Skip to main content

Advertisement

SpringerLink
Log in

The relationship between the esophageal endoscopic submucosal dissection technical difficulty and its intraoperative process

  • Original Article
  • Published:
Esophagus Aims and scope Submit manuscript

Abstract

Background

Estimating the esophageal endoscopic submucosal dissection (ESD) technical difficulty is important to reduce complications. Endoscopic duration is one of the related factors to a technical difficulty. The relationship between the esophageal ESD technical difficulty and its intraoperative process was analyzed as a first step toward automatic technical difficulty recognition using artificial intelligence.

Methods

This study enrolled 75 patients with superficial esophageal cancer who underwent esophageal ESD. The technical difficulty score was established, which consisted of three factors, including total procedure duration, en bloc resection, and complications. Additionally, technical difficulty-related factors, which were perioperative factors that included the intraoperative process, were investigated.

Results

Eight (11%) patients were allocated to high difficulty, whereas 67 patients (89%) were allocated to low difficulty. The intraoperative process, which was shown as the extension of each endoscopic phase, was significantly related to a technical difficulty. The area under the curve (AUC) values were higher at all the phase duration than at the clinical characteristics. Submucosal dissection phase (AUC 0.902; 95% confidence intervals (CI) 0.752–1.000), marking phase (AUC 0.827; 95% CI 0.703–0.951), and early phase which was defined as the duration from the start of marking to the end of submucosal injection (AUC 0.847; 95% CI 0.701–0.992) were significantly related to technical difficulty.

Conclusions

The intraoperative process, particularly early phase, was strongly associated with esophageal ESD technical difficulty. This study demonstrated the potential for automatic evaluation of esophageal ESD technical difficulty when combined with an AI-based automatic phase evaluation system.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability statement

The datasets generated and analyzed in this study are available from the corresponding author upon reasonable request.

References

  1. Oyama T, Tomori A, Hotta K, Morita S, Kominato K, Tanaka M, et al. Endoscopic submucosal dissection of early esophageal cancer. Clin Gastroenterol Hepatol. 2005;3:S67–70.

    Article  PubMed  Google Scholar 

  2. Guo HM, Zhang XQ, Chen M, Huang SL, Zou XP. Endoscopic submucosal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol. 2014;20:5540–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Takahashi H, Arimura Y, Masao H, Okahara S, Tanuma T, Kodaira J, et al. Endoscopic submucosal dissection is superior to conventional endoscopic resection as a curative treatment for early squamous cell carcinoma of the esophagus (with video). Gastrointest Endosc. 2010;72:255–64.

    Article  PubMed  Google Scholar 

  4. Ishihara R, Arima M, Iizuka T, Oyama T, Katada C, Kato M, et al. Endoscopic submucosal dissection/endoscopic mucosal resection guidelines for esophageal cancer. Dig Endosc. 2020;32:452–93.

    Article  PubMed  Google Scholar 

  5. Hong KH, Shin SJ, Kim JH. Learning curve for endoscopic submucosal dissection of gastric neoplasms. Eur J Gastroenterol Hepatol. 2014;26:949–54.

    Article  PubMed  Google Scholar 

  6. Yang G, Mu Z, Pu K, Chen Y, Zhang L, Zhou H, et al. A reliable nomogram model for predicting esophageal stricture after endoscopic submucosal dissection. Medicine (Baltim). 2022;101: e28741.

    Article  Google Scholar 

  7. Mitsui T, Kadota T, Wakabayashi M, Nakajo K, Shinmura K, Sunakawa H, et al. Factors of technical difficulty in conventional and traction-assisted esophageal endoscopic submucosal dissection. Esophagus. 2022;19:452–9.

    Article  PubMed  Google Scholar 

  8. Takeuchi M, Collins T, Ndagijimana A, Kawakubo H, Kitagawa Y, Marescaux J, et al. Automatic surgical phase recognition in laparoscopic inguinal hernia repair with artificial intelligence. Hernia. 2022;26:1669–78.

    Article  CAS  PubMed  Google Scholar 

  9. An P, Yang D, Wang J, Wu L, Zhou J, Zeng Z, et al. A deep learning method for delineating early gastric cancer resection margin under chromoendoscopy and white light endoscopy. Gastric Cancer. 2020;23:884–92.

    Article  PubMed  Google Scholar 

  10. van Rutte P, Nienhuijs SW, Jakimowicz JJ, van Montfort G. Identification of technical errors and hazard zones in sleeve gastrectomy using OCHRA: “OCHRA for sleeve gastrectomy.” Surg Endosc. 2017;31:561–6.

    Article  PubMed  Google Scholar 

  11. Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al. Transanal total mesorectal excision: international registry results of the first 720 cases. Ann Surg. 2017;266:111–7.

    Article  PubMed  Google Scholar 

  12. Celentano V, Smart N, McGrath J, Cahill RA, Spinelli A, Obermair A, et al. LAP-VEGaS practice guidelines for reporting of educational videos in laparoscopic surgery: a joint trainers and trainees consensus statement. Ann Surg. 2018;268:920–6.

    Article  PubMed  Google Scholar 

  13. Rice TW, Ishwaran H, Ferguson MK, Blackstone EH, Goldstraw P. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol. 2017;12:36–42.

    Article  PubMed  Google Scholar 

  14. Tsuji K, Yoshida N, Nakanishi H, Takemura K, Yamada S, Doyama H. Recent traction methods for endoscopic submucosal dissection. World J Gastroenterol. 2016;22:5917–26.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mizuta H, Nishimori I, Kuratani Y, Higashidani Y, Kohsaki T, Onishi S. Predictive factors for esophageal stenosis after endoscopic submucosal dissection for superficial esophageal cancer. Dis Esophagus. 2009;22:626–31.

    Article  CAS  PubMed  Google Scholar 

  16. Nakamura R, Omori T, Takeuchi H, Kawakubo H, Takahashi T, Wada N, et al. Salvage endoscopic resection as a treatment for locoregional failure or recurrence following chemoradiotherapy or radiotherapy for esophageal cancer. Oncol Lett. 2016;11:3631–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Ono S, Fujishiro M, Niimi K, Goto O, Kodashima S, Yamamichi N, et al. Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial squamous cell neoplasms. Endoscopy. 2009;41:661–5.

    Article  CAS  PubMed  Google Scholar 

  18. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, et al. Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol. 2006;4:688–94.

    Article  PubMed  Google Scholar 

  19. Hazama H, Tanaka M, Kakushima N, Yabuuchi Y, Yoshida M, Kawata N, et al. Predictors of technical difficulty during endoscopic submucosal dissection of superficial esophageal cancer. Surg Endosc. 2019;33:2909–15.

    Article  PubMed  Google Scholar 

  20. Yoshida M, Takizawa K, Nonaka S, Shichijo S, Suzuki S, Sato C, et al. Conventional versus traction-assisted endoscopic submucosal dissection for large esophageal cancers: a multicenter, randomized controlled trial (with video). Gastrointest Endosc. 2020;91:55-65.e52.

    Article  PubMed  Google Scholar 

  21. Noguchi M, Yano T, Kato T, Kadota T, Imajoh M, Morimoto H, et al. Risk factors for intraoperative perforation during endoscopic submucosal dissection of superficial esophageal squamous cell carcinoma. World J Gastroenterol. 2017;23:478–85.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ge PS, Thompson CC, Jirapinyo P, Aihara H. Suture pulley countertraction method reduces procedure time and technical demand of endoscopic submucosal dissection among novice endoscopists learning endoscopic submucosal dissection: a prospective randomized ex vivo study. Gastrointest Endosc. 2019;89:177–84.

    Article  PubMed  Google Scholar 

  23. Hashimoto DA, Axelsson CG, Jones CB, Phitayakorn R, Petrusa E, Mckinley SK, et al. Surgical procedural map scoring for decision-making in laparoscopic cholecystectomy. Am J Surg. 2019;217:356–61.

    Article  PubMed  Google Scholar 

  24. Kitaguchi D, Takeshita N, Matsuzaki H, Hasegawa H, Igaki T, Oda T, et al. Deep learning-based automatic surgical step recognition in intraoperative videos for transanal total mesorectal excision. Surg Endosc. 2022;36:1143–51.

    Article  PubMed  Google Scholar 

  25. Takeuchi M, Kawakubo H, Saito K, Maeda Y, Matsuda S, Fukuda K, et al. Automated surgical phase recognition for robot-assisted minimally invasive esophagectomy using artificial intelligence. Ann Surg Oncol. 2022;29:6847–55.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We wish to thank Kumiko Motooka, a staff member at the Department of Surgery in Keio University School of Medicine, for her help with the preparation of this manuscript.

Funding

Author Y.K received lecture fees from Chugai Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd., Asahi Kasei Pharma Corporation, Otsuka Pharmaceutical Factory Inc., Shionogi & Co., Ltd., Nippon Covidien Inc., Ethicon, Inc., Ono Pharmaceutical Co., Ltd., Olympus Corporation, Bristol-Myers Squibb K.K., AstraZeneca K.K., MSD K.K., Smith & Nephew KK, KAKEN PHARMACEUTICAL CO.,LTD., ASKA Pharmaceutical Co., Ltd. Author Y.K was supported by grants from Takeda Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd., Yakult Honsha Co. Ltd., Asahi Kasei Pharma Corporation, Otsuka Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Tsumura & Co., Kyouwa Hakkou Kirin Co., Ltd., Dainippon Sumitomo Pharma Co., Ltd., EA Pharma Co., Ltd., Medicon Inc., Kaken Pharmaceutical Co. Ltd., Eisai Co., Ltd., Otsuka Pharmaceutical Factory Inc., Teijin Pharma Limited, Nihon Pharmaceutical Co., Ltd., and Nippon Covidien Inc. Author Y.K held an endowed chair provided by Ono Pharmaceutical Co., Ltd., Bristol-Myers Squibb, outside the submitted work.

Author information

Author notes

  1. Tasuku Furube and Masashi Takeuchi have contributed equally to this article.

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Tasuku Furube, Masashi Takeuchi, Hirofumi Kawakubo, Yusuke Maeda, Satoru Matsuda, Kazumasa Fukuda, Rieko Nakamura & Yuko Kitagawa

Authors
  1. Tasuku Furube
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masashi Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hirofumi Kawakubo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yusuke Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoru Matsuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazumasa Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rieko Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuko Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hirofumi Kawakubo.

Ethics declarations

Ethical Statement

This study was approved by the Ethics Committee of Keio University School of Medicine (approval number: 20150044) and performed according to the Declaration of Helsinki.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Furube, T., Takeuchi, M., Kawakubo, H. et al. The relationship between the esophageal endoscopic submucosal dissection technical difficulty and its intraoperative process. Esophagus 20, 264–271 (2023). https://doi.org/10.1007/s10388-022-00974-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10388-022-00974-x

Keywords

Search

Navigation