Entity

Time filter

Source Type


Okada K.,Cancer Institute Hospital | Okada K.,Yokohama City University | Yamamoto Y.,Cancer Institute Hospital | Yamamoto Y.,Cancer Institute Ariake Hospital of Japanese Foundation for Cancer Research | And 11 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2011

Background: Delayed bleeding is one of the major complications of endoscopic submucosal dissection (ESD). The aim of this study is to determine the incidence rate and clinical factors associated with delayed bleedinģ as well as the time interval between bleeding and ESD for gastric neoplasm. Methods: We investigated 647 lesions in 582 consecutive patients undergoing ESD for gastric neoplasm. Results: Delayed bleeding after ESD was evident in all 28 lesions from 28 patients (4.33% of all specimens, 4.81% of patients), and all achieved endoscopic hemostasis. Resected specimen width (≤40 mm) was the only significant factor associated with delayed bleeding on univariate and multivariate analysis. In early delayed bleeding (bleeding occurring on or before the fourth postoperative day), wide resected specimen and tumor location in the lower third of the stomach were significant risk factors. In late delayed bleeding (bleeding occurring after the fifth operative day), wide resected specimen, tumor location in the middle third of the stomach, hypertension, and high body mass index (≤25 kg/m 2) were significant factors. Delayed bleeding in patients with tumors in the upper and middle third of the stomach (median 8.0 days; range 1-20 days) occurred significantly later as compared with patients who had tumors in the lower third (median 2.0 days; range 1-34 days). Conclusions: Risk factors for delayed bleeding, and the probable underlying mechanism involved, differed depending on the time elapsed between surgery and the bleeding episode. © 2010 Springer Science+Business Media, LLC.


Okada K.,Cancer Institute Ariake Hospital of Japanese Foundation for Cancer Research | Fujisaki J.,Cancer Institute Ariake Hospital of Japanese Foundation for Cancer Research | Kasuga A.,Cancer Institute Ariake Hospital of Japanese Foundation for Cancer Research | Omae M.,Cancer Institute Ariake Hospital of Japanese Foundation for Cancer Research | And 8 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2011

Background: Endoscopic ultrasonography (EUS) has become a reliable method for predicting the invasion depth of early gastric cancer (EGC). This study evaluated the accuracy of EUS in identifying lesions meeting expanded-indication criteria for endoscopic submucosal dissection (ESD) and analyzed clinicopathologic factors influencing the diagnostic accuracy of EUS in assessing tumor invasion depth. Methods: This study investigated 542 EGCs of 515 patients who underwent EUS pretreatment. The pretreatment EUS-determined diagnosis was compared with the final histopathologic evaluation of resected specimens, and the impact of various clinicopathologic parameters on diagnostic accuracy was analyzed. Results: The diagnostic accuracy of EUS in identifying lesions meeting expanded-indication criteria for ESD was 87.8% (259/295) for differentiated adenocarcinoma (D-type) 30 mm in diameter or smaller, 43.5% (10/23) for D-type tumor larger than 30 mm in diameter, and 75% (42/56) for undifferentiated adenocarcinoma (UD-type) 20 mm in diameter or smaller. Using multivariate analysis, the diagnostic accuracy of EUS in predicting tumor invasion depth was determined to be decreased significantly by ulcerous change and large tumor size (diameter, ≥30 mm). Conclusion: For patients with EGC, D-type lesions 30 mm in diameter or smaller and UD-type lesions 20 mm in diameter or smaller can be diagnosed with high accuracy by EUS, but larger D-type lesions (diameter, >30 mm) should be considered carefully in terms of EUS-based treatment decisions. Findings of ulceration and large tumors are associated with incorrect diagnosis of tumor invasion depth by EUS. © 2010 Springer Science+Business Media, LLC.

Discover hidden collaborations