Usefulness of a traction method using dental floss and a hemoclip for gastric endoscopic submucosal dissection: a propensity score matching analysis (with videos).

BACKGROUND AND AIMS: Although endoscopic submucosal dissection (ESD) is a significant advancement in therapeutic endoscopy, it is a complicated technique and requires considerable expertise. In this exploratory study, we evaluated the efficacy of a simple traction method that uses dental floss and a hemoclip (DFC) and was developed to overcome the technical difficulties of ESD. METHODS: In total, 238 early gastric cancers treated by ESD between May 2012 and December 2014 at Tokyo Medical University were retrospectively reviewed. Lesions treated by conventional ESD (n = 185) and by ESD with DFC (ESD-DFC) (n = 53) were compared. Multivariable analyses and propensity score matching were used to compensate for the differences in age, sex, resected specimen size, lesion location, lesion position, presence of ulceration, and operator level. The procedure time, rate of en bloc and complete resection, and rates of adverse events were evaluated between the 2 groups. RESULTS: Propensity score matching analysis created 43 matched pairs. Adjusted comparisons between ESD-DFC and conventional ESD showed similar treatment outcomes (en bloc resection rate: 97.7% vs 100%, P = .315; complete resection rate: 90.7% vs 95.3%, P = .397; perforation during ESD rate: 2.3% vs 2.3%, P = 1.000; post-ESD bleeding rate: 4.7% vs 4.7%, P = 1.000) but a significantly shorter procedure time for ESD-DFC (82.2 ± 79.5 minutes vs 118.2 ± 71.6 minutes, P = .002). CONCLUSION: ESD-DFC facilitated rapid ESD with good visualization and traction while ensuring high curability and safety.

Reasonable decision of anesthesia methods in patients who underwent endoscopic submucosal dissection for superficial esophageal carcinoma: A retrospective analysis in a single Japanese institution.

BACKGROUND/AIMS: Despite being a valuable therapeutic option, it has not yet been reported whether endoscopic submucosal dissection (ESD) for superficial esophageal carcinoma should be performed under general or non-general anesthesia (sedation). MATERIALS AND METHODS: The clinicopathological factors (age, sex, histology, tumor size, tumor location, tumor macroscopic morphology, and adverse events) of 110 superficial esophageal carcinoma lesions (98 patients) treated by ESD at a single Japanese institution from January 2007 to December 2013 were retrospectively reviewed using medical records. RESULTS: Among 110 lesions, 94 lesions were resected under general anesthesia, and 16 lesions were resected under non-general anesthesia by an experienced endoscopist. Although the number of complications was 12 in the group of general anesthesia and 1 in sedated patients, no significant differences between both groups were found in the incidence of adverse events (total adverse events: 12.2% versus 1.02%, p=0.456; mediastinal emphysema: 11.2% versus 1.02%, p=0.518; pulmonary atelectasis: 1.02% versus 0%, p=0.679). All of the events could be managed conservatively. CONCLUSION: For ordered management of accidental events during esophageal ESD, general anesthesia might be a crucial option for a better clinical outcome even when administered by non-experienced operators.

Clinical Backgrounds and Outcomes of Elderly Japanese Patients with Gastrointestinal Bleeding.

OBJECTIVE: Elderly gastrointestinal bleeding (GIB) patients sometimes cannot be discharged home. In some cases, they die after hemostasis, even following appropriate treatment. This study investigates the clinical backgrounds and outcomes of elderly Japanese GIB patients. METHODS: The medical records of 185 patients (123 men, 62 women; mean age 68.2 years; range 10-99 years) with GIB symptoms who underwent esophagogastroduodenoscopy or colonoscopy to detect or treat the source of GIB were retrospectively reviewed. We compared the outcomes between patients ≤70 (n=85) and >70 (n=100) years. The clinical backgrounds of the patients who died or changed hospitals to undergo rehabilitation or receive palliative care were evaluated, as were the association of four factors with these poor outcomes: GIB (re-bleeding or uncontrolled bleeding), endoscopic procedure-related complications, exacerbation of the pre-existing comorbidity, and any complications that were not directly related to GIB. RESULTS: Of the patients ≤70 and >70 years of age, three (3.5%) and 17 (17.0%), respectively, were transferred to another hospital (p=0.003). One (1.2%) and five (5.0%), respectively, died (p=0.144). All three patients ≤70 years old that changed hospitals did so because their comorbidities became worse. The reasons for changing hospitals in the 17 patients >70 years of age included exacerbation of a pre-existing comorbidity (41.1%, 7/17), other complications (35.4%, 6/17), GIB itself (17.6%, 3/17), and endoscopic procedure-related complications (5.9%, 1/17). CONCLUSION: Although non-elderly and elderly GIB patients had similar mortality rates, many more elderly patients could not be discharged home for various reasons.