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Background: The optimal diameter for endoscopic dilatation of anastomotic strictures after esophagectomy has not been elucidated. This study aimed to determine the optimal target diameter for endoscopic dilatation for anastomotic stricture after esophagectomy. Methods: The medical records of patients who underwent endoscopic dilatation for anastomotic stricture after esophagectomy between January 2009 and June 2024 at Pusan National University Yangsan Hospital were reviewed. The stricture recurrence rate, dilatation-free period, and complications according to the dilatation diameter were collected and included in the analysis. Results: We analyzed 149 endoscopic dilatations (diameters from 10 to 18 mm) in 43 patients. The median follow-up period was 47 months (range, 5–157). The stricture recurrence rate was 72.5%, and the median dilatation-free period was 60 days. The stricture recurrence rate was the lowest (41.7%, p= 0.022), and the overall dilatation-free period was the longest (median 490 days, p= 0.171) in dilations up to 16.5 mm. The stricture recurrence rate was higher in dilations up to 18 mm than in those up to 16.5 mm (54.5% vs. 41.7%, p= 0.331). Moreover, the bleeding rate was higher in patients with dilations up to 18 mm (18.2% vs. 4.2%, p= 0.205). Conclusion: In patients with anastomotic strictures after esophagectomy, dilation up to 16.5 mm showed a lower stricture recurrence rate, longer dilation-free period, and less postprocedural bleeding than those of dilation up to 18 mm.

Background: Endoscopic submucosal dissection (ESD) is not as tiresome as gastrectomy, but it is a time-consuming procedure. One-step knife (OSK) is a novel knife that combines a knife for ESD and an injection needle into one sheath. In this study, we aimed to compare the insulated tip type of OSK and conventional knife (CK) in terms of procedure time and complication rate. Methods: Medical records of patients with ESD using CK between February and September 2020 were retrospectively reviewed. Subsequently, data from patients who underwent ESD using OSK by September 2021 were prospectively collected. Total procedure time, procedure time by location and complication rate in the OSK and CK group were compared. Results: In the study period, a total of 203 patients (OSK, 102 patients; CK, 101 patients) were analyzed. On multivariate analysis, using CK, body location, resection size ≥ 40 mm, and submucosal fibrosis were associated with longer procedure time. The total procedure time was statistically significantly reduced in the OSK group (median 11 vs. 17 min, p< 0.01). The procedure time for each location was more reduced in the body (median 14 vs. 19 min p< 0.01) than the antrum (median 10 vs. 14 min, p= 0.01) in the OSK group. There was no significant difference in post-ESD bleeding and perforation in the two groups (3.9 vs. 3.9%, p= 0.99 and 1.0 vs. 2.0%, p= 0.56). Conclusions: OSK significantly reduced the total procedure time of ESD. OSK could be an effective and safe knife for gastric ESD, especially for body lesions.

Background: Enteric drainage into the recipient duodenum in pancreas transplantation (PT) can identify the graft duodenum by endoscopy. This study aimed to identify the characteristic endoscopic findings associated with graft failure or acute rejection in patients with PT. Methods: We reviewed the medical records of patients who underwent PT with duodenoduodenostomy (DD) between January 2015 and August 2019. During this period, there were 44 PTs with DD in 42 patients; 122 endoscopies were performed and analyzed. Results: Overall, pancreatic graft survival was 82% at a mean follow-up of 27 months (range 6–55 months). There were 8 graft failures and 10 acute rejections. In all 8 graft failures, a deep ulcer covered with fibrinous exudates of the graft duodenum was confirmed on endoscopy. Diffuse erythema inside the graft duodenum was observed in 8 of 10 acute rejections. The factors associated with acute rejection were elevated serum lipase level (OR 8.5, p= 0.02) and diffuse erythema inside the graft duodenum on endoscopy (OR 20.5, p< 0.01) in multivariate analysis. Conclusions: In PT with DD patients, graft failure can be visualized by endoscopy, and diffuse erythema inside the graft duodenum may be a finding of acute rejection.

Background and aims: Although gastric endoscopic submucosal dissection (ESD) achieves a higher en-bloc resection rate compared to that with endoscopic mucosal resection (EMR) for gastric epithelial tumors, the higher complication rate and the longer procedure time are obstacles for its widespread use. Rescue EMR may be a valuable treatment option during difficult ESD procedures. We have aimed to identify the clinical outcomes and associated factors of rescue EMR during ESD. Patients and methods: The medical records of patients who underwent ESD between January 2009 and February 2016 were reviewed. The clinical outcomes of rescue EMR during ESD and associated factors with rescue EMR were evaluated. Results: A total of 1778 gastric epithelial lesions were enrolled. ESD without using a snare and rescue EMR were performed in 94.5% and 5.5% of patients, respectively. Lesion locations of mid-third [odd ratio (OR 4.470)], upper-third (OR 1.997), and submucosal fibrosis (OR 1.906) were the significant associated factors with rescue EMR. The en-bloc resection rate and complete resection rate of rescue EMR were lower than that of ESD (98.4% vs. 93.8% and 96.2% vs. 83.5%, respectively). Local recurrence rate was higher after rescue EMR than that after ESD (4.1% vs. 1.2%). Procedure-related complications and procedure time were not significantly different between the two groups. Conclusions: In a difficult ESD procedure, rescue EMR may be an alternative treatment option, especially for lesions located at the mid-to-upper third of the stomach, without increasing either the procedure time or the rate of complications.

Background: Tumors located on the proximal stomach are associated with a longer procedure time and lower en-block resection of endoscopic submucosal dissection (ESD). Additionally, it is more difficult to perform ESD for lesions after distal gastrectomy because of the narrow inner space. We aimed to evaluate the therapeutic outcomes of ESD for lesions on the remnant stomach compared with those on the upper third of the entire stomach. Methods: A total of 135 patients with a neoplasm located on the proximal stomach who received ESD between Aug 2008 and Dec 2016 were enrolled. We retrospectively reviewed en-bloc resection rate, complete resection rate, and complication rate according to whether distal gastrectomy was performed. Clinical outcomes were compared among the 1:2 propensity-matched groups. Results: Between the remnant stomach and entire stomach, the en-bloc [92% (23/25) and 92.0% (46/50), respectively; P= 1.000] and complete resection [84% (21/25) and 88.0 (44/50), respectively; P= 0.723] rates were not significantly different. In patients with lesions that indicated ESD, there was no significant difference in en-bloc and complete resection rates. In a multivariable analysis, submucosal fibrosis [odds ratio (OR) 5.9, 95% confidence interval (CI) 1.1–30.7] and submucosa invasive cancer (OR 10.1, 95% CI 1.4–74.3) were independent risk factors for incomplete resection. Conclusions: ESD is a feasible therapeutic option for lesions located on the proximal stomach regardless the operation history of distal gastrectomy. However, the complete resection rate decreases for lesions with submucosal fibrosis or the submucosa invasion.

A correction to this paper has been published: https://doi.org/10.1007/s00464-021-08454-6