scholarly journals Two Cases of Rectal Neuroendocrine Tumor Resection Combined with Dissection of the Circular Muscle Layer Using the Endoscopic Submucosal Dissection Technique

2016 ◽  
Vol 10 (3) ◽  
pp. 693-700 ◽  
Author(s):  
Kumpei Honjo ◽  
Kazumasa Kure ◽  
Ryosuke Ichikawa ◽  
Hisashi Ro ◽  
Rina Takahashi ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Therapy ◽  
Tumor Resection ◽  
Circular Muscle ◽  
Muscle Layer ◽  
En Bloc ◽  
Lower Rectum ◽  
Longitudinal Muscle Layer ◽  
Circular Muscle Layer ◽  
Submucosal Dissection

Generally, lesions of rectal neuroendocrine tumors (NETs) 10 mm or smaller are less malignant and are indicated for endoscopic therapy. However, the vertical margin may remain positive after conventional endoscopic mucosal resection (EMR) because NETs develop in a way similar to submucosal tumors (SMTs). The usefulness of EMR with a ligation device, which is modified EMR, and endoscopic submucosal dissection (ESD) was reported, but no standard treatment has been established. We encountered 2 patients in whom rectal NETs were completely resected by combined dissection and resection of the circular muscle layer using the ESD technique. Case 1 was an 8-mm NET of the lower rectum. Case 2 was NET of the lower rectum treated with additional resection for a positive vertical margin after EMR. In both cases, the circular muscle layer was dissected applying the conventional ESD technique, followed by en bloc resection while conserving the longitudinal muscle layer. No problems occurred in the postoperative course in either case. Rectal NETs are observed in the lower rectum in many cases, and it is less likely that intestinal perforation by endoscopic therapy causes peritonitis. The method employed in these cases, namely combined dissection and resection of the circular muscle layer using the ESD technique, can be performed relatively safely, and it is possible to ensure negativity of the vertical margin. In addition, it may also be useful for additional treatment of cases with a positive vertical margin after EMR.

scholarly journals First reported case of per anal endoscopic myectomy (PAEM): A novel endoscopic technique for resection of lesions with severe fibrosis in the rectum

2017 ◽  
Vol 05 (03) ◽  
pp. E146-E150 ◽  
Author(s):  
David Rahni ◽  
Takashi Toyonaga ◽  
Yoshiko Ohara ◽  
Francesco Lombardo ◽  
Shinichi Baba ◽  
...  
Keyword(s):  
Longitudinal Muscle ◽  
Circular Muscle ◽  
Muscle Layer ◽  
Rectal Tumor ◽  
Resection Margins ◽  
Submucosal Layer ◽  
Longitudinal Muscle Layer ◽  
Circular Muscle Layer ◽  
Tunneling Method ◽  
Severe Fibrosis

Background and study aims A 54-year-old man was diagnosed with a rectal tumor extending through the submucosal layer. The patient refused surgery and therefore endoscopic submucosal dissection (ESD) was pursued. The lesion exhibited the muscle retraction sign. After dissecting circumferentially around the fibrotic area by double tunneling method, a myotomy was performed through the internal circular muscle layer, creating a plane of dissection between the internal circular muscle layer and the external longitudinal muscle layer, and a myectomy was completed.The pathologic specimen verified T1b grade 1 sprouting adenocarcinoma with 4350 µm invasion into the submucosa with negative resection margins.

Effects of transmural field stimulation in isolated muscle strips from human esophagus

1990 ◽  
Vol 258 (3) ◽  
pp. G344-G351 ◽  
Author(s):  
A. Tottrup ◽  
A. Forman ◽  
P. Funch-Jensen ◽  
U. Raundahl ◽  
K. E. Andersson
Keyword(s):  
Longitudinal Muscle ◽  
Circular Muscle ◽  
Muscle Layer ◽  
Isometric Tension ◽  
Field Stimulation ◽  
Platinum Electrodes ◽  
Longitudinal Muscle Layer ◽  
Circular Muscle Layer ◽  
Human Esophagus ◽  
40 Hz

Smooth muscle strips representing longitudinal and circular muscle layers of the esophagogastric junction (EGJ) and esophageal body (EB) of the human esophagus were prepared. The strips were mounted in organ baths and isometric tension was recorded. Square wave stimulation was applied through platinum electrodes. Only responses abolished by tetrodotoxin (TTX) were considered neurogenic. Strips taken from longitudinal muscle layers of the EB and EGJ contracted during field stimulation. The responses evoked were abolished by atropine, and optimal frequency of stimulation was 40 Hz. In strips taken from the circular muscle layer of the EB, a contraction occurred after cessation of the stimulus. Atropine inhibited 90% of this response; the optimal stimulation frequency was 40 Hz. When a tone was induced in strips from this layer, a TTX-sensitive relaxation was seen during field stimulation. During stimulation of strips from the EGJ circular muscle layer, which was the only preparation developing spontaneous active tone, a relaxation was seen. A small contraction followed after termination of the stimulus. The relaxation, which was nonadrenergic, noncholinergic, reached maximum at 10 Hz. Atropine inhibited 40% of the contraction. The results suggest that in the longitudinal muscle layer of the human lower esophagus field stimulation causes postganglionic nerves to release transmitter(s) acting on muscarinic receptors. The responses of circular muscle layers seem to be mediated through release of at least two transmitters.

Longitudinal contractions in the duodenum: their fluid-mechanical function

1975 ◽  
Vol 228 (6) ◽  
pp. 1887-1892 ◽  
Author(s):  
J Melville ◽  
E Macagno ◽  
J Christensen
Keyword(s):  
Longitudinal Muscle ◽  
Circular Muscle ◽  
Muscle Layer ◽  
Slow Waves ◽  
Longitudinal Muscle Layer ◽  
Circular Muscle Layer ◽  
Model Flow ◽  
Displacement Wave ◽  
Marked Points

The hypothesis examined was that contractions of the longitudinal muscle layer occurin the duodenum which are independent of those of the circular muscle layer and that they induce flow of duodenal contents. A segment of opossum duodenum isolated in vitro was marked and photographed during periods of longitudinal muscle contraction, when the circular muscle layer appeared inactive. The prequency of longitudinal oscillation of the marked points was 20.5 cycles/min. The longitudinal displacement wave spread caudad with an average velocity of 3.27 cm/s. Frequency and velocity of electrical slow waves were determined in similiar duodenal segments. Slow-wave frquencywas 18.9 cycles/min. In a two-dimensional mechanical model, flow induced by simulatedlongitudinal muscle layer appear to be driven by the electrical slow waves of the duodenum. They are capable of inducing a pattern of flow in which ocntents flow betweenthe core and the periphery of the intestinal conduit.

scholarly journals Clinical effectiveness of the pocket-creation method for colorectal endoscopic submucosal dissection

2017 ◽  
Vol 05 (12) ◽  
pp. E1299-E1305 ◽  
Author(s):  
Akira Kanamori ◽  
Masakazu Nakano ◽  
Masayuki Kondo ◽  
Takanao Tanaka ◽  
Keiichiro Abe ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Conventional Method ◽  
Clinical Effectiveness ◽  
Muscle Layer ◽  
En Bloc Resection ◽  
Control Group ◽  
Colorectal Tumors ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Endoscopic submucosal dissection (ESD) is a technically advanced procedure for colorectal tumors. Hayashi et al. invented the “pocket-creation method (PCM),” and reported that Is-type lesions with fibrosis could be efficaciously and safely resected. However, only case studies have been published, and there are no previous reports on the usefulness of PCM in colorectal ESD for all lesions, as compared with the conventional method. This study aimed to evaluate the effectiveness and safety of PCM in colorectal ESD. Patients and methods Ninety-six colorectal tumors were treated: 47 using the PCM and the other 49, considered the control group, using the conventional method. Therapeutic effectiveness and safety were retrospectively assessed. Results The comparison between the PCM and control groups revealed higher rates of en bloc resection (100 % vs. 88 %, P = 0.015) and curative endoscopic resection (100 % vs. 84 %, P = 0.0030) with PCM. There was no significant difference in perforation as an adverse event (AE) between the two groups, though perforation was observed in only 6 % of the control group and none of the PCM group. Compared with the control group, the PCM group had lower incidences of perforation and post-ESD coagulation syndrome, and both AEs were associated with excessive thermal denaturation of the muscle layer (2 % vs. 16 %, P = 0.018). Conclusions This study demonstrated the effectiveness and safety of ESD with PCM for colorectal tumors. Although there is a possible learning curve, PCM enables the endoscopist to safely perform ESD in most cases without encountering the difficulties associated with conventional ESD.

Die histomorphologischen Veränderungen der Crosse bei der Varikosis der V. saphena magna

VASA ◽  
2000 ◽  
Vol 29 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Markus Stücker ◽  
Krey ◽  
Röchling ◽  
Schultz-Ehrenbur ◽  
Altmeyer
Keyword(s):  
Saphenous Vein ◽  
Femoral Vein ◽  
Circular Muscle ◽  
Muscle Layer ◽  
Clinical Severity ◽  
Venous Disease ◽  
Longitudinal Muscle Layer ◽  
Circular Muscle Layer ◽  
Maximal Thickness ◽  
The Media

Background: Insufficiency of the greater saphenous vein starts at its junction with the femoral vein, so that the histomorphologic changes at the saphenofemoral junction are of special interest. Methods: In this study we examined which histologic changes occur in the vein walls 5 cm distal to the junction of the greater saphenous vein into the femoral vein and whether these changes correlate to the clinical severity of venous disease. For this the morphologic changes of 28 venous specimens were described qualitatively and the two layers of the media were measured at their thickest and thinnest points. Results: The three-layered structure of the vessel wall with intima, media and adventitia was destroyed in 21% of the cases, the intima and media were fused into one another due to loss of the membrana elastica interna. In 93% the intima was thickened at circumscribed areas. Sprouting of capillaries into the intima was found only if varicosis lasted for longer than 15 years. Aneurysms were found in 29% of the specimen. In parts of severe aneurysms the media was completely missing. The thickness of the circular muscle layer of the media varied more than that of the longitudinal muscle layer (difference between minimal and maximal thickness 400 ± 130 mum compared to 190 ± 90 mum). With increasing clinical severity of the chronic venous insufficiency the difference between minimal and maximal thickness of the circular muscle layer increased (330 ± 90 mum at stage I according to Widmer, 490 ± 130 at stage III). Conclusion: The coexistence of muscular hypertrophy and atrophy in varicose veins is regarded by us as a reaction to altered perfusion and pressure in the veins. Considering the frequently severe damage to the veins, indication for a vein sparing therapy has to be viewed with care.

Coordination of electrical activities in muscle layers of the pig colon

1987 ◽  
Vol 252 (1) ◽  
pp. G136-G142
Author(s):  
J. D. Huizinga ◽  
E. Chow ◽  
N. E. Diamant ◽  
T. Y. el-Sharkaway
Keyword(s):  
Longitudinal Muscle ◽  
Circular Muscle ◽  
Muscle Layer ◽  
Simultaneous Recording ◽  
Frequency Range ◽  
Longitudinal Muscle Layer ◽  
Circular Muscle Layer ◽  
High Level ◽  
Electrical Activities

Simultaneous recording of electrical activities from the circular and longitudinal muscle layers of the pig colon was performed in vitro to study possible coordination of activities. The electrical activity of both muscle layers consisted of electrical oscillations with superimposed spikes. The frequency range of the electrical oscillations in the circular muscle was 0.5-3.5 cycles per minute (cpm) and in the longitudinal muscle 24-42 cpm. Coordination of the activities of both muscle layers occurred consistently only after stretch or cholinergic stimulation. Then it occurred in a unique fashion. Each oscillation in the circular muscle layer occurred at the same time as the onset of a burst of oscillations in the longitudinal muscle. In addition, multiple simultaneous recordings of the electrical activities from each muscle layer were obtained showing that within the circular muscle layer electrical oscillations were phase locked in the circumferential direction and along the long axis of the colon. They appeared to propagate in either the oral or aboral direction. In tetrodotoxin (with stretch as stimulus) and also in presence of carbachol, bursts of oscillations in the longitudinal muscle layer were phase locked circumferentially (in the different taeniae) and longitudinally. This study shows that the muscle layers in the colon, which have different myogenic electrical activities, can obtain a high level of coordination.

scholarly journals The results and limitations of endoscopic submucosal dissection for colorectal tumors

2008 ◽  
Vol 55 (3) ◽  
pp. 17-23 ◽  
Author(s):  
T. Toyanaga ◽  
M. Man-I ◽  
D. Ivanov ◽  
T. Sanuki ◽  
Y. Morita ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Tumors ◽  
En Bloc ◽  
Lower Rectum ◽  
Efficient Treatment ◽  
Submucosal Cancer ◽  
Submucosal Dissection

In the colorectal tumor, the lesions suitable for the endoscopic treatment are those with no lymph node metastasis such as adenomas, intramucosal cancers, and minimally invasive submucosal cancer (invasion depth 1000 m, well and moderately differentiated type, no lymphovascular invasion). The new endoscopic technique, endoscopic submucosal dissection (ESD) enables en-bloc resection of the lesions regardless of their size and location. In order to perform ESD more easily, safely, and efficiently, we invented water jet short needle knives (Flush knife). Emitting a jet of water from the tip of a sheath enables submucosal local injection with a knife itself without replacement of operative instruments, which leads to efficient treatment. Especially, Flush knife is very effective for the lesions located at lower rectum and anal canal where there are many vessels. We treated a total of 361 colorectal lesions by ESD between June 2002 and July 2007, and en-block complete resection rate was 98.3 %. In 12 cases, "muscle retracting sign" was recognized. This sign is an index of the discontinuation of ESD, but it is impossible to diagnose preoperatively. The postoperative bleeding occurred in 0.8 % (3 cases: no blood transfusion is needed). The intraoperative perforation occurred in 1.9 % (6 cases: 5 cases were treated conservatively, 1 case was treated surgically) and the postoperative perforation occurred in 1case (0.3%) treated surgically. ESD is the extremely effective treatment for the colorectal tumors and also is possible to be performed safely with the appropriate choice of the devices and strategy for dissection.

scholarly journals Don’t Interrupt! A Case Report of Continuing Peritoneal Dialysis After Endoscopic Gastric Tumor Resection

2019 ◽  
Vol 6 ◽  
pp. 205435811988714 ◽  
Author(s):  
William K. Silverstein ◽  
Christopher Teshima ◽  
Simran Jolly ◽  
Jeffrey Perl
Keyword(s):  
Peritoneal Dialysis ◽  
Endoscopic Submucosal Dissection ◽  
Tumor Resection ◽  
Posterior Wall ◽  
Lymph Node Involvement ◽  
Gastric Tumor ◽  
Deficiency Anemia ◽  
Low Grade ◽  
En Bloc ◽  
Submucosal Dissection

Rationale: The evidence supporting the safety of restarting peritoneal dialysis (PD) immediately after abdominal surgery and interventions is scant. In particular, there are no reported cases characterizing periprocedural management of PD for patients undergoing endoscopic submucosal dissection for gastric intramucosal tumor removal. Presenting concerns of the patient: A 66-year-old female with end-stage kidney disease secondary to diabetic nephropathy, currently on nocturnal automatic PD, presented with new iron-deficiency anemia. Workup revealed an intramucosal gastric lesion proximal to the pylorus, without surrounding lymph node involvement. Endoscopic submucosal dissection was performed with en bloc endoscopic resection of a 5-cm, partially flat, partially sessile mass along the posterior wall and lesser curvature of the gastric antrum. Pathology revealed low-grade dysplasia without features of malignancy. There was no evidence of hemorrhage or leak post-dissection. Diagnoses: The clinical presentation was consistent with an uncomplicated endoscopic submucosal dissection. Interventions: Peritoneal dialysis was held for 48 hours and restarted thereafter with no complications. The patient did not require bridging with hemodialysis. Outcomes: The patient had an uncomplicated post-endoscopic course, with no subsequent episodes of PD-associated peritonitis after at least 6-month follow-up. Novel finding: This is the first reported case of PD reinitiation after endoscopic submucosal dissection of a gastric tumor.

scholarly journals Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions

2020 ◽  
Vol 08 (12) ◽  
pp. E1832-E1839
Author(s):  
Yuichiro Kuroki ◽  
Toshiyuki Endo ◽  
Kenta Iwahashi ◽  
Naoki Miyao ◽  
Reika Suzuki ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Tumor Location ◽  
Proximal Colon ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Serrated Lesions

Abstract Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm2/h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.

scholarly journals Fibrin glue: Novel submucosal injection agent for endoscopic submucosal dissection

2021 ◽  
Vol 09 (03) ◽  
pp. E319-E323
Author(s):  
Madoka Takao ◽  
Yoshitaka Takegawa ◽  
Toshitatsu Takao ◽  
Hiroya Sakaguchi ◽  
Yoshiko Nakano ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Fibrin Glue ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Submucosal Injection ◽  
Submucosal Dissection ◽  
Vitro Model ◽  
Histopathologic Findings

Abstract Background and study aims Adequate mucosal elevation by submucosal injection is crucial for patient safety and efficiency during endoscopic submucosal dissection (ESD). This study aimed to evaluate the efficacy of fibrin glue (FG) as a long-lasting submucosal injection agent and to evaluate the technical feasibility of FG injection for ESD. Materials and methods To compare the capabilities of different agents in maintaining submucosal evaluation, we injected FG, hyaluronic acid solution, and normal saline into the porcine gastric specimen that was incised into approximately 5 × 5 cm squares. Then, we measured the height of submucosal elevations over time. Moreover, three hypothetical lesions from the resected porcine stomach underwent ESD with FG injection. Thereafter, we conducted macroscopic and histopathologic analyses. Results FG maintained the greatest submucosal elevation among all the injection agents. Three ESD procedures were performed with en bloc resection. Both macroscopic and histopathologic findings showed a thick FG clot on the ulcers. Conclusions The FG solution can be potentially used as an ESD submucosal injection agent in an in vitro model.

Sign in / Sign up

Export Citation Format

Share Document