Browsing by Subject "Endoscopic submucosal dissection (ESD)"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Endoscopic submucosal dissection with a novel high viscosity injection solution (LiftUp) in an ex vivo model: a prospective randomized study
    (Thieme, 2019-05) Wedi, E.; Koehler, P.; Hochberger, J.; Maiss, J.; Milenovic, S.; Gromski, M.; Ho, N.; Gabor, C.; Baulain, U.; Ellenrieder, V.; Jung, C.; Medicine, School of Medicine
    Introduction  Endoscopic submucosal dissection (ESD) is increasingly being used in the western world. Submucosal injectates are an essential tool for the ESD procedure. In this study, we evaluated a novel copolymer injectate (LiftUp, Ovesco, Tübingen Germany) in an established ESD model (EASIE-R) in comparison to existing submucosal injectables. Materials and methods  We conducted a prospective, randomized ex vivo study performing ESD with three injectates: LiftUp, hydroxyethyl starch (HAES 6 %) and normal saline solution (NaCl 0.9 %). A total of 60 artificial lesions, each 3 × 3 cm in size, were resected in an ex vivo porcine model, utilizing one of the three studied injectates (n = 20 ESDs per injectate). Study parameters were: en bloc resection rate, perforation rate, lifting property, time of injection, injectate volume, general ESD procedure time, and overall procedure time. Results  All 60 lesions were successfully resected using the standard ESD technique. LiftUp had no procedure related perforations, one perforation occurred in the HAES group, and two perforations in the NaCl group ( P  > 0.05). Furthermore, adequate lifting was achieved in 16/20 (80 %) using LiftUp, 6/20 (30 %) in the HAES group and 6/20 (30 %) in the NaCl group ( P  < 0.0002). En bloc resection was achieved in 19 (95 %) with LiftUp, in 20 (100 %) with HAES, and in 16 (80 %) with NaCl. General ESD procedure time and overall procedure time were not different among the three groups. Conclusion  LiftUp appears to be a safe alternative to established fluids for ESD. It had a significantly improved lifting effect and required significantly less injected volume compared to well-established lifting solutions.
  • Thumbnail Image
    Item
    Endoscopic treatments for early gastroesophageal lesions
    (AME, 2021) Srinivasan, Sachin; Hamade, Nour; Emura, Fabian; Sharma, Prateek; Medicine, School of Medicine
    Gastroesophageal (GEJ) carcinoma is well-recognized since the 1970s and has shown 2.5-fold increase in incidence since then. There still exists much controversy and ambiguity in the literature about the occurrence and recurrence of these lesions post-treatment. This has been attributed to the variability in the terms and definitions used in these junctional lesions. Despite this, great strides have been made in the treatment of early lesions decreasing morbidity and mortality from surgical treatment options. The current modalities involve ablation [like radiofrequency, cryo or argon plasma coagulation (APC)] and/or resection [endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD)] depending on the type and nature of lesion. These techniques are an effective tool demonstrating high rates of complete eradication of metaplasia or dysplasia (CE-IM/CE-D). It is crucial that the endoscopists are mindful about meticulous examination of the GEJ and Cardia as well as partake in appropriate surveillance post-endoscopic eradication. In addition, appropriate documentation of the location and type of lesion is also extremely important. This review aims to compare current endoscopic techniques in their efficacy, need for expertise and risk of complications when used in the treatment of early junctional lesions. Future studies and guideline recommendations to standardize definitions, diagnoses and post-treatment surveillance are needed.