title: A feasibility study of chemically assisted endoscopic submucosal mechanical dissection using mesna for superficial esophageal squamous cell carcinomas.
abstract: BACKGROUND
  Injection of mesna into submucosal layers was recently reported to chemically soften connective tissue and facilitate the gastric endoscopic submucosal dissection (ESD) procedure. This study aimed to evaluate the safety and feasibility of similarly using mesna for esophageal ESD (mesna ESD).
  
  
  METHODS
  We performed mesna ESD in 20 consecutive patients with superficial esophageal squamous cell carcinomas (SESCCs). To do this, a submucosal fluid cushion was initially formed using sodium hyaluronate, and the esophageal lesion was circumferentially isolated with a short blade needle-knife. Mesna solution was then injected into the submucosal layer, which was dissected mechanically by cleavage using the tip of a cap-fitted endoscope. The number of electrosurgical incisions was recorded by computer software in real time. The data from 20 conventional ESD procedures without mesna (consecutive 10 SESCCs pre and post the 20 consecutive mesna ESD) were used for comparison to evaluate the mesna ESD.
  
  
  RESULTS
  The mesna ESDs achieved en bloc and R0 resection success rates of 100 and 95 %, respectively. There was no perforation or uncontrollable hemorrhage during and after mesna ESD, and the median procedural time of submucosal dissection was significantly less with mesna ESD than with conventional ESD (median; 8 vs. 15 min, P < 0.05). There were also significantly fewer electrosurgical incisions made during the mesna ESD than with conventional ESDs (median; 65 vs. 183 times, P < 0.01).
  
  
  CONCLUSIONS
  Mesna ESD for SESCCs is a safe procedure with the potential to facilitate esophageal ESD.
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan. akira.dobashi@nifty.com.
authors.forename: Akira
authors.initials: A
authors.lastname: Dobashi
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goda
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Masakuni
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Tomohiko R
authors.initials: TR
authors.lastname: Ohya
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Toyoizumi
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Epidemiology, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.affiliation: Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.|Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi Shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004210:Dissection / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005100:Expectorants / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D015080:Mesna / Q000008:administration & dosage*; D008875:Middle Aged; D009092:Mucous Membrane / Q000601:surgery; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005100:Expectorants; D015080:Mesna
keywords: Endoscopic resection; Endoscopic submucosal dissection; Mechanical submucosal dissection; Mesna; Superficial esophageal squamous cell carcinoma