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Chen Y, Zhu X, Ding S, Chen M, Yang J, Deng K. Minimally invasive treatment strategies for submucosal tumors of the upper gastrointestinal tract: Advances in innovative endoscopy-based therapies. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109626. [PMID: 39874944 DOI: 10.1016/j.ejso.2025.109626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Revised: 01/01/2025] [Accepted: 01/18/2025] [Indexed: 01/30/2025]
Abstract
The increasing detection of submucosal tumors (SMTs) in the upper gastrointestinal tract (UGI) is due to the increased clinical use of endoscopy and imaging technology. Some of these SMTs have malignant potential and may cause clinical symptoms. Thus, it is recommended in clinical guidelines to consider resection of these SMTs. Endoscopic techniques have become widely used in the diagnosis and treatment of SMT in the UGI as compared with traditional surgery due to their advantages of minimally invasive, quick recovery, and economical cost. Recently, new endoscopic techniques and instruments have been continuously implemented, leading to revolutionary innovation in endoscopic treatments. However, the safety and efficacy of these innovative techniques remain unclear. Therefore, we have comprehensively summarized the various techniques used in the treatment of UGI tumors in recent years, evaluated the indications and effects of each technique, and compared their benefits and disadvantages. We hope that this review will provide a more comprehensive reference for clinical and endoscopic practitioners, and help them develop more individualized treatment plans for different patients. This will ultimately expand the patient population that can benefit from these innovative technologies.
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Affiliation(s)
- Yuxiang Chen
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xinrui Zhu
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Shasha Ding
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Mo Chen
- Department of Gerontology, Tibetan Chengdu Branch Hospital of West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Department of Gerontology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, 610041, China
| | - Jinlin Yang
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Kai Deng
- Department of Gastroenterology & Hepatology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China; Sichuan University-Oxford University Huaxi Gastrointestinal Cancer Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Tokuhara M, Sano Y, Watanabe Y, Nakata H, Nakahira H, Furukawa S, Ohtsu T, Nakamura N, Ito T, Torii I, Yamashina T, Shimatani M, Naganuma M. A method of "Noninjecting Resection using Bipolar Soft coagulation mode; NIRBS" for superficial non-ampullary duodenal epithelial tumor: a pilot study. BMC Gastroenterol 2024; 24:343. [PMID: 39354393 PMCID: PMC11446073 DOI: 10.1186/s12876-024-03439-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 09/26/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Complete endoscopic resection of superficial non-ampullary duodenal epithelial tumors (SNADETs) is technically difficult, especially with an extremely high risk of adverse event (AE), although various endoscopic resection methods including endoscopic mucosal resection (EMR), underwater EMR (UEMR), and endoscopic submucosal dissection (ESD) have been tried for SNADETs. Accordingly, a novel simple resection method that can completely resect tumors with a low risk of AEs should be developed. AIMS A resection method of Noninjecting Resection using Bipolar Soft coagulation mode (NIRBS) which has been reported to be effective and safe for colorectal lesions is adapted for SNADETs. In this study we evaluated its effectiveness, safety, and simplicity for SNADETs measuring ≤ 20 mm. RESULTS This study included 13 patients with resected lesions with a mean size of 7.8 (range: 3-15) mm. The pathological distributions of the lesions were as follows: adenomas, 77% (n = 10) and benign and non-adenomatous lesions, 23% (n = 3). The en bloc and R0 resection rate was 100% (n = 13). The median procedure duration was 68 s (32-105). None of the patients presented with major AEs including bleeding and perforation. CONCLUSIONS Large studies such as prospective, randomized, and controlled trials should be conducted for the purpose of validating effectiveness, safety, and simplicity of the NIRBS for SNADETs measuring ≤ 20 mm suggested in this study.
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Affiliation(s)
- Mitsuo Tokuhara
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan.
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan.
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Kobe, Hyogo, Japan
| | - Yoshifumi Watanabe
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - Hidetoshi Nakata
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - Hiroko Nakahira
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - Shingo Furukawa
- Department of Gastroenterology, Japan Community Healthcare Organization Hoshigaoka Medical Center, 4-8-1 Hoshigaoka, Hirakata, Osaka, 573-8511, Japan
| | - Takuya Ohtsu
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
| | - Naohiro Nakamura
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
| | - Takashi Ito
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
| | - Ikuko Torii
- Department of Pathology, Japan Community Healthcare Organization Hoshigaoka Medical Center, Hirakata, Osaka, Japan
| | - Takeshi Yamashina
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
| | - Masaaki Shimatani
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
| | - Makoto Naganuma
- Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University Hirakata Hospital, Hirakata, Osaka, Japan
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Tanaka I, Hirasawa D, Saito H, Akahira J, Matsuda T. Usefulness of the S-O clip for duodenal endoscopic submucosal dissection: a propensity score-matched study. Clin Endosc 2023; 56:769-777. [PMID: 37524568 PMCID: PMC10665626 DOI: 10.5946/ce.2022.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/22/2022] [Accepted: 10/08/2022] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND/AIMS Endoscopic submucosal dissection (ESD) for superficial non-ampullary duodenal tumors (SNADETs) is associated with a high rate of en bloc resection. However, the technique for ESD remains challenging. Recent studies have demonstrated the effectiveness of S-O clips in colonic and gastric ESD. We evaluated the efficacy and safety of duodenal ESD using an S-O clip for SNADETs. METHODS Consecutive patients who underwent ESD for SNADETs between January 2011 and December 2021 were retrospectively enrolled. Propensity score matching analysis was used to compare patients who underwent duodenal ESD with the S-O clip (S-O group) and those who underwent conventional ESD (control group). Intraoperative perforation rate was the primary outcome, while procedure time and R0 resection rate were the secondary outcomes. RESULTS After propensity score matching, 16 pairs were created: 43 and 17 in the S-O and control groups, respectively. The intraoperative perforation rate in the S-O group was significantly lower than that in the control group (p=0.033). A significant difference was observed in the procedure time between the S-O and control groups (39±9 vs. 82±30 minutes, respectively; p=0.003). CONCLUSION The S-O clip reduced the intraoperative perforation rate and procedure time, which may be useful and effective in duodenal ESD.
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Affiliation(s)
- Ippei Tanaka
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Junichi Akahira
- Department of Pathology, Sendai Kousei Hospital, Sendai, Japan
| | - Tomoki Matsuda
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
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Hirose T, Kato M, Hatta W, Abe S, Takizawa K, Yano T. Superficial non-ampullary duodenal epithelial tumors now: endoscopic diagnosis and therapy. Jpn J Clin Oncol 2023; 53:877-884. [PMID: 37394910 DOI: 10.1093/jjco/hyad073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
With the recent increase in the frequency of duodenal tumor detection, significant progress has been made in endoscopic diagnosis and treatment. Although the first guidelines were issued in Japan, patient treatment varies widely among institutions. There is a need for improving the quality of endoscopic diagnosis and more curative and safer treatments. Biopsy is the standard diagnostic method; however, the diagnostic accuracy of endoscopic biopsy is not so high. Therefore, the differentiation of superficial non-ampullary duodenal epithelial tumors from non-neoplastic lesions is being developed. The incidence of lymph node and distant metastases of duodenal epithelial tumors is extremely rare in intramucosal carcinomas, and they are considered good candidates for endoscopic treatment if the technical difficulties can be resolved. Adverse events associated with endoscopic treatment are greatly reduced at advanced facilities through novel resection and closure methods, and further improvements are expected in the future. Clarifying the risk of metastatic recurrence may lead to the development of more appropriate treatments and curative resection criteria.
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Affiliation(s)
- Takashi Hirose
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Motohiko Kato
- Department of Gastroenterology and Hepatology, Keio University Graduate School of Medicine, Tokyo, Japan
| | - Waku Hatta
- Department of Gastroenterology and Hepatology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Takizawa
- Department of Endoscopy, Koyukai Shin-Sapporo Hospital, Hokkaido, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
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Hamada K, Techigawara K, Shiwa Y, Horikawa Y, Ishikawa M, Honda M. Duodenal endoscopic submucosal dissection with a retracted needle knife. Endosc Int Open 2023; 11:E712-E713. [PMID: 37564330 PMCID: PMC10411231 DOI: 10.1055/a-2109-8009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- Koichi Hamada
- Gastroenterology, Southern Tohoku Research Institute for Neuroscience Southern Tohoku General Hospital, Koriyama, Japan
- Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Kae Techigawara
- Gastroenterology, Southern Tohoku Research Institute for Neuroscience Southern Tohoku General Hospital, Koriyama, Japan
| | - Yoshiki Shiwa
- Gastroenterology, Southern Tohoku Research Institute for Neuroscience Southern Tohoku General Hospital, Koriyama, Japan
| | - Yoshinori Horikawa
- Gastroenterology, Southern Tohoku Research Institute for Neuroscience Southern Tohoku General Hospital, Koriyama, Japan
| | - Masafumi Ishikawa
- Gastroenterology, Southern Tohoku Research Institute for Neuroscience Southern Tohoku General Hospital, Koriyama, Japan
| | - Michitaka Honda
- Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
- Surgery, Southern Tohoku Research Institute for Neuroscience Southern Tohoku General Hospital, Koriyama, Japan
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Tashima T, Ishikawa T, Ryozawa S. Novel traction and mucosal defect closure methods using clip-traction bands for duodenal endoscopic submucosal dissection. Dig Endosc 2022; 34:e159-e161. [PMID: 36039007 DOI: 10.1111/den.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/08/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Tomoaki Tashima
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tsubasa Ishikawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
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