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대한소화기내시경학회> Clinical Endoscopy> Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis

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Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis

Young Kwon Choi , Jin Hee Noh , Do Hoon Kim , Hee Kyong Na , Ji Yong Ahn , Jeong Hoon Lee , Kee Wook Jung , Kee Don Choi , Ho June Song , Gin Hyug Lee , Hwoon-yong Jung
  • : 대한소화기내시경학회
  • : Clinical Endoscopy 55권3호
  • : 연속간행물
  • : 2022년 05월
  • : 381-389(9pages)
Clinical Endoscopy

DOI


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INTRODUCTION
METHODS
RESULTS
DISCUSSION
Supplementary Material
Conflicts of Interest
Funding
Author Contributions
ORCID
REFERENCES

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Background/Aims: The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis.
Methods: The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed.
Results: ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85).
Conclusions: ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

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간행물정보

  • : 의약학분야  > 내과학
  • : KCI등재
  • : SCOPUS
  • : 격월
  • : 2234-2400
  • : 2234-2443
  • : 학술지
  • : 연속간행물
  • : 2011-2022
  • : 1288


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1Recent developments in small bowel endoscopy: the “black box” is now open!

저자 : Luigina Vanessa Alemanni , Stefano Fabbri , Emanuele Rondonotti , Alessandro Mussetto

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 473-479 (7 pages)

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Over the last few years, capsule endoscopy has been established as a fundamental device in the practicing gastroenterologist's toolbox. Its utilization in diagnostic algorithms for suspected small bowel bleeding, Crohn's disease, and small bowel tumors has been approved by several guidelines. The advent of double-balloon enteroscopy has significantly increased the therapeutic possibilities and release of multiple devices (single-balloon enteroscopy and spiral enteroscopy) aimed at improving the performance of small bowel enteroscopy. Recently, some important innovations have appeared in the small bowel endoscopy scene, providing further improvement to its evolution. Artificial intelligence in capsule endoscopy should increase diagnostic accuracy and reading efficiency, and the introduction of motorized spiral enteroscopy into clinical practice could also improve the therapeutic yield. This review focuses on the most recent studies on artificial-intelligence-assisted capsule endoscopy and motorized spiral enteroscopy.

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2Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice

저자 : Kyeong Ok Kim

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 480-488 (9 pages)

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Endoscopy is vital for diagnosis, assessing treatment response, monitoring and surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

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3Post-polypectomy surveillance: the present and the future

저자 : Masau Sekiguchi , Takahisa Matsuda , Kinichi Hotta , Yutaka Saito

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 489-495 (7 pages)

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An appropriate post-polypectomy surveillance program requires the effectiveness of reducing colorectal cancer and safety. In addition, the post-polypectomy surveillance program should consider the burden of limited medical resource capacity, cost-effectiveness, and patient adherence. In this sense, a risk-stratified surveillance program based on baseline colonoscopy results is ideal. Major international guidelines for post-polypectomy surveillance, such as those from the European Union and the United States, have recommended risk-stratified surveillance programs. Both guidelines have recently been updated to better differentiate between high- and low-risk individuals. In both updated guidelines, more individuals have been downgraded to lower-risk groups that require less frequent or no surveillance. Furthermore, increased attention has been paid to the surveillance of patients who undergo serrated polyp removal. Previous guidelines in Japan did not clearly outline the risk stratification in post-polypectomy surveillance. However, the new colonoscopy screening and surveillance guidelines presented by the Japan Gastroenterological Endoscopy Society include a risk-stratified post-polectomy surveillance program. Further discussion and analysis of unresolved issues in this field, such as the optimal follow-up after the first surveillance, the upper age limit for surveillance, and the ideal method for improving adherence to surveillance guidelines, are warranted.

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4Endoscopic treatment for rectal neuroendocrine tumor: which method is better?

저자 : Seung Min Hong , Dong Hoon Baek

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 496-506 (11 pages)

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Recently, research on rectal neuroendocrine tumors (NETs) has increased during the last few decades. Rectal NETs measuring <10 mm without atypical features and confined to the submucosal layer have only 1% risk of metastasis, and the long-term survival probability of patients without metastasis at the time of diagnosis is approximately 100%. Therefore, the current guidelines suggest endoscopic resection of rectal NETs of <10 mm is regarded as a safe therapeutic option. However, there are currently no clear recommendations for technique selection for endoscopic resection. The choice of treatment modality for rectal NETs should be based on the lesion size, endoscopic characteristics, grade of differentiation, depth of vertical involvement, lymphovascular invasion, and risk of metastasis. Moreover, the complete resection rate, complications, and experience at the center should be considered. Modified endoscopic mucosal resection is the most suitable resection method for rectal NETs of < 10 mm, because it is an effective and safe technique that is relatively simple and less time-consuming compared with endoscopic submucosal dissection. Endoscopic submucosal dissection should be considered when the tumor size is >10 mm, suctioning is not possible due to fibrosis in the lesion, or when the snaring for modified endoscopic mucosal resection does not work well.

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5Endoscopic diagnosis of gastric metastases from malignant melanoma: systematic review

저자 : Helena Campoli Reggiani , Ana Clara Aguiar Pongeluppi , Vitória Froes Miraglia Martins Ferreira , Isadora Pinheiro Felix , Paulo Moacir De Oliveira Campoli

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 507-515 (9 pages)

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Background/Aims: Metastases of malignant melanoma (MM) are rare and associated with poor prognosis. The objective of this study was to analyze the clinical and endoscopic characteristics of gastric metastases of MM by systematically reviewing cases and case series involving patients diagnosed using upper gastrointestinal endoscopy.
Methods: The PubMed and LILACS databases were searched. Reports containing individual patient data were included. Outcomes such as clinical data, endoscopic findings, treatments, and survival were analyzed.
Results: A total of 88 studies with individual data from 113 patients with gastric metastases of MM were included. The primary sites of MM were the skin (62%), eyes (10%), and mucous membranes (6%). Most patients (56%) had multiple metastases in the stomach, located predominantly in the gastric body (approximately 80%). The overall survival rate at 2 years was 4%. There was a significant reduction in the survival of patients with multiple gastric metastases compared to that of patients with single metastasis (hazard ratio, 0.459; 95% confidence interval, 0.235-0.895; p=0.022).
Conclusions: Gastric metastases of MM have a poor prognosis, especially in patients with multiple implants in the stomach. Additional studies are needed to verify whether ocular and mucosal melanomas are associated with a higher risk of gastric metastases than that of cutaneous melanomas.

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6Prevention of stricture after endoscopic submucosal dissection for esophageal cancer: intralesional steroid infusion using a spray tube

저자 : Jong Yeul Lee

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 516-517 (2 pages)

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7Clinical and economic value of bispectral index monitoring for adequate endoscopic sedation

저자 : Se Woo Park

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 518-519 (2 pages)

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8Intralesional steroid infusion using a spray tube to prevent stenosis after endoscopic submucosal dissection of esophageal cancer

저자 : Atsushi Goto , Takeshi Okamoto , Ryo Ogawa , Kouichi Hamabe , Shinichi Hashimoto , Jun Nishikawa , Taro Takami

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 520-524 (5 pages)

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Background/Aims: Intralesional steroid injections have been administered as prophylaxis for stenosis after esophageal endoscopic submucosal dissection. However, this method carries a risk of potential complications such as perforation because a fine needle is used to directly puncture the postoperative ulcer. We devised a new method of steroid intralesional infusion using a spray tube and evaluated its efficacy and safety.
Methods: Intralesional steroid infusion using a spray tube was performed on 27 patients who underwent endoscopic submucosal dissection for superficial esophageal cancer with three-quarters or more of the lumen circumference resected. The presence or absence of stenosis, complications, and the number of endoscopic balloon dilations (EBDs) performed were evaluated after treatment.
Results: Although stenosis was not observed in 22 of the 27 patients, five patients had stenosis and dysphagia requiring EBD. The stenosis in these five patients was relieved after four EBDs. No complications related to intralesional steroid infusion using the spray tube were observed.
Conclusions: Intralesional steroid infusion using a spray tube is a simple and safe technique that is adequately effective in preventing stenosis (clinical trial number, UMIN000037567).

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9Application of a traction metal clip with a fishhook-like device in wound sutures after endoscopic resection

저자 : Wang Fangjun , Leng Xia , Gao Yi , Shen Xiuyun , Wang Wenping , Liu Huamin , Liu Pengfei

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 525-531 (7 pages)

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Background/Aims: Endoscopic wound suturing is an important factor that affects the ability to remove large and full-thickness lesions during endoscopic resection. We aimed to evaluate the effect of a traction metal clip with a fishhook-like device on wound sutures after endoscopic resection.
Methods: From July 2020 to April 2021, patients who met the enrollment criteria were treated with a fishhook-like device during the operation to suture the postoperative wound (group A). Patients with similar conditions and similar size wounds who were treated with a “purse-string suture” to suture the wounds were retrospectively analyzed as the control group (group B). Difference in the suture rate, adverse events, time required for suturing, and number of metal clips were compared between the two groups.
Results: The time required for suturing was 7.72±0.51 minutes in group A and 11.50±0.91 minutes in group B. This difference was statistically significant (F=13.071, p=0.001). The number of metal clamps used in group A averaged 8.1 pieces/case, and the number of metal clamps used in group B averaged 7.3 pieces/case. This difference was not statistically significant (F=0.971, p=0.331).
Conclusions: The traction metal clip with the fishhook-like device is ingeniously designed and easy to operate. It has a good suture effect on the wound after endoscopic submucosal dissection and effectively prevents postoperative adverse events.

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10Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases

저자 : Luca Elli , Erica Centorrino , Andrea Costantino , Maurizio Vecchi , Stefania Orlando , Mirella Fraquelli

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 4호 발행 연도 : 2022 페이지 : pp. 532-539 (8 pages)

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Background/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods: We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results: A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions: CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

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1Quality indicators in esophagogastroduodenoscopy

저자 : Sang Yoon Kim , Jae Myung Park

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 319-331 (13 pages)

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Esophagogastroduodenoscopy (EGD) has been used to diagnose a wide variety of upper gastrointestinal diseases. In particular, EGD is used to screen high-risk subjects of gastric cancer. Quality control of EGD is important because the diagnostic rate is examiner-dependent. However, there is still no representative quality indicator that can be uniformly applied in EGD. There has been growing awareness of the importance of quality control in improving EGD performance. Therefore, we aimed to review the available and emerging quality indicators for diagnostic EGD.

KCI등재SCOUPUS

2Quality indicators in colonoscopy: the chasm between ideal and reality

저자 : Su Bee Park , Jae Myung Cha

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 332-338 (7 pages)

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Continuous measurement of quality indicators (QIs) should be a routine part of colonoscopy, as a wide variation still exists in the performance and quality levels of colonoscopy in Korea. Among the many QIs of colonoscopy, the adenoma detection rate, average withdrawal time, bowel preparation adequacy, and cecal intubation rate should be monitored in daily clinical practice to improve the quality of the procedure. The adenoma detection rate is the best indicator of the quality of colonoscopy; however, it has many limitations for universal use in daily practice. With the development of natural language processing, the adenoma detection rate is expected to become more effective and useful. It is important that colonoscopists do not strictly and mechanically maintain an average withdrawal time of 6 minutes but instead perform careful colonoscopy to maximally expose the colonic mucosa with a withdrawal time of at least 6 minutes. To achieve adequate bowel preparation, documentation of bowel preparation with the Boston Bowel Preparation Scale (BBPS) should be a routine part of colonoscopy. When colonoscopists routinely followed the bowel preparation protocols, ≥85% of outpatient screening colonoscopies had a BBPS score of ≥6. In addition, the cecal intubation rate should be ≥95% of all screening colonoscopies. The first step in improving colonoscopy quality in Korea is to apply these key performance measurements in clinical practice.

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3Endoscopic clipping in non-variceal upper gastrointestinal bleeding treatment

저자 : Giuseppe Galloro , Angelo Zullo , Gaetano Luglio , Alessia Chini , Donato Alessandro Telesca , Rosa Maione , Matteo Pollastro , Giovanni Domenico De Palma , Raffaele Manta

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 339-346 (8 pages)

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Since the earliest reports, advanced clipping systems have been developed, and it is possible to choose among many models with different structural and technical features. The main drawback of through-the-scope clips is their small size, which allows the compression of limited amounts of tissue needed for large-size vessel treatment. Therefore, the over-the-scope clip system was realized, allowing a larger and stronger mechanical compression of large tissue areas, with excellent results in achieving a definitive hemostasis in difficult cases. Many studies have analyzed the indications and efficacy of two-pronged endoclips and have shown good results for initial and permanent hemostasis. The aim of this review was to provide updated information on indications, positioning techniques, and results of clip application for endoscopic treatment of upper gastrointestinal non-variceal bleeding lesions.

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4Comparing palliative treatment options for cholangiocarcinoma: photodynamic therapy vs. radiofrequency ablation

저자 : Tayyaba Mohammad , Michel Kahaleh

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 347-354 (8 pages)

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Referral to an endoscopist is often done once curative resection is no longer an option for cholangiocarcinoma management. In such cases, palliation has become the main objective of the treatment. Photodynamic therapy and radiofrequency ablation can be performed to achieve palliation, with both procedures associated with improved stent patency and survival. Despite the greatly increased cost and association with photosensitivity, photodynamic therapy allows transmission to the entire biliary tree. In contrast, radiofrequency ablation is cheaper and faster to apply, but requires intraductal contact. This paper reviews both modalities and compares their efficacy and safety for bile duct cancer palliation.

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5Does computer-aided diagnostic endoscopy improve the detection of commonly missed polyps? A meta-analysis

저자 : Arun Sivananthan , Scarlet Nazarian , Lakshmana Ayaru , Kinesh Patel , Hutan Ashrafian , Ara Darzi , Nisha Patel

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 355-364 (10 pages)

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Background/Aims: Colonoscopy is the gold standard diagnostic method for colorectal neoplasia, allowing detection and resection of adenomatous polyps; however, significant proportions of adenomas are missed. Computer-aided detection (CADe) systems in endoscopy are currently available to help identify lesions. Diminutive (≤5 mm) and nonpedunculated polyps are most commonly missed. This meta-analysis aimed to assess whether CADe systems can improve the real-time detection of these commonly missed lesions.
Methods: A comprehensive literature search was performed. Randomized controlled trials evaluating CADe systems categorized by morphology and lesion size were included. The mean number of polyps and adenomas per patient was derived. Independent proportions and their differences were calculated using DerSimonian and Laird random-effects modeling.
Results: Seven studies, including 2,595 CADe-assisted colonoscopies and 2,622 conventional colonoscopies, were analyzed. CADe-assisted colonoscopy demonstrated an 80% increase in the mean number of diminutive adenomas detected per patient compared with conventional colonoscopy (0.31 vs. 0.17; effect size, 0.13; 95% confidence interval [CI], 0.09-0.18); it also demonstrated a 91.7% increase in the mean number of nonpedunculated adenomas detected per patient (0.32 vs. 0.19; effect size, 0.05; 95% CI, 0.02-0.07).
Conclusions: CADe-assisted endoscopy significantly improved the detection of most commonly missed adenomas. Although this method is a potentially exciting technology, limitations still apply to current data, prompting the need for further real-time studies.

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6Lessons learned in clinical epidemiology of esophageal adenocarcinoma

저자 : Hye Kyung Jung

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 365-366 (2 pages)

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7A new band ligation device to treat colonic diverticular bleeding

저자 : Yunho Jung

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 367-368 (2 pages)

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8Covered self-expandable metal stents for distal biliary obstruction from pancreatic carcinoma: what type of stent is preferred?

저자 : Hideyuki Shiomi , Ryota Nakano , Shogo Ota

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 369-371 (3 pages)

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9Epidemiology of early esophageal adenocarcinoma

저자 : Thuy-van P. Hang , Zachary Spiritos , Anthony M. Gamboa , Zhengjia Chen , Seth Force , Vaishali Patel , Saurabh Chawla , Steven Keilin , Nabil F. Saba , Bassel El-rayes , Qiang Cai , Field F. Willingham

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 372-380 (9 pages)

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Background/Aims: Endoscopic resection has become the preferred treatment approach for select early esophageal adenocarcinoma (EAC); however, the epidemiology of early stage disease has not been well defined.
Methods: Surveillance Epidemiology and End Results (SEER) data were analyzed to determine age-adjusted incidence rates among major epithelial carcinomas, including EAC, from 1973 to 2017. The percent change in incidence over time was compared according to tumor subtype. Early T-stage, node-negative EAC without metastasis was examined from 2004 to 2017 when precise T-stage data were available.
Results: The percent change in annual incidence from 1973 to 2017 was 767% for EAC. Joinpoint analysis showed that the average annual percent change in EAC from 1973 to 2017 was 5.11% (95% confidence interval, 4.66%-5.56%). The annual percent change appeared to plateau between 2004 and 2017; however, early EAC decreased from 2010 to 2017, with an annual percent change of -5.78%.
Conclusions: There has been a 7-fold increase in the incidence of EAC, which was significantly greater than that of the other major epithelial malignancies examined. More recently, the incidence of early EAC has been decreasing. Approximately one in five patients has node negative, potentially resectable early stage disease.

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10Outcomes of endoscopic submucosal dissection for superficial esophageal neoplasms in patients with liver cirrhosis

저자 : Young Kwon Choi , Jin Hee Noh , Do Hoon Kim , Hee Kyong Na , Ji Yong Ahn , Jeong Hoon Lee , Kee Wook Jung , Kee Don Choi , Ho June Song , Gin Hyug Lee , Hwoon-yong Jung

발행기관 : 대한소화기내시경학회 간행물 : Clinical Endoscopy 55권 3호 발행 연도 : 2022 페이지 : pp. 381-389 (9 pages)

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Background/Aims: The treatment of superficial esophageal neoplasms (SENs) in cirrhotic patients is challenging and rarely investigated. We evaluated the outcomes of endoscopic submucosal dissection (ESD) to determine the efficacy and safety of treating SENs in patients with liver cirrhosis.
Methods: The baseline characteristics and treatment outcomes of patients who underwent ESD for SENs between November 2005 and December 2017 were retrospectively reviewed.
Results: ESD was performed in 437 patients with 481 SENs, including 15 cirrhotic patients with 17 SENs. En bloc resection (88.2% vs. 97.0%) and curative resection (64.7% vs. 78.9%) rates were not different between the cirrhosis and non-cirrhosis groups (p=0.105 and p=0.224, respectively). Bleeding was more common in cirrhotic patients (p=0.054), and all cases were successfully controlled endoscopically. The median procedure and hospitalization duration did not differ between the groups. Overall survival was lower in cirrhotic patients (p=0.003), while disease-specific survival did not differ between the groups (p=0.85).
Conclusions: ESD could be a safe and effective treatment option for SENs in patients with cirrhosis. Detailed preprocedural assessments are needed, including determination of liver function, esophageal varix status, and remaining life expectancy, to identify patients who will obtain the greatest benefit.

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자료제공: 네이버학술정보
발행기관 최신논문
자료제공: 네이버학술정보

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