Download PDF
CC BY 4.0 · Endoscopy 2023; 55(S 01): E721-E722
DOI: 10.1055/a-2079-2910
E-Videos

A successful case of endoscopic submucosal dissection using the water pressure method for hypopharyngeal carcinoma with severe fibrosis

Kurato Miyazaki
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
2   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Motohiko Kato 
2   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Yusaku Takatori
2   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Takanori Kanai
1   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
,
Naohisa Yahagi
2   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Endoscopic submucosal dissection (ESD) is a local treatment method for pharyngeal carcinoma that can preserve organs and maintain patientsʼ quality of life. However, it is challenging because of the narrow and three-dimensional structure, which makes it difficult to use a traction method like with other organs. We have previously reported the usefulness of the water pressure method (WPM) in other organs [1] [2] [3] [4] [5]. In addition to the magnified effect obtained by underwater ESD, WPM makes it easier to get under the mucosal flap and identify the submucosal edge to be dissected by using the water stream. Here, we report a successful ESD using WPM for hypopharyngeal carcinoma ([Video 1]).

Video 1 A successful case of endoscopic submucosal dissection using water pressure method for hypopharyngeal carcinoma with severe fibrosis.


Quality:

A 62-year-old man underwent ESD for hypopharyngeal carcinoma 5 years ago, and a curative resection was achieved. At surveillance endoscopy, a new hypopharyngeal carcinoma was detected adjacent to the post-ESD scar, and we performed ESD.

We identified the lesion with iodine staining, and marking dots were placed around the lesion ([Fig. 1]). First, we performed a mucosal incision at the distal edge to ensure the endpoint of the subepithelial dissection prior to circumferential incision. Thereafter, this case was very challenging because of the narrow space and the vertical approach to the muscular layer. In addition, fibrosis caused by the post-ESD scar was one of the difficulties in this case ([Fig. 2]). However, WPM made it possible to visualize the edges of the layers to be dissected and distinguish between the fibrotic tissue and the muscle layer. Furthermore, the tapered hood and the magnifying effect in the underwater condition enabled us to perform precise dissection ([Fig. 3]). En bloc resection was achieved without any adverse events ([Fig. 4]) despite severe fibrosis ([Fig. 5]).

Zoom Image
Fig. 1 A white light image of the lesion with iodine staining. After iodine staining, marking dots were placed around the lesion.
Zoom Image
Fig. 2 A white light image of severe fibrosis. Severely fibrotic tissue due to post-endoscopic submucosal dissection (ESD) scar spread adjacent to the lesion.
Zoom Image
Fig. 3 A white light image of a three-dimensional structure with severe fibrosis. We could get into the narrow space with a tapered therapeutic hood and perform precise ESD.
Zoom Image
Fig. 4 A white light image of specimen with iodine staining. En bloc resection was achieved without any adverse events.
Zoom Image
Fig. 5 An image of the specimen stained with hematoxylin and eosin. Severely fibrotic tissue is observed adjacent to the lesion.

The water pressure method seems to be particularly useful for hypopharyngeal lesions because it could overcome the difficulty due to the anatomical features of pharynx, which are the narrow space and undulating structure.

Endoscopy_UCTN_Code_TTT_1AQ_2AD

Endoscopy E-Videos
https://eref.thieme.de/e-videos

E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).

This section has its own submission website at https://mc.manuscriptcentral.com/e-videos



Publication History

Article published online:
15 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Yahagi N, Nishizawa T, Sasaki M. et al. Water pressure method for duodenal endoscopic submucosal dissection. Endoscopy 2017; 49: E227-E228
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Masunaga T, Kato M, Yahagi N. Successful endoscopic submucosal dissection using the water pressure method for cervical esophageal cancer. Dig Endosc 2021; 33: e93-e94
    CrossrefPubMedSearch in Google Scholar
  • 3 Kato M, Takatori Y, Sasaki M. et al. Water pressure method for duodenal endoscopic submucosal dissection (with video). Gastrointest Endosc 2021; 93: 942-949
    CrossrefPubMedSearch in Google Scholar
  • 4 Masunaga T, Kato M, Yahagi N. Water pressure method overcomes the gravitational side in endoscopic submucosal dissection for gastric cancer. VideoGIE 2021; 6: 457-459
    Search in Google Scholar
  • 5 Miyazaki K, Kato M, Kanai T. et al. A successful case of endoscopic submucosal dissection using the water pressure method for early gastric cancer with severe fibrosis. VideoGIE 2022; 7: 219-222
    CrossrefPubMedSearch in Google Scholar