Akira Dobashi1, Kenichi Goda2, Kazuki Sumiyama2, Masakuni Kobayashi2, Tomohiko R Ohya2, Masayuki Kato2, Hirobumi Toyoizumi2, Tomohiro Kato2, Masato Matsushima3, Hisao Tajiri2,4. 1. Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan. akira.dobashi@nifty.com. 2. Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan. 3. Department of Epidemiology, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan. 4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Abstract
BACKGROUND: Injection of mesna into submucosal layers was recently reported to chemically soften connective tissue and facilitate the gastric endoscopic submucosal dissection (ESD) procedure. This study aimed to evaluate the safety and feasibility of similarly using mesna for esophageal ESD (mesna ESD). METHODS: We performed mesna ESD in 20 consecutive patients with superficial esophageal squamous cell carcinomas (SESCCs). To do this, a submucosal fluid cushion was initially formed using sodium hyaluronate, and the esophageal lesion was circumferentially isolated with a short blade needle-knife. Mesna solution was then injected into the submucosal layer, which was dissected mechanically by cleavage using the tip of a cap-fitted endoscope. The number of electrosurgical incisions was recorded by computer software in real time. The data from 20 conventional ESD procedures without mesna (consecutive 10 SESCCs pre and post the 20 consecutive mesna ESD) were used for comparison to evaluate the mesna ESD. RESULTS: The mesna ESDs achieved en bloc and R0 resection success rates of 100 and 95 %, respectively. There was no perforation or uncontrollable hemorrhage during and after mesna ESD, and the median procedural time of submucosal dissection was significantly less with mesna ESD than with conventional ESD (median; 8 vs. 15 min, P < 0.05). There were also significantly fewer electrosurgical incisions made during the mesna ESD than with conventional ESDs (median; 65 vs. 183 times, P < 0.01). CONCLUSIONS: Mesna ESD for SESCCs is a safe procedure with the potential to facilitate esophageal ESD.
BACKGROUND: Injection of mesna into submucosal layers was recently reported to chemically soften connective tissue and facilitate the gastric endoscopic submucosal dissection (ESD) procedure. This study aimed to evaluate the safety and feasibility of similarly using mesna for esophageal ESD (mesna ESD). METHODS: We performed mesna ESD in 20 consecutive patients with superficial esophageal squamous cell carcinomas (SESCCs). To do this, a submucosal fluid cushion was initially formed using sodium hyaluronate, and the esophageal lesion was circumferentially isolated with a short blade needle-knife. Mesna solution was then injected into the submucosal layer, which was dissected mechanically by cleavage using the tip of a cap-fitted endoscope. The number of electrosurgical incisions was recorded by computer software in real time. The data from 20 conventional ESD procedures without mesna (consecutive 10 SESCCs pre and post the 20 consecutive mesna ESD) were used for comparison to evaluate the mesna ESD. RESULTS: The mesna ESDs achieved en bloc and R0 resection success rates of 100 and 95 %, respectively. There was no perforation or uncontrollable hemorrhage during and after mesna ESD, and the median procedural time of submucosal dissection was significantly less with mesna ESD than with conventional ESD (median; 8 vs. 15 min, P < 0.05). There were also significantly fewer electrosurgical incisions made during the mesna ESD than with conventional ESDs (median; 65 vs. 183 times, P < 0.01). CONCLUSIONS:Mesna ESD for SESCCs is a safe procedure with the potential to facilitate esophageal ESD.
Authors: S Farhat; S Chaussade; T Ponchon; D Coumaros; A Charachon; T Barrioz; S Koch; P Houcke; C Cellier; D Heresbach; V Lepilliez; B Napoleon; P Bauret; E Coron; M Le Rhun; P Bichard; E Vaillant; A Calazel; E Bensoussan; S Bellon; L Mangialavori; F Robin; F Prat Journal: Endoscopy Date: 2011-05-27 Impact factor: 10.093
Authors: K Sumiyama; H Tajiri; C J Gostout; M Kawamura; H Imazu; T R Ohya; K Ikeda; K Goda; S Saito; T Kato Journal: Endoscopy Date: 2010-06-15 Impact factor: 10.093
Authors: Kazuki Sumiyama; Christopher J Gostout; Elizabeth Rajan; Timothy A Bakken; Mary A Knipschield Journal: Gastrointest Endosc Date: 2008-03 Impact factor: 9.427
Authors: K Goda; H Tajiri; M Ikegami; Y Yoshida; N Yoshimura; M Kato; K Sumiyama; H Imazu; K Matsuda; M Kaise; T Kato; S Omar Journal: Dis Esophagus Date: 2009-02-13 Impact factor: 3.429