporation of this new technologies in Brazil and in Latin-America.