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Can endoscopic submucosal dissection be safely performed in a smaller specialized clinic?
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2013 Jan 28; Vol. 19 (4), pp. 528-35. - Publication Year :
- 2013
-
Abstract
- Aim: To investigate whether endoscopic submucosal dissection (ESD) can be safely performed at small clinics, such as the Shirakawa Clinic.<br />Methods: One thousand forty-seven ESDs to treat gastrointestinal tumors were performed at the Shirakawa Clinic from April 2006 to March 2011. The efficacy, technical feasibility and associated complications of the procedures were assessed. The ESD procedures were performed by five endoscopists. Sedation was induced with propofol for esophagogastorduodenal ESD.<br />Results: One thousand forty-seven ESDs were performed to treat 64 patients with esophageal cancer (E), 850 patients with gastric tumors (G: 764 patients with cancer, 82 patients with adenomas and four others), four patients with duodenal cancer (D) and 129 patients with colorectal tumors (C: 94 patients with cancer, 21 patients with adenomas and 14 others). The en bloc resection rate was 94.3% (E: 96.9%, G: 95.8%, D: 100%, C: 79.8%). The median operation time was 46 min (range: 4-360 min) and the mean size of the resected specimens was 18 mm (range: 2-150 mm). No mortal complications were observed in association with the ESD procedures. Perforation occurred in 12 cases (1.1%, E: 1 case, G: 9 cases, D: 1 case, C: 1 case) and postoperative bleeding occurred in 53 cases (5.1%, G: 51 cases, D: 1 case, C: 1 case); however, no case required either emergency surgery or blood transfusion. All of the perforations and postperative bleedings were resolved by endoscopic clipping or hemostasis. The other problematic complication observed was pneumonia, which was treated with conservative therapy.<br />Conclusion: ESD can be safely performed in a clinic with established therapeutic methods and medical services to address potential complications.
- Subjects :
- Adult
Aged
Aged, 80 and over
Dissection adverse effects
Feasibility Studies
Female
Gastrointestinal Neoplasms pathology
Humans
Hypnotics and Sedatives therapeutic use
Japan
Male
Middle Aged
Patient Selection
Postoperative Complications etiology
Postoperative Complications therapy
Propofol therapeutic use
Risk Assessment
Risk Factors
Treatment Outcome
Ambulatory Care Facilities
Dissection methods
Endoscopy, Gastrointestinal adverse effects
Gastrointestinal Neoplasms surgery
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 19
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 23382632
- Full Text :
- https://doi.org/10.3748/wjg.v19.i4.528