KENDI YAMAZAKI
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Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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- INITIAL EXPERIENCE OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN BRAZIL TO TREAT EARLY GASTRIC AND ESOPHAGHEAL CANCER: a multi-institutional analysis(2013) CHAVES, Dalton Marques; MOURA, Eduardo Guimaraes H.; MILHOMEM, Daniela; ARANTES, Vitor N.; YAMAZAKI, Kendi; MALUF, Fauze; ALBUQUERQUE, Walton; CONRADO, Antonio Carlos C.; ARAUJO, Julia C.; UEJO, Paula H. S.; SAKAI, PauloObjective This study aimed to evaluate the feasibility and clinicopathological characteristics of early gastric and esophageal cancers treated with endoscopic submucosal dissection (ESD) at five centers in Brazil. Methods Five centers in Brazil reported their initial experience with ESD. The cases reported had already been collected by each center before pooled analysis. Results Were resected 62 gastric lesions; 52(83,8%) of the gastric lesions were well-differentiated adenocarcinoma, 31(50%) from the antrum, 24 (38.7%) type IIa. 51 (82.2%) lesions had en-block resection with three showing lateral margin compromise. Concerning invasion, 25 (40.3%) tumors were M1. Mean tumor diameter was 18.9 mm (range, 0.6-5.0 cm) and mean procedure duration was 119.45 minutes. Gastric perforation occurred in three (4.8%) patients. Mean follow-up duration was 11.3 months, with two local recurrences and one death from pneumonia Seven months after treatment. Of the 16 esophageal lesions resected, 14 (87.4%) were squamous cell carcinoma, 10 (62.5%) were located proximally and 8 (50.0%) type IIa. Mean tumor diameter was 23.8 mm (range, 6-60 mm). Thirteen (81.2%) lesions had en-block resection with five cases of lateral margin compromise. Eight (50.0%) lesions were M1. Mean procedure duration was 78 minutes (range, 20-150 min). Complications included pneumomediastinum in two (12.5%) patients and stenosis in one (6.2%). Mean duration of follow-up was 8.6 months, with no local recurrence despite the presence of lateral margin compromise. Conclusion Different centers in Brazil feasibly perform ESD with a high success rate.
conferenceObject Learning Curve for ESD: Experience From a South American Center(2012) MOURA, Eduardo G. H. De; YAMAZAKI, Kendi; MESTIERI, Luiz H.; MIYAJIMA, Nelson T.; CHAVES, Dalton M.; SANTOS, Marcos E. Lera Dos; IDE, Edson; FRANZINI, Tomazo; PESSORRUSSO, Fernanda C.; SAKAI, PauloIntroduction: Endoscopic resection techniques such as endoscopic submucosal dissection (ESD) for early gastric cancer are gaining acceptance in many countries. However complication rates on this procedure reaches 20% on non-experienced hands. Experts recommend that ESD should first be carried out in animal models before starting to be performed in humans, in order to overcome the initial learning curve. Aims: To evaluate the learning curve during intensive ESD training on live porcine models under supervision of experts. Material and Methods: Forty endoscopists have performed ESD during an intensive training course on live porcine models, under experts’ supervision. This training had duration of two days. Simulation of a gastric lesion was obtained by aspirating the gastric mucosa with a cap on the tip of the endoscope. The following variables were analyzed: procedure time, resected specimen size, complete en bloc resection rate, circumferential incision time, submucosal solution injected volume, distance between the circumferential incision and the lesion (lateral margin) and complication rates as perforation, bleeding and death. And from the beginning to the end of the last procedure a questionnaire was given to the participants to see if they felt secure to perform ESD without supervision. Results: At the end of 2 days training, 125 gastric ESDs were achieved. Each participant performed at least 3 complete ESDs. The mean procedure time for the first cases were 32.69 min ± 15.89 (CI 95% 6.52 - 19.36) and at the end of the third case 19.7min ± 8.57 (CI 95% 6.52 - 19.36), p 0.001; the distance between the circumferential incision and the lesion (lateral margin) has increased from 2.54mm 1.75 (CI 95% 1.24 - 1.05) to 2.71mm ± 2.70(CI 95% 1.24 - 1.05), p=0.87 at the end of the third case. Bleeding rate has decreased from 18.75% to 15.63%. At the end of the training course 56.25% of the endoscopists felt secure to do ESD without supervision, a percentage that was 6.25% at the beginning of the course. Conclusion: Training ESD on live porcine models may help endoscopist overcome the learning curve but more training is needed to make it secure in humans.