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A feasibility study of chemically assisted endoscopic submucosal mechanical dissection using mesna for superficial esophageal squamous cell carcinomas

Abstract

Background

Injection of mesna into submucosal layers was recently reported to chemically soften connective tissue and facilitate the gastric endoscopic submucosal dissection (ESD) procedure. This study aimed to evaluate the safety and feasibility of similarly using mesna for esophageal ESD (mesna ESD).

Methods

We performed mesna ESD in 20 consecutive patients with superficial esophageal squamous cell carcinomas (SESCCs). To do this, a submucosal fluid cushion was initially formed using sodium hyaluronate, and the esophageal lesion was circumferentially isolated with a short blade needle-knife. Mesna solution was then injected into the submucosal layer, which was dissected mechanically by cleavage using the tip of a cap-fitted endoscope. The number of electrosurgical incisions was recorded by computer software in real time. The data from 20 conventional ESD procedures without mesna (consecutive 10 SESCCs pre and post the 20 consecutive mesna ESD) were used for comparison to evaluate the mesna ESD.

Results

The mesna ESDs achieved en bloc and R0 resection success rates of 100 and 95 %, respectively. There was no perforation or uncontrollable hemorrhage during and after mesna ESD, and the median procedural time of submucosal dissection was significantly less with mesna ESD than with conventional ESD (median; 8 vs. 15 min, P < 0.05). There were also significantly fewer electrosurgical incisions made during the mesna ESD than with conventional ESDs (median; 65 vs. 183 times, P < 0.01).

Conclusions

Mesna ESD for SESCCs is a safe procedure with the potential to facilitate esophageal ESD.

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Abbreviations

ESD:

Endoscopic submucosal dissection

SESCC:

Superficial esophageal squamous cell carcinoma

EMR:

Endoscopic mucosal resection

SCC:

Squamous cell carcinoma

HGIN:

High-grade intraepithelial neoplasia

NBI:

Narrow band imaging

EP:

Intraepithelium

LPM:

Lamina propria mucosae

MM:

Muscularis mucosae

SM:

Submucosae

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Acknowledgments

A part of this paper was presented as a video poster at United European Gastroenterology Week, 12-16th October 2013, Berlin, Germany.

Disclosures

Drs. Akira Dobashi, Kenichi Goda, Kazuki Sumiyama, Masakuni Kobayashi, Tomohiko R Ohya, Masayuki Kato, Hirobumi Toyoizumi, Tomohiro Kato, Masato Matsushima, and Hisao Tajiri have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Akira Dobashi.

Electronic supplementary material

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The procedural steps of mesna ESD with mechanical submucosal dissection. (WMV 47662 kb)

The procedural steps of mesna ESD with mechanical submucosal dissection. (WMV 47662 kb)

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Dobashi, A., Goda, K., Sumiyama, K. et al. A feasibility study of chemically assisted endoscopic submucosal mechanical dissection using mesna for superficial esophageal squamous cell carcinomas. Surg Endosc 29, 3373–3381 (2015) doi:10.1007/s00464-014-4031-7

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Keywords

  • Endoscopic resection
  • Endoscopic submucosal dissection
  • Mechanical submucosal dissection
  • Mesna
  • Superficial esophageal squamous cell carcinoma