In:
Digestion, S. Karger AG, Vol. 89, No. 3 ( 2014), p. 184-193
Abstract:
〈 b 〉 〈 i 〉 Backgrounds/Aims: 〈 /i 〉 〈 /b 〉 Endoscopic submucosal dissection (ESD) of early cancer allows precise staging and avoids recurrence or surgery. Tutored by experts, ESD has rapidly spread in Japan, but still demands 〈 i 〉 untutored 〈 /i 〉 learning in Western countries. A step-up approach starts with easiest gastric neoplasias, but fails on their low prevalence in Western countries. A prevalence-based approach includes challenging colonic neoplasias. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We analyzed an 〈 i 〉 untutored 〈 /i 〉 series of initial 50 ESD procedures by an experienced endoscopist on consecutive lesions referred according to prevalence. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Overall, 48 lesions (20% upper gastrointestinal, 80% colorectal; 2 hyperplastic (inflammatory) lesions, 46 neoplasms) were completely resected intention-to-treat with ESD, 2 required a second ESD. Neoplasias were resected 76% en-bloc (46% ESD, 30% ESD with snaring), 17% by ESD with snaring in 2-3 pieces, and 6.5% as ESD with snaring in multiple pieces. None of 15 neoplasias with high-grade intraepithelial neoplasia or an early esophageal cancer (R0) had recurred. Complications were 2 bleedings (4%) and 7 perforations (14%), 5 clipped and 2 (4%) operated. All patients were discharged within 9 days without long-term morbidity. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 〈 i 〉 Untutored 〈 /i 〉 learning of ESD is feasible on colonic lesions. We propose to establish ESD in Europe with structured training and a 〈 i 〉 prevalence-of-lesions-based 〈 /i 〉 approach.
Type of Medium:
Online Resource
ISSN:
0012-2823
,
1421-9867
Language:
English
Publisher:
S. Karger AG
Publication Date:
2014
detail.hit.zdb_id:
1482218-0
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