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FOCUS ON. ORIGINAL ARTICLE Endoscopic submucosal dissection as minimally invasive treatment for superficial pharyngeal cancer: a phase II study (with video) Noboru Hanaoka, MD, Ryu Ishihara, MD, Yoji Takeuchi, MD, Motoyuki Suzuki, MD, Shinji Otozai, MD, Kota Kida, MD, Tadashi Yoshii, MD, Takashi Fujii, MD, Kunitoshi Yoshino, MD, Toshimitsu Sugawa, MD, Koji Kitamura, MD, Ryo Kanemura, MD, Ryosuke Koike, MD, Noriya Uedo, MD, Koji Higashino, MD, Tomofumi Akasaka, MD, Takeshi Yamashina, MD, Takashi Kanesaka, MD, Noriko Matsuura, MD, Kenji Aoi, MD, Yasushi Yamasaki, MD, Kenta Hamada, MD, Hiroyasu Iishi, MD, Yasuhiko Tomita, MD Although endoscopic submucosal dissection (ESD) has been applied for superficial pharyngeal cancer, no prospective trials have been reported. To investigate the efficacy and safety of ESD for superficial pharyngeal cancer, the authors conducted a prospective phase II trial. Fifty-four patients with 73 lesions were enrolled from September 2010 to August 2014, and ESD was performed. The primary endpoint was the complete resection rate. Secondary endpoints were safety, recurrence-free survival, overall survival, and incidence of metachronous pharyngeal cancer. Fifty-four patients had stage 0-III cancer: stage 0, n Z 22; stage I, n Z 14; stage II, n Z 17; and stage III, n Z 1. The en bloc resection rate was 100%, and the complete resection rate was 79.5% (58/73 lesions; 95% confidence interval, 68%-88%). No serious adverse events related to ESD were encountered. Four patients required nasogastric intubation and feeding. No patients required percutaneous endoscopic gastrostomy and tracheotomy. Swallowing, speech, and airway functions were preserved in all patients. One of the 54 patients died of an unrelated illness. Median follow-up was 27 months (range 6-55 months). Local cervical lymph node metastasis was observed in 1 patient, and the case was salvaged successfully with lymph node dissection. The 3-year overall and recurrence-free survival rates were 97.7% and 98.1%, respectively. Cumulative development of multiple cancers of the pharynx at 3 years was 18.4%. The authors concluded that ESD appears to be a safe and effective minimally invasive treatment in patients with superficial pharyngeal cancer.
Read this article on pages 1002-8 in this issue.
ORIGINAL ARTICLE Efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection: a randomized, double-blind, controlled, prospective study Su Young Kim, MD, Jun-Won Chung, MD, PhD, Dong Kyun Park, MD, PhD, Kwang An Kwon, MD, PhD, Kyoung Oh Kim, MD, PhD, Yoon Jae Kim, MD, PhD Endoscopic submucosal dissection (ESD) is commonly performed under air insufflation and is often accompanied by abdominal discomfort. CO2 is absorbed more rapidly by the body than is air; however, the use of CO2 insufflation in ESD remains controversial. This randomized, doubleblind, controlled, prospective study was designed to assess the efficacy of CO2 versus air insufflation in gastric ESD. Between May 2012 and August 2014, a total of 110 patients with gastric tumors were randomly assigned to the CO2 insufflation (CO2 group, n Z 54) or air insufflation group (air group, n Z 56). Abdominal pain after ESD was chronologically recorded via visual analog scale (VAS) scores. Secondary outcome measurements were adverse events, abdominal circumference, amount of sedatives prescribed, and use of analgesics. Neither the baseline patient characteristics nor the mean procedural time differed between the groups. The VAS score for abdominal pain was 35.2 in the CO2 insufflation group versus 48.5 in the air insufflation group 1 hour after ESD (P Z .026), 27.8 versus 42.5 three hours after ESD (P Z .007), 18.4 versus 34.8 six hours after ESD (P Z .001), and 9.2 versus 21.9 one day after ESD (P ! .001). Changes in abdominal circumference, the amounts of sedative drugs taken, and the adverse events did not differ between the groups. However, the air insufflation group required more analgesics than did the CO2 insufflation group (CO2 group, 22.0% [11/50]; air group, 42.3% [22/52]; P Z .028). Dr Kim and colleagues concluded that CO2 insufflation during gastric ESD significantly reduced abdominal pain and analgesic usage compared with air insufflation.
Read this article on pages 1018-24 in this issue.
12A GASTROINTESTINAL ENDOSCOPY Volume 82, No. 6 : 2015
www.giejournal.org
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FOCUS ON. ORIGINAL ARTICLE Endoscopic submucosal dissection as minimally invasive treatment for superficial pharyngeal cancer: a phase II study (with video) Noboru Hanaoka, MD, Ryu Ishihara, MD, Yoji Takeuchi, MD, Motoyuki Suzuki, MD, Shinji Otozai, MD, Kota Kida, MD, Tadashi Yoshii, MD, Takashi Fujii, MD, Kunitoshi Yoshino, MD, Toshimitsu Sugawa, MD, Koji Kitamura, MD, Ryo Kanemura, MD, Ryosuke Koike, MD, Noriya Uedo, MD, Koji Higashino, MD, Tomofumi Akasaka, MD, Takeshi Yamashina, MD, Takashi Kanesaka, MD, Noriko Matsuura, MD, Kenji Aoi, MD, Yasushi Yamasaki, MD, Kenta Hamada, MD, Hiroyasu Iishi, MD, Yasuhiko Tomita, MD Although endoscopic submucosal dissection (ESD) has been applied for superficial pharyngeal cancer, no prospective trials have been reported. To investigate the efficacy and safety of ESD for superficial pharyngeal cancer, the authors conducted a prospective phase II trial. Fifty-four patients with 73 lesions were enrolled from September 2010 to August 2014, and ESD was performed. The primary endpoint was the complete resection rate. Secondary endpoints were safety, recurrence-free survival, overall survival, and incidence of metachronous pharyngeal cancer. Fifty-four patients had stage 0-III cancer: stage 0, n Z 22; stage I, n Z 14; stage II, n Z 17; and stage III, n Z 1. The en bloc resection rate was 100%, and the complete resection rate was 79.5% (58/73 lesions; 95% confidence interval, 68%-88%). No serious adverse events related to ESD were encountered. Four patients required nasogastric intubation and feeding. No patients required percutaneous endoscopic gastrostomy and tracheotomy. Swallowing, speech, and airway functions were preserved in all patients. One of the 54 patients died of an unrelated illness. Median follow-up was 27 months (range 6-55 months). Local cervical lymph node metastasis was observed in 1 patient, and the case was salvaged successfully with lymph node dissection. The 3-year overall and recurrence-free survival rates were 97.7% and 98.1%, respectively. Cumulative development of multiple cancers of the pharynx at 3 years was 18.4%. The authors concluded that ESD appears to be a safe and effective minimally invasive treatment in patients with superficial pharyngeal cancer.
Read this article on pages 1002-8 in this issue.
ORIGINAL ARTICLE Efficacy of carbon dioxide insufflation during gastric endoscopic submucosal dissection: a randomized, double-blind, controlled, prospective study Su Young Kim, MD, Jun-Won Chung, MD, PhD, Dong Kyun Park, MD, PhD, Kwang An Kwon, MD, PhD, Kyoung Oh Kim, MD, PhD, Yoon Jae Kim, MD, PhD Endoscopic submucosal dissection (ESD) is commonly performed under air insufflation and is often accompanied by abdominal discomfort. CO2 is absorbed more rapidly by the body than is air; however, the use of CO2 insufflation in ESD remains controversial. This randomized, doubleblind, controlled, prospective study was designed to assess the efficacy of CO2 versus air insufflation in gastric ESD. Between May 2012 and August 2014, a total of 110 patients with gastric tumors were randomly assigned to the CO2 insufflation (CO2 group, n Z 54) or air insufflation group (air group, n Z 56). Abdominal pain after ESD was chronologically recorded via visual analog scale (VAS) scores. Secondary outcome measurements were adverse events, abdominal circumference, amount of sedatives prescribed, and use of analgesics. Neither the baseline patient characteristics nor the mean procedural time differed between the groups. The VAS score for abdominal pain was 35.2 in the CO2 insufflation group versus 48.5 in the air insufflation group 1 hour after ESD (P Z .026), 27.8 versus 42.5 three hours after ESD (P Z .007), 18.4 versus 34.8 six hours after ESD (P Z .001), and 9.2 versus 21.9 one day after ESD (P ! .001). Changes in abdominal circumference, the amounts of sedative drugs taken, and the adverse events did not differ between the groups. However, the air insufflation group required more analgesics than did the CO2 insufflation group (CO2 group, 22.0% [11/50]; air group, 42.3% [22/52]; P Z .028). Dr Kim and colleagues concluded that CO2 insufflation during gastric ESD significantly reduced abdominal pain and analgesic usage compared with air insufflation.
Read this article on pages 1018-24 in this issue.
12A GASTROINTESTINAL ENDOSCOPY Volume 82, No. 6 : 2015
www.giejournal.org