ESD and Pit Pattern Diagnosis: Lessons from a Japanese Endoscopist Working in the United States

Conventional Versus Traction Endoscopic Submucosal Dissection for Colorectal Tumors: A Meta-analysis of Randomized Controlled Trials

INTRODUCTION

Compared with conventional endoscopic submucosal dissection (C-ESD) for colorectal lesions, the traction method (T-ESD) allows the lesion to be stabilized with easier dissection. However, randomized controlled trials (RCTs) have reported conflicting results on the clinical outcomes of T-ESD as compared with C-ESD. We conducted a meta-analysis to compile the data.

METHODS

Multiple databases were searched for RCTs evaluating C-ESD versus T-ESD for colorectal tumors. The end points of interest were procedure time (min), resection speed (mm²/min), R0 resection, en bloc resection, delayed bleeding, and perforation. Standard meta-analysis methods were employed using the random-effects model.

RESULTS

Six RCTs with a total of 566 patients (C-ESD n=284, T-ESD n=282) were included. The mean age was 67±10 y and 60% were men. As compared with the T-ESD technique, the C-ESD group was associated with longer procedure time (SMD 0.91, 95% CI 0.58 to 1.23, P <0.00001) and lesser resection speed (SMD -1.03, 95% CI -2.01 to -0.06, P =0.04). No significant difference was found in the 2 groups with respect to R0 resection rate (RR 1.00, 95% CI 0.94 to 1.06, P =0.87), en bloc resection (RR 0.99, 95% CI 0.97 to 1.01, P =0.35), delayed bleeding (RR 0.66, 95% CI 0.17 to 2.59, P =0.55) and perforation (RR 2.16, 95% CI 0.75 to 6.27, P =0.16).

DISCUSSION

On meta-analysis, pooled procedure time was significantly faster with T-ESD compared with C-ESD. The clinical outcomes, however, were comparable.

Effects of integrated management on surgical outcomes and mental health of patients following endoscopic submucosal dissection

BACKGROUND

Endoscopic submucosal dissection (ESD) is a less invasive local treatment for diseases throughout the gastrointestinal tract.

AIM

To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD.

METHODS

The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management.

RESULTS

The management group exhibited shortened fasting time and length of hospital stay compared to the control group (P < 0.05). The management group exhibited a higher incidence rate of postoperative complications than the control group (3 cases vs 11 cases; P = 0.043). The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery (P < 0.05). The management group gave more scores on the domains of patient familiarity to the responsible nurses, professional skills of responsible nurses, and general evaluation compared to the control group. The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group (P < 0.01). The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery (P < 0.01).

CONCLUSION

The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.

The Impact of Traction Methods on Endoscopic Submucosal Dissection Efficacy for Gastric Neoplasia: A Systematic Review and Meta-analysis

BACKGROUND

Endoscopic submucosal dissection (ESD) for gastric neoplasms can be challenging due to limited traction and visualization. The efficacy of traction-assisted endoscopic submucosal dissection (TA-ESD) continues to require additional validation. This study aims to explore the safety and efficiency of TA-ESD for early gastric neoplasms located at varying sites, in comparison with conventional endoscopic submucosal dissection (C-ESD).

METHODS

We conducted a comprehensive literature search using databases up until August 2022. The outcome measures procedure time, en bloc resection rate, complete resection rate, procedure time, and procedure-related adverse event rate. We calculated pooled mean differences (MDs) and odds ratios (ORs) for these outcomes.

RESULTS

The mean procedure time was significantly shorter in the TA-ESD group compared to the C-ESD group (MD - 14.9, 95% CI - 21.78 to - 8.03, I2 = 83%, p < 0.0001). Subgroup analysis revealed that mean procedure times for lesions on the greater curvature and upper/middle of the stomach were significantly shorter in the TA-ESD group - 19.2 min (95% CI - 27.75 to - 10.65, I2 = 12%, p < 0.0001) and - 7.35 min (95% CI - 35.4 to - 1.15, p = 0.04), respectively. The en bloc resection and complete resection rates were comparable between the two groups. The rate of perforation was significantly lower in the TA-ESD group than in the C-ESD group (OR 0.36, 95% CI 0.15-0.85, p = 0.02, I2 = 0%).

CONCLUSIONS

This study demonstrates the potential benefits of TA-ESD over C-ESD in treating patients with early-stage gastric tumors, highlighting its safety and efficacy. The findings indicate a significant reduction in procedure times at challenging stomach sites with TA-ESD in comparison to C-ESD.

PDCA nursing in improving quality management efficacy in endoscopic submucosal dissection

BACKGROUND

Endoscopic submucosal dissection (ESD) is a common surgical strategy for the treatment of early gastrointestinal tumors and precancerous lesions. PDCA nursing can effectively prevent potential risks in the nursing process, protect patient privacy, and improve patient satisfaction, nursing integrity, and service quality.

AIM

To explore the effects of PDCA nursing model on the quality management of gastrointestinal ESD, the 36-item Shot-Form Health Survey (SF-36) score, and negative emotions.

METHODS

A total of 178 patients who underwent ESD between January 2020 and January 2021 were divided into two groups. The usual care mode was the control group, with 80 cases from January to July 2020; from July 2020 to January 2021, 98 patients were enrolled in the PDCA care mode as the research group. The length of hospital stay and the costs of the two groups were statistically analyzed. The visual analog scale (VAS), SF-36 score, Zung self-rating scale for anxiety and depression, and postoperative complications were also assessed.

RESULTS

The length of hospitalization and cost in the research group were lower than in the control group (P < 0.05), and the VAS scores were lower than those before care (P < 0.05). Moreover, the VAS score of the research group was lower than that of the control group (P < 0.05). The SF-36 scores for physical function, role status, social function, pain, mental health, and physical strength were higher in the research group than in the control group (P < 0.05). Depression and anxiety scores of the research group were lower than those of the control group (P < 0.05). The postoperative complication rate in the research group (6.12%) was lower than in the control group (32.50%) (P < 0.05).

CONCLUSION

PDCA nursing can improve the quality of management of ESD surgery, shorten the length of hospital stay and cost, reduce the VAS and Zung scale scores to alleviate adverse emotions, improve the SF-36 score, and reduce postoperative complications.