We have contrived and enforced the “Three-channeled method” as a new technique of ESD for the colonic tumors. In this study, we used scissors-shaped cutting device “SB knife, Jr type” (Sumitomo Bakelite Co.,Ltd) which had developed for colorectal use.
“Three-channeled method” is worked out as one kind of counter-traction technique, which use two-channeled colonoscope, added the third channel outside the scope. Through these channels, we can use some different type of devices to enforce the operations, to say, local injection, lifting up and dissection of the tumor. With this method, we can get a wide view of dissecting field, and SB knife will contribute for more safe cutting procedure, because it works mainly in pulling back action.
Five cases of colonic ESD using the “Three-channeled method with SB knife” is discussed in this study. The mean diameter of removal tissue is 37.6mm and the average removing time is 57.4 minutes, which reveals no statistical difference from 79 cases of conventional method. We didn′t experienced any severe complications as perforations nor hemorrhages.
It judged that this technique is very useful in performing the colonic ESD more safely.

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Endoscopic submucosal dissection (ESD) has been recently introduced as a treatment option for colorectal tumor； however, the efficacy of ESD in treating residual or locally recurrent tumor occurring after endoscopic treatment has not been evaluated. To this effect, in the present study, we assessed the clinical outcomes of colorectal ESD for treating residual or locally recurrent tumor after endoscopic treatment.
Between April 2008 and May 2011, 97 consecutive colorectal tumors in 95 patients were treated using ESD. Of these 6 patients, each with 1 lesion, had residual or locally recurrent tumors with scars after endoscopic treatment (3 recurred after endoscopic mucosal resection, and the other 3 after transanal endoscopic microsurgery) . The rates of both en bloc and curative resection of the 6 lesions were 83.3%. On histological examinations, all lesions showed well-differentiated adenocarcinomas that were confined to the mucosa and had adenomatous components. A piecemeal-resected lesion of 1 patient was observed to be a local recurrence, which was easily treated by hot biopsy. Perforation occurred in 2 cases for which no additional surgical treatment was administered, and no other complications were seen.
Colorectal ESD for residual or locally recurrent tumor with scar occurring after endoscopic treatment is a technically difficult procedure and should be considered carefully when it is weighed with other choices of treatment.
Although we have observed excellent en bloc and curative resection rates, perforation occurred in 2 cases because of the difficulty of the procedure. This finding implies that colorectal ESD for residual or locally recurrent tumors with scars occurring at the same site of a previous endoscopic treatment may be relative indication.

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Background :
In chemoradiotherapy (CRT) for treatment of esophageal cancer, complete response (CR) of the primary lesion could be a surrogate marker of good prognosis. We retrospectively analyzed the association between the response of primary lesion and the clinical outcomes of advanced esophageal cancer following the CRT.
Patients and Methods :
Twenty-eight patients underwent definitive CRT for advanced esophageal cancer between January 2009 and October 2010 at Kanagawa Cancer Center. Among these patients, 15 patients were further reviewed since they fulfilled the following criteria : 1) completion of the CRT course for squamous cell carcinoma of thoracic esophagus, 2) completion of the planned endoscopic examination, 3) confirmation of the disease progression or follow-up for more than 6 months after completing the treatment. Endoscopic evaluation of the primary lesion was performed at the two time points. One was after the CRT, while another was after the boost chemotherapy. According to the Guidelines for the Clinical and Pathological Studies on Carcinoma of the Esophagus (The 10th Edition) , the patients were categorized into primary-CR and non-CR groups. Statistics were performed by Kaplan-Meier method, Log-rank test, and Chi-square test. The data were analyzed in February 2011.
Result :
The characteristics of 17 patients were as follows : median age, 65 years ; male/female, 14/1 ; Stage (UICC) IIA/III/IVa/IVb, 1/11/1/2 Patients. After the first evaluation, only 4 exhibited CR at the primary site (primary CR) . Finally, 7 were diagnosed with primary CR after the boost chemotherapy. Median survival time was 414 days (range, 150-641 days) . Primary CR group showed good outcome in median survival and progression-free survival (442 days ; range,291-641, and 334 days ; range,231-604 days, respectively) compared with primary non-CR group (309 days ; range,150-490, and 175days ; range, 101-490 days, respectively) , with statistic significance (p＝0.010 and 0.035, respectively) .
Discussion :
In our study, the primary-CR group tended to show better outcome than the non-CR group. The primary CR could be a surrogate marker for good prognosis in CRT for esophageal cancer, as previously reported. Primary-CR was confirmed after the boost chemotherapy in about half of the group. Close and careful endoscopic follow-up should be continued when the evaluation cannot be confirmed.

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The aim of the present study was to evaluate risk factors of lymph node metastasis of colorectal carcinoid tumor in less than 20mm diameter and significance of specific staining method when assessing their lymphatic and venous invasion.
A total of 51 cases with colorectal carcinoid tumor were resected endoscopically or surgically from April 2001 to April 2010. We clinicopathologically investigated them focusing on risk factors of lymph node metastasis. We also evaluated relasionships between “lymphatic and venous invasion” and nodal metastasis with both standard HE 2staining method and specific staining method (D2-40 and Victoria blue VB) .
As a result, metastatic factors of colorectal carcinoid were considered to be reddish color, semipedunculated form, depression of tumor surface, lymphatic invasion and venous invasion with statistical significance (P<0.05) . As for relashionship between “lymphatic and venous invasion” and nodal metastasis, specific staining method revealed less specificity with statistical significance (P<0.05) than standard HE staining method.
These results indicate that “lymphatic and venous invasion” are important risk factors of lymph node metastasis in colorectal carcinoid tumor under 20mm in size, however the significance of “lymphatic and venous invasion” with specific staining method needs much more discussion.

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