";s:4:"text";s:6480:"Endoscopic submucosal dissection was developed in Japan, early in this century, to provide a minimally invasive yet curative treatment for the large numbers of patients with early gastric cancer identified by the national screening program. The Surveillance, Epidemiology, and End Results (SEER) Program estimated that 45,780 new cases of oral cavity and pharyngeal cancer would occur in the United States in 2015, making up 2. A resection margin or surgical margin is the margin of apparently non-tumorous tissue around a tumor that has been surgically removed, called "resected", in surgical oncology.The resection is an attempt to remove a cancer tumor so that no portion of the malignant growth extends past the edges or margin of the removed tumor and surrounding tissue. ESD: Endoscopic submucosal dissection; EMR: Endoscopic mucosal resection. A previous study also showed that patients who underwent ESD had lower medical costs than those who underwent surgery, although the data were of patients with early gastric cancerThe current study had some limitations.
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Median follow-up duration was 24.5 (15-53.75) mo, and the 1-year follow up rate was 81.0% (115/142). The results of the current study showed that a shorter procedure time for EMR than for ESD reduces the cost of medical staff, including the operator for the endoscopic procedure, assistant for manipulating the device, and assistant for monitoring patients. Although ESD tended to result in a higher complete resection rate than did EMR, ESD was a significantly longer procedure and required longer hospital stay with a tendency of having a higher adverse event rate. For example, lesions with a positive nonlifting sign or large cancerous lesions that must be removed en bloc for accurate histopathological examination can be resected only by ESD. The selection of endoscopic treatments for superficial non-ampullary duodenal epithelial tumors (SNADETs) is controversial.To compare the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for SNADETs.We retrospectively analyzed the data of patients with SNADETs from a database of endoscopic treatment for SNADETs, which included eight hospitals in Fukuoka, Japan, between April 2001 and October 2017. Therefore, although ESD was more effective than EMR, all SNADETs cannot be treated with ESD because of the possible risk of adverse events and higher cost of hospitalization.ESD for duodenal tumors achieved higher curability rates with a higher adverse event risk than EMRPrevious reports suggested that duodenal tumors < 20 mm in size should be treated with EMR and not ESDESD resulted in an extremely high curability rate in the current study; the Duodenal ESD is difficult to perform because the duodenum has a very thin wall ( < 2 mm thickness) with limited space surrounding the duodenum, and therefore, the maneuverability around the space is limited, possibly resulting in a higher risk of perforation than ESD for lesions in the rest of the gastrointestinal tractThe time taken for the procedure and the hospital stay were significantly shorter in patients who underwent EMR than in those who underwent ESD. Corresponding Author of This Article
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2012;27(4):728-733. Publishing Process of This Article
A: Injection into the submucosal layer; B: Snaring of the lesion; C: Mucosal defect after endoscopic submucosal dissection; and D: Clip closure of mucosal defect.
The EMR group had significantly shorter procedure time and hospital stay than the ESD group.
Clin Endosc. Abdominoperineal resection with intersphincteric dissection (APE + ID) Depending on personal experience, the stapler is fired without cutting the intestine, or the staple is fired and the bowel cut and the tumour-bearing bowel specimen removed. Therefore, EMR should preferably be selected as a local treatment for SNADETs, especially for adenomas, mucosal lesions, and small lesions.Endoscopic treatments have been used as local treatments for superficial non-ampullary duodenal epithelial tumors (SNADETs) instead of surgery.It remains to be determined whether endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is more appropriate for treating SNADETs.The aim of this multi-center retrospective study was to compare the treatment outcomes of EMR and ESD for SNADETs.Patients with SNADETs treated by EMR or ESD at eight institutions between April 2001 and October 2017.
Moreover, the low rate of adverse events might result in shorter hospitalization, thereby contributing to the cost of hospital stay. Therefore, the differences in the effectiveness and safety between EMR and ESD are unclear for SNADETs. Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Eikichi Ihara, MD, PhD, Associate Professor, Department of Gastroenterology and Metabolism, Graduate School of Medicine Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 8128582, Japan. Continuous variables that were distributed abnormally were presented as the median and interquartile range.
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The decision to perform one operation over the other is based primarily on the tumor location in relation to the sphincter complex. In addition, the endo-knife used during ESD with hemostatic forceps is much more expensive than the snare used during EMR. The characteristics of patients between the two groups were similar after matching. All patients treated The procedure for EMR has been previously described in detailThe procedure for ESD has been previously described in detailMucosal defects in most cases, including those with intraoperative perforations, were closed after endoscopic resection, including EMR and ESD, After removal, EMR/ESD specimens were fixed in 10% formalin. The study protocol was performed in accordance with the 2008 revision of the Declaration of Helsinki and was approved by the Institutional Review Board of all eight centers. BPG is committed to discovery and dissemination of knowledge
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