Clinical Endoscopy

Improved visibility of palisade vessels within Barrett’s esophagus using red dichromatic imaging: a retrospective cross-sectional study in Japan: Chise Ueda, Shinwa Tanaka, Tetsuya Yoshizaki, Hirofumi Abe, Masato Kinoshita, Hiroya Sakaguchi, Hiroshi Takayama, Hitomi Hori, Ryosuke Ishida, Shinya Houki, Hiroshi Tanabe, Eri Nishikawa, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Takashi Toyonaga, Yuzo Kodama; Received May 13, 2024 Accepted August 8, 2024 Published online November 11, 2024; DOI: https://doi.org/10.5946/ce.2024.122 [Epub ahead of print]

Graphical Abstract Abstract PDF PubReader ePub: Background
/Aims: Visualization of palisade vessels (PVs) in Barrett’s esophagus is crucial for proper assessment. This study aimed to determine whether red dichromatic imaging (RDI) improves PV visibility compared with white-light imaging (WLI) and narrow-band imaging (NBI).
Methods
Five expert and trainee endoscopists evaluated the PV visibility in Barrett’s esophagus using WLI, NBI, and RDI on 66 images from 22 patients. Visibility was rated on a 4-point scale: 4, excellent; 3, good; 2, fair; and 1, poor. The color difference between the most recognizable PV spots and surrounding areas with undetectable blood vessels was also analyzed.
Results
Mean visibility scores were 2.6±0.7, 2.3±0.6, and 3.4±0.4 for WLI, NBI, and RDI, respectively. The RDI scores were significantly higher than the WLI (p<0.001) and NBI (p<0.001) scores. These differences were recognized by trainees and expert endoscopists. Color differences in PVs were 7.74±4.96 (WLI), 10.43±5.09 (NBI), and 15.1±6.54 (RDI). The difference in RDI was significantly higher than that in WLI (p<0.001) and NBI (p=0.006).
Conclusions
RDI significantly improved PV visibility compared to WLI and NBI based on objective and subjective measures.

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Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum: Nobuaki Ikezawa, Takashi Toyonaga, Shinwa Tanaka, Tetsuya Yoshizaki, Toshitatsu Takao, Hirofumi Abe, Hiroya Sakaguchi, Kazunori Tsuda, Satoshi Urakami, Tatsuya Nakai, Taku Harada, Kou Miura, Takahisa Yamasaki, Stuart Kostalas, Yoshinori Morita, Yuzo Kodama; Clin Endosc 2022;55(3):417-425. Published online May 12, 2022; DOI: https://doi.org/10.5946/ce.2021.245

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD.
Methods
D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed.
Results
The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively.
Conclusions
D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.

Citations

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Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy: Kei Matsumoto, Shinwa Tanaka, Takashi Toyonaga, Nobuaki Ikezawa, Mari Nishio, Masanao Uraoka, Tomoatsu Yoshihara, Hiroya Sakaguchi, Hirofumi Abe, Tetsuya Yoshizaki, Madoka Takao, Toshitatsu Takao, Yoshinori Morita, Hiroshi Yokozaki, Yuzo Kodama; Clin Endosc 2022;55(1):86-94. Published online August 13, 2021; DOI: https://doi.org/10.5946/ce.2021.084

Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site.
Methods
We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups.
Results
The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group.
Conclusions
Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.

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