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1.
Artigo em Inglês | MEDLINE | ID: mdl-32003276

RESUMO

Background: Endoscopic submucosal tunnel dissection (ESTD) has recently been an effective procedure for resecting large early esophageal neoplasm. However, excessive dissection beyond the distal limit may occur because the prepared distal end often cannot be distinguished through the tunnel. This study aimed to assess the efficacy and safety of a novel crystal violet navigation (CVN) for identifying the distal end.Material and methods: In the observational case series study, all 22 patients who underwent esophageal ESTD using the CVN were included. When setting the distal end, the distal incision line was dyed purple using a crystal violet solution. The rates of purple color identified via the tunnel, successful tunnel penetration without extra dissection, en bloc and curative resection, procedure time for ESTD and CVN, and procedure-associated complications were evaluated.Results: The rates of purple color and successful tunnel penetration were both 100%. En bloc and curative resection were 100%, and 86%, respectively. The mean total procedure time was 103.9 ± 46.2 (mean ± SD) minutes, while the mean time for the CVN was 14.1 ± 3.44 s. No complications were observed.Conclusions: The simple CVN method can be a navigation tool for identifying the distal end during the ESTD procedure.

3.
J Gastrointestin Liver Dis ; 28(4): 397-404, 2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31826062

RESUMO

BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric neoplasia. However, as the upper and middle body of the greater curvature has a rich vasculature and submucosal fibrosis, ESD of neoplasia in these locations requires a specific strategy. We aimed to investigate the efficacy and safety of the J-shaped superficial cutting and splashed submucosal dissection (JSCS) technique for neoplasia of the greater curvature by comparing ESD using JSCS with conventional ESD. METHODS: Twenty-two patients who underwent ESD for gastric neoplasia affecting the upper and middle body of the greater curvature were divided into two groups for retrospective analysis. Nine patients underwent conventional ESD (c-Group), while 13 underwent ESD with JSCS (j-Group). Primary outcome was the en bloc resection rate. Secondary outcomes included complete resection (R0) rate, procedure time, perforation rate, total bleeding time, and the total number of massive bleeding events and of hemostatic forceps times applied during ESD. RESULTS: There were no significant differences between both groups (c-Group vs j-Group) in en bloc resection rate, or R0 resection rate. Compared with the c-Group, the j-Group tended to have a decreased mean procedure time (mean 133 minutes vs 74 minutes, p=0.11) and perforation rate (11% vs 0%, p=0.41). Compared with the c-Group, the j-Group had significantly fewer bleeding incidents (13.4 times vs 6.6 times, p=0.0095), shorter total bleeding time (17.6 min vs 7.4 min, p=0.036), and fewer usages of hemostatic forceps (6.3 times vs 2.4 times, p=0.026) during ESD. CONCLUSION: Endoscopic submucosal dissection with JSCS is superior to conventional ESD, as it reduces intraprocedural bleeding. This technique has the potential to become the standard strategy for neoplasia affecting the upper and middle body of the greater curvature.

5.
Int J Mol Sci ; 20(11)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31146370

RESUMO

Galectin-9 (Gal-9) enhances tumor immunity mediated by T cells, macrophages, and dendritic cells. Its expression level in various cancers correlates with prognosis. Furthermore, Gal-9 directly induces apoptosis in various cancers; however, its mechanism of action and bioactivity has not been clarified. We evaluated Gal-9 antitumor effect against esophageal squamous cell carcinoma (ESCC) to analyze the dynamics of apoptosis-related molecules, elucidate its mechanism of action, and identify relevant changes in miRNA expressions. KYSE-150 and KYSE-180 cells were treated with Gal-9 and their proliferation was evaluated. Gal-9 inhibited cell proliferation in a concentration-dependent manner. The xenograft mouse model established with KYSE-150 cells was administered with Gal-9 and significant suppression in the tumor growth observed. Gal-9 treatment of KYSE-150 cells increased the number of Annexin V-positive cells, activation of caspase-3, and collapse of mitochondrial potential, indicating apoptosis induction. c-Jun NH2-terminal kinase (JNK) and p38 mitogen-activated protein kinase (p38) phosphorylation were activated and could be involved in apoptosis. Therefore, Gal-9 induces mitochondria-mediated apoptosis of ESCC and inhibits cell proliferation in vitro and in vivo with JNK and p38 activation.


Assuntos
Antineoplásicos/farmacologia , Apoptose/efeitos dos fármacos , Carcinoma de Células Escamosas/metabolismo , Neoplasias Esofágicas/metabolismo , Galectinas/farmacologia , Animais , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Linhagem Celular Tumoral , Neoplasias Esofágicas/tratamento farmacológico , Galectinas/uso terapêutico , Humanos , Sistema de Sinalização das MAP Quinases , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Mitocôndrias/metabolismo
8.
J Gastroenterol Hepatol ; 34(1): 22-30, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30069935

RESUMO

Rescue therapy for gastrointestinal (GI) refractory bleeding, perforation, and fistula has traditionally required surgical interventions owing to the limited performance of conventional endoscopic instruments and techniques. An innovative clipping system, the over-the-scope clip (OTSC), may play an important role in rescue therapy. This innovative device is proposed as the final option in endoscopic treatment. The device presents several advantages including having a powerful sewing force for closure of GI defects using a simple mechanism and also having an innovative feature, whereby a large defect and fistula can be sealed using accessory forceps. Consequently, it is able to provide outstanding clinical effects for rescue therapy. This review clarifies the current status and limitations of OTSC according to different indications of GI refractory disease, including refractory bleeding, perforation, fistula, and anastomotic dehiscence. An extensive literature search identified studies reported 10 or more cases in which the OTSC system was applied. A total of 1517 cases described in 30 articles between 2010 and 2018 were retrieved. The clinical success rates and complications were calculated overall and for each indication. The average clinical success rate was 78% (n = 1517) overall, 85% for bleeding (n = 559), 85% (n = 351) for perforation, 52% (n = 388) for fistula, 66% (n = 97) for anastomotic dehiscence, and 95% (n = 122) for other conditions, respectively. The overall and severe OTSC-associated complications were 1.7% (n = 23) and 0.59% (n = 9), respectively. This review concludes that the OTSC system may serve as a safe and productive device for GI refractory diseases, albeit with limited success for fistula.


Assuntos
Fístula do Sistema Digestório/terapia , Endoscopia Gastrointestinal/instrumentação , Hemorragia Gastrointestinal/terapia , Perfuração Intestinal/terapia , Fístula Anastomótica/terapia , Endoscopia Gastrointestinal/efeitos adversos , Perfuração Esofágica/terapia , Humanos , Terapia de Salvação
9.
Minim Invasive Ther Allied Technol ; 28(3): 194-197, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29869577

RESUMO

Although stapler dissection and closure is commonly used for laparoscopic distal pancreatectomy (LDP), it is risky in patients with thick pancreatic parenchyma or titanium allergy. We performed laparoscopic pancreatic parenchymal dissection with cavitron ultrasonic surgical aspirator (CUSA) successfully in a patient with titanium allergy. Slinging the pancreas with nylon tape delineates the surgical plane. Pancreatic parenchyma was transected by CUSA in an almost bloodless field. Pancreatic duct branches and vessels were adequately exposed and dissected with a vessel sealing system. The main pancreatic duct was closed with Hem-O-lock. CUSA is an alternative to stapler dissection during LDP in select patients.


Assuntos
Laparoscopia/métodos , Pâncreas/cirurgia , Pancreatectomia/métodos , Adulto , Dissecação , Feminino , Humanos , Neoplasias Pancreáticas/cirurgia , Ultrassom
11.
Minim Invasive Ther Allied Technol ; 27(6): 327-332, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29764299

RESUMO

Background: Duodenal ESD is considered especially difficult with perforation and bleeding. This study assessed safer duodenal ESD procedures, especially with regard to obtaining a good operation view using a ring-thread method and closure of a post-ESD artificial ulcer. Methods: From 2013 to 2015, 17 patients who were diagnosed with duodenal adenoma or early duodenal cancer >20 mm in diameter underwent conventional ESD (C group). From 2016 to 2017, 12 patients underwent ring-shaped thread counter traction ESD with hemoclips and/or Over-The-Scope Clip (OTSC) (Ovesco Endoscopy GmbH, Tuebingen, Germany) closure of post ESD artificial ulcer (ring group). An observational study between the C group and Ring group was conducted. The primary outcome was perforation events during ESD (UMIN000026184). Results: There was a significant difference in perforation during ESD with five cases vs. 0 case in C and ring groups (p = .038). For bleeding that needed to be coagulated by forceps during ESD, there was a significant difference with four cases in the C group (p = .07). The total procedure time was 96.6 ± 28.2 and 72.8 ± 24.2 (min) with a significant difference (p = .027). Conclusions: Ring-shaped thread counter traction makes the most difficult duodenal ESD safer and easier without complications.


Assuntos
Adenoma/cirurgia , Neoplasias Duodenais/cirurgia , Duodeno/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Idoso , Idoso de 80 Anos ou mais , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Tração , Resultado do Tratamento
12.
Dig Endosc ; 30 Suppl 1: 25-31, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29658644

RESUMO

Flexible endoscopy has developed from a diagnostic tool for tissue biopsy sampling to a treatment tool for endoscopic resection of neoplasms in the digestive tract. In the near future, one of the advanced endoscopic techniques, endoscopic full-thickness resection (EFTR), is expected to be a feasible endoscopic procedure. In the present review, systematic review of conventional exposed EFTR was carried out. Search queries were (endoscopic full-thickness resection or EFTR) (over-the-scope clip or OTSC) (Overstitch System) from 2015 to 2017. Four retrospective, single-center studies with regard to conventional EFTR were identified. With regard to indication for conventional exposed EFTR, gastrointestinal stromal tumor was a good indication for EFTR. Mean tumor size of all four studies was 20.71 mm. In two studies, endoclips were used to close the resected opening without any complications, but the other two studies reported complications such as delayed perforation even using OTSC. Procedure times were reported from a minimum of 40 min to a maximum of 105 min. We also refer to introduction of a newly developed procedure of EFTR (non-exposed EFTR), and development of a new suturing device in Japan.


Assuntos
Ressecção Endoscópica de Mucosa/métodos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Técnicas de Sutura , Adulto , Idoso , Ressecção Endoscópica de Mucosa/mortalidade , Ressecção Endoscópica de Mucosa/tendências , Feminino , Previsões , Mucosa Gástrica/patologia , Mucosa Gástrica/cirurgia , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Estudos Retrospectivos , Medição de Risco , Neoplasias Gástricas/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
14.
Oncol Lett ; 15(1): 407-414, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29387226

RESUMO

Pancreatic cancer is the eighth-leading cause of cancer-associated mortality in males and the ninth-leading cause in females worldwide. Even when diagnosed early enough to be potentially resectable, the prognosis of invasive pancreatic cancer is poor. Galectin-9 (Gal-9) is a tandem-repeat type galectin that has recently been demonstrated to possess an anti-proliferative effect on cancer cells. Therefore, the present study evaluated the effects of Gal-9 on the proliferation of human pancreatic cancer cells and examined the microRNAs that are associated with the antitumor effects of Gal-9. Gal-9 suppressed the proliferation of multiple pancreatic cancer cell lines. In addition, Gal-9 treatment increased the levels of caspase-cleaved keratin 18 and the expression of cytochrome c in pancreatic cancer cell lines. This data suggests that Gal-9 induces intrinsic apoptosis in pancreatic cancer cell lines through the caspase-dependent and caspase-independent pathways. In addition, Gal-9 reduced the expression levels of phosphorylated epidermal growth factor receptor and numerous receptor tyrosine kinases (RTKs). In conclusion, Gal-9 may suppress the growth of human pancreatic cancer cells in vitro. These findings suggest that Gal-9 may be a new therapeutic agent for the treatment of pancreatic cancer.

15.
Int J Clin Oncol ; 23(4): 707-714, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29446041

RESUMO

BACKGROUND: Colposcopy, which is a standard modality for diagnosing cervical intraepithelial neoplasia (CIN), can have limited accuracy owing to poor visibility. Flexible magnifying endoscopy with narrow band imaging (ME-NBI) has excellent diagnostic accuracy for early gastrointestinal neoplasms and is expected to be highly useful for CIN diagnosis. This study aimed to determine the characteristic findings and evaluate the diagnostic ability of ME-NBI for lesions ≥ CIN 3. METHODS: A well-designed prospective diagnostic case series conducted at multiple tertiary-care centers. A total of 24 patients who underwent cervical conization with a preoperative diagnosis of high-grade squamous cell intraepithelial lesions (HSILs) or lesions ≥ CIN 3 were enrolled. Prior to conization, still images and video of ME-NBI were captured to investigate the cervical lesions. The images were reviewed based on histological examination of the resected specimens. RESULTS: The NBI-ME images revealed the following abnormal findings: (1) light white epithelium (l-WE), (2) heavy white epithelium (h-WE), and (3) atypical intra-epithelial papillary capillary loop (IPCL). Pathological examination of the resected specimens confirmed cervical lesions ≥ CIN 3 in 21 patients. The ME-NBI findings were classified into four groups: l-WE, l-WE with atypical IPCL, h-WE, and h-WE with atypical IPCL, at rates of 0, 23.8, 9.5, and 66.7%, respectively. Additionally, all 3 patients with micro-invasive carcinoma showed a strong irregularity of IPCLs. CONCLUSION: The lesions ≥ CIN 3 demonstrated characteristic ME-NBI findings of h-WE alone, or l-/h-WE with atypical micro-vessels. This study indicates that ME-NBI may have novel value for CIN diagnosis.


Assuntos
Carcinoma de Células Escamosas/patologia , Neoplasia Intraepitelial Cervical/patologia , Endoscopia/métodos , Imagem de Banda Estreita/métodos , Neoplasias do Colo do Útero/patologia , Adulto , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasia Intraepitelial Cervical/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Gradação de Tumores , Valor Preditivo dos Testes , Estudos Prospectivos , Neoplasias do Colo do Útero/diagnóstico por imagem
17.
Surg Endosc ; 32(7): 3076-3086, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29313127

RESUMO

BACKGROUND: Although there have been several reports of treating large post-endoscopic submucosal dissection (ESD) ulcers by covering them with a polyglycolic acid sheet (PGAs), this approach presents problems regarding PGAs delivery. This study assessed the usefulness of a device delivery station system (DDSS) to evaluate the appropriate and rapid PGAs coating method with DDSS. METHODS: Thirty-nine of 41 patients who were diagnosed with early gastric cancer over 20 mm in diameter and pathologically diagnosed with well-differentiated adenocarcinoma were randomly allocated to the following two groups according to delivery method: the conventional PGAs delivery group (C group) (n = 19) and the new DDSS group (DDSS group) (n = 20). The primary outcome was the coating area per minute in the C group and DDSS group (cm2/min). RESULTS: There were significant differences in the coating time (min), with values of 34.1 (15.0-60.7) vs. 16.85 (11.5-27.2) min for the C group and DDSS group, respectively (p = 0.001). There was also a significant difference in coating area per minute, with values of 0.261 (0.02-1.00) and 0.96 (0.173-2.06) cm2/min for the C group and DDSS group, respectively (p = 0.001). There were four cases of post-ESD bleeding (1-7 days after ESD) in the C group compared with 0 in the DDSS group, which represented a significant difference (p = 0.030). CONCLUSIONS: The DDSS was very useful for rapidly delivering and tightly attaching a PGAs to control post-ESD bleeding. TRIAL REGISTRATION: University Hospital Medical Network (UMIN) 000026377.


Assuntos
Sistemas de Liberação de Medicamentos/instrumentação , Ressecção Endoscópica de Mucosa/efeitos adversos , Ácido Poliglicólico , Complicações Pós-Operatórias/terapia , Úlcera Cutânea/terapia , Cicatrização/efeitos dos fármacos , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ressecção Endoscópica de Mucosa/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Úlcera Cutânea/etiologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Fatores de Tempo , Resultado do Tratamento
18.
World J Gastroenterol ; 24(2): 211-215, 2018 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-29375206

RESUMO

AIM: To evaluate appropriate and rapid polyglycolic acid sheet (PGAs) covering time using device delivery station system (DDSS). METHODS: This pilot basic study was conducted to evaluate the potential of accurate and rapid PGAs delivery using DDSS. Three 11-mo-old female Beagle dogs were used in this study. Two endoscopic submucosal dissections (ESDs) 4cm in diameter were performed in lesser curvature of middle gastric body and greater curvature of antrum (total 6 ESDs performed). DDSS (3 cm length, 12 mm in outer diameter) has 2 chambers which 16 cm2 large 2 PGAs were stored, and DDSS was attached post ESD ulcers, respectively. Beriplast P® (CSL Behring K.K., Tokyo, Japan) (combination of fibrin glue and thrombin) was applied equally to the artificial ulcer, and tight attachment of 2 PGAs with DDSS were completed. The evaluation items were covering times, post ESD bleeding and perforation during ESD. RESULTS: The covering time of PGAs (defined as the duration from the beginning of endoscope insertion into the mouth to the end of the fibrin glue coating process) was 6.07 (4.86-8.29) min. There was no post-ESD bleeding (1-7 d after ESD), and there was no perforation during ESD. CONCLUSION: DDSS was very useful for rapid delivering and tight attachment of PGAs, and has potentials of multi-purpose delivery station system.


Assuntos
Sistemas de Liberação de Medicamentos/instrumentação , Ressecção Endoscópica de Mucosa/instrumentação , Gastroscópios , Gastroscopia/instrumentação , Ácido Poliglicólico/administração & dosagem , Antro Pilórico/efeitos dos fármacos , Antro Pilórico/cirurgia , Cicatrização/efeitos dos fármacos , Animais , Aprotinina/administração & dosagem , Cães , Formas de Dosagem , Combinação de Medicamentos , Composição de Medicamentos , Ressecção Endoscópica de Mucosa/efeitos adversos , Fator XIII/administração & dosagem , Feminino , Fibrinogênio/administração & dosagem , Gastroscopia/efeitos adversos , Duração da Cirurgia , Projetos Piloto , Ácido Poliglicólico/química , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Trombina/administração & dosagem , Fatores de Tempo
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