Luis F Giraldo-Cadavid - Profile on Academia.edu (original) (raw)

Papers by Luis F Giraldo-Cadavid

Plants

The use of cannabis and cannabinoid products for the treatment of neuropathic pain is a growing a... more The use of cannabis and cannabinoid products for the treatment of neuropathic pain is a growing area of research. This type of pain has a high prevalence, limited response to available therapies and high social and economic costs. Systemic cannabinoid-based therapies have shown some unwanted side effects. Alternative routes of administration in the treatment of neuropathic pain may provide better acceptance for the treatment of multiple pathologies associated with neuropathic pain. To examine the efficacy, tolerability, and safety of cannabinoids (individualized formulations, phytocannabinoids, and synthetics) administered by routes other than oral or inhalation compared to placebo and/or conventional medications in the management of neuropathic pain. This systematic review of the literature reveals a lack of clinical research investigating cannabis by routes other than oral and inhalation as a potential treatment for neuropathic pain and highlights the need for further investigatio...

Respiratory Care

BACKGROUND: COPD is diagnosed by using FEV 1 /FVC, which has limitations as a diagnostic test. We... more BACKGROUND: COPD is diagnosed by using FEV 1 /FVC, which has limitations as a diagnostic test. We assessed the validity of several measures derived from the expiratory phase of the flow-volume curve obtained from spirometry to diagnose COPD: the slopes that correspond to the volume expired after the 50% and 75% of the FVC, the slope formed between the peak expiratory flow (PEF) and the FVC, and the area under the expiratory flow/volume curve. METHODS: We conducted a cross-sectional diagnostic test study in 765 consecutive subjects referred for spirometry because of respiratory symptoms. We compared the reproducibility and accuracy of the proposed measures against post-bronchodilator FEV 1 /FVC < 0.70. We also evaluated the proportion of respiratory symptoms for the FEV 1 /FVC, FEV 1 per FEV in the first 6 s (FEV 6), and the PEF slope. RESULTS: The subjects had a mean age of 65.8 y, 57% were women, and 35% had COPD. The testretest intraclass correlation coefficient values were 0.89, 0.85, and 0.83 for FEV 1 /FVC, FEV 1 /FEV 6 , and the PEF slope, respectively. The area under the curve values were 0.93 (expiratory flow/volume), 0.96 (potential expiratory flow/volume), 0.97 (potential expiratory flow/volume at 75% of FVC), and 0.82 (potential expiratory flow/volume at 50% of FVC). The area under the receiver operating characteristic curve was 0.

Cost‐utility analysis of an integrated care program for children with asthma in a medium‐income country

Pediatric Pulmonology, 2020

To evaluate the cost‐utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for c... more To evaluate the cost‐utility of an integrated care program (ASMAIRE Infantil Program [PAI]) for children with asthma compared with standard of care.

International Journal of Environmental Research and Public Health

Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive upper airway... more Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive upper airway obstruction, intermittent hypoxemia, and recurrent awakenings during sleep. The most used treatment for this syndrome is a device that generates a positive airway pressure—Continuous Positive Airway Pressure (CPAP), but it works continuously, whether or not there is apnea. An alternative consists on systems that detect apnea episodes and produce a stimulus that eliminates them. Article focuses on the development of a simple and autonomous processing system for the detection of obstructive sleep apneas, using polysomnography (PSG) signals: electroencephalography (EEG), electromyography (EMG), respiratory effort (RE), respiratory flow (RF), and oxygen saturation (SO2). The system is evaluated using, as a gold standard, 20 PSG tests labeled by sleep experts and it performs two analyses. A first analysis detects awake/sleep stages and is based on the accumulated amplitude in a channel-depen...

Acta Médica Colombiana, 2014

Se presenta el caso de una mujer de 59 años con diagnóstico de encefalopatía anóxico-isquémica, q... more Se presenta el caso de una mujer de 59 años con diagnóstico de encefalopatía anóxico-isquémica, quien se encuentra en estado vegetativo persistente y epilepsia secundaria de difícil control, quien en el transcurso de su evolución clínica desarrolla apnea central del sueño con índice de apnea hipopnea (IAH) de 87.86/h con patrón de respiración de Cheyne-Stokes (RCS) y bruxismo severo documentado mediante polisomnografía, alteraciones que mejoraron tras la administración de oxigeno por cánula nasal a 1 L/min. La asociación de bruxismo con respiración de Cheyne-Stokes y la respuesta simultánea y completa de las dos alteraciones a la administración de oxigeno suplementario no ha sido reportada previamente

Dysphagia, 2016

Dysphagia might affect 12 % of the general population, and its complications include pneumonia, m... more Dysphagia might affect 12 % of the general population, and its complications include pneumonia, malnutrition, social isolation, and death. No validated Spanish symptom survey exists to quantify dysphagia symptoms among Latin Americans. Therefore, we performed a prospective cohort study in a tertiary care university hospital to validate the Spanish version of the 10-Item Eating-Assessment-Tool (EAT-10 spa) for use in Colombia. After an interdisciplinary committee of five bilingual specialists evaluated the EAT-10 spa (translated and validated in Spain) and deemed it appropriate for the Colombian culture, its feasibility, reliability, validity, sensitivity to change, and diagnostic capacity were evaluated. As a reference standard, we used the flexible endoscopic evaluation of swallowing with sensory testing and a standardized clinical evaluation. All assessments were blinded. In total, 133 subjects were included (52 % women, mean age 55 years) and completed the EAT-10 spa (median completion time: 2 min [IQR 1-3 min]), 39 % of whom had an elementary-level education. Cronbach's a coefficient: 0.91; test-retest intra-class correlation coefficient: 0.94. The Spearman's correlation coefficient of the EAT-10 spa with the 8-point penetration-aspiration scale was 0.54 (P \ 0.001). The area under the receiver-operating-characteristic-curve (AUC-ROC) for dysphagia and aspiration were 0.79 (P \ 0.001) and 0.81 (P \ 0.001), respectively. The best cutoff points for dysphagia and aspiration were EAT-10 spa C2 (sensitivity 93.6 %, specificity 36.4 %) and EAT-10 spa C4 (sensitivity 94.3 %, specificity 49.5 %), respectively. A reduction in the EAT-10 C3 was the best cutoff point for a clinically significant improvement (AUC-ROC 0.83; P \ 0.0001). The EAT-10 spa showed excellent psychometric properties and discriminatory capacity for use in Colombia.

Design of an electronic device for the measurement of respiratory signals

2021 4th International Conference on Bio-Engineering for Smart Technologies (BioSMART), 2021

Respiratory problems while sleeping cause several health effects, thus it becomes important to mo... more Respiratory problems while sleeping cause several health effects, thus it becomes important to monitor respiratory signals to search the causes or moments when said health effects occur. This paper presents the design of an electronic system that first measures, then is instrumented and finally captures signals related to breathing: nasal flow and chest and abdomen respiratory effort. The designed device achieves the visualization of the previously mentioned signals through the Matlab software for its subsequent analysis, ensuring that the system can detect apnea and hypopnea events based solely on the respiratory signals.

F1000Research, 2021

Obstructive sleep apnoea-hypopnoea syndrome (OSA) is a respiratory disorder characterised by repe... more Obstructive sleep apnoea-hypopnoea syndrome (OSA) is a respiratory disorder characterised by repetitive obstruction of the upper airway, leading to several interruptions during sleep. It is currently one of the main public health problems worldwide and one of the main cardiovascular risk factors in developed and intermediate developing countries, whose populations are increasing in rates of obesity and age. One of the common treatments for OSA is a continuous positive airway pressure (CPAP) device, which pumps air through a hose, reaches a mask that the patient has over his or her nose and travels the airway, keeping the upper airway open during sleep and avoiding episodes of airway collapse. The problem is that CPAP is not accepted by some patients due to a lack of adaptation, so alternative treatments may be needed. For some years, there have been explorations of treatments related to electrical stimulation of the muscles of the upper airway as therapy to reduce the number of epis...

Analysis of biological signals through LabVIEW software with possible application in the measurement of variables related to sleep apnea syndrome

Obstructive sleep apnea (OSA) is a disorder that primarily affects the respiratory system and occ... more Obstructive sleep apnea (OSA) is a disorder that primarily affects the respiratory system and occurs during the sleep period. (OSA) is a respiratory disorder related to common sleep, characterized by repetitive obstruction of the upper airway, intermittent hypoxemia and recurrent awakenings during sleep. The absence of this stimulus generates a lack of respiratory effort, because the diaphragm muscle is not being stimulated. People with this disorder increase the risk of suffering fatigue, daytime sleepiness, psychological disorders, cardiovascular problems and respiratory and physical weakness, among many others. For this reason, the present project presents an electronic device that allows the measurement and / or detection of physical variables related to the diagnosis of OSA, using LabVIEW software. The developed device is non-invasive, designed to measure the distance of the thoracic cavity, the nasal temperature, the respiratory flow and the sound produced by the snoring origi...

European Archives of Oto-Rhino-Laryngology, 2017

laryngeal-adductor reflex threshold (LART), cough reflex threshold (CRT) and gag reflex threshold... more laryngeal-adductor reflex threshold (LART), cough reflex threshold (CRT) and gag reflex threshold (GRT) using the LPEER. We assessed the Bland-Altman limits of agreement, the intraclass correlation coefficients (ICCs) and Spearman correlation coefficients (SCCs). For the inter-rater comparisons, we contrasted the expert and novel raters. A total of 1608 measurements were obtained from 34 dysphagic stroke patients and 33 non-dysphagic patients. The intra-rater ICCs for all reflex thresholds were >0.90. The inter-rater ICCs were 0.87 for the LART, 0.79 for the CRT and 0.70 for the GRT. The intra-rater SCCs for all reflex thresholds were above 0.88 (P < 0.0001). The inter-rater SCC were 0.80 for the LART, 0.79 for the CRT and 0.70 for the GRT (all P < 0.0001). The Bland-Altman plots revealed good agreement for the LART and CRT and moderate agreement for the GRT. The median normal value was 0.14 mN for the LART, 4.4 mN for the CRT and 11.9 mN for the GRT. The median thresholds values in patients with aspiration were LART: 1.31 mN; CRT: 32.9 mN and GRT: 32.9 mN (all P < 0.006 vs normal thresholds). The LPEER exhibited substantial to excellent intra-and inter-rater reliability.

BioMedical Engineering OnLine, 2016

Background: Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, ... more Background: Laryngo-pharyngeal mechano-sensitivity (LPMS) is involved in dysphagia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because it assesses only the laryngeal adductor reflex during fiber-optic endoscopic evaluations of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity. We designed, developed and validated a new air-pulse laryngo-pharyngeal endoscopic esthesiometer with a built-in laser range-finder (LPEER) based on the evaluation and control of air-pulse variability determinants and on intrinsic observer variability and subjectivity determinants of the distance, angle and site of stimulus impact. The LPEER was designed to be capable of delivering precise and accurate stimuli with a wide range of intensities that can explore most laryngo-pharyngeal reflexes. We initially explored the potential factors affecting the reliability of LPMS tests and included these factors in a multiple linear regression model. The following factors significantly affected the precision and accuracy of the test (P < 0.001): the tube conducting the air-pulses, the supply pressure of the system, the duration of the air-pulses, and the distance and angle between the end of the tube conducting the air-pulses and the site of impact. To control all of these factors, an LPEER consisting of an air-pulse generator and an endoscopic laser range-finder was designed and manufactured. We assessed the precision and accuracy of the LPEER's stimulus and range-finder according to the coefficient of variation (CV) and by looking at the differences between the measured properties and the desired values, and we performed a pilot validation on ten human subjects. The air-pulses and range-finder exhibited good precision and accuracy (CV < 0.06), with differences between the desired and measured properties at <3 % and a range-finder measurement error of <1 mm. The tests in patients demonstrated obtainable and reproducible thresholds for the laryngeal adductor, cough and gag reflexes. The new LPEER was capable of delivering precise and accurate stimuli for exploring laryngo-pharyngeal reflexes.

Biomédica, 2012

Bastidas intervinieron en el diagnóstico y manejo del paciente, redacción de la historia clínica,... more Bastidas intervinieron en el diagnóstico y manejo del paciente, redacción de la historia clínica, discusión y revisión del documento final. Carlos Vélez y María R. Forero intervinieron en la redacción de la historia clínica, consecución de las imágenes y redacción del documento.

13th IEEE International Conference on BioInformatics and BioEngineering, 2013

Factors determining the variability of air-pulse pressure to determine the thresholds of laryngea... more Factors determining the variability of air-pulse pressure to determine the thresholds of laryngealpharyngeal reflexes, which are related to swallowing and airway protection, were explored. Potential factors affecting the reproducibility of air-pulses were experimentally evaluated and included in a multiple linear regression model. A novel device controlling these factors and minimizing variability was designed. Its reproducibility was assessed by the coefficient of variation (CV) of the pressures and duration of air-pulses, and its validity was assessed by comparing obtained pressures and durations with desired pressures and durations. Differences in the pressures of airpulse categories were assessed by a one-way ANOVA of repeated measures, a Tukey test and a box and whisker plot. The distance and angle between the exit of the tube conducting the pulses and the surface to be impacted, the diameter of the tube, the feeding pressure of the system, and the duration of air-pulses significantly affected the accuracy of air-pulses. The novel device incorporated electronic valves and a telemeter for use during the fiberoptic endoscopic evaluation of swallowing. The differences between the desired and obtained pressures and durations were below 3%. The CV of the air-pulse pressures of the novel device was 0.02. The CV of air-pulse duration was 0.05. The oneway ANOVA, Tukey test and box and whisker plot showed that the outlet pressures of air-pulse categories had statistically significant differences between them without overlap between categories, which helps to obtain an accurate threshold.

Respiratory Research, 2020

Background The disposable bronchoscope is an excellent alternative to face the problem of SARS-Co... more Background The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. Methods To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. Results The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 9...

Aspiration in the Fiberoptic Endoscopic Evaluation of Swallowing Associated with an Increased Risk of Mortality in a Cohort of Patients Suspected of Oropharyngeal Dysphagia

Dysphagia

There is a general lack of published studies on the risk of mortality due to alterations in the s... more There is a general lack of published studies on the risk of mortality due to alterations in the safety of swallowing detected during the fiberoptic endoscopic evaluation of swallowing (FEES). We aimed at assessing the risk of mortality of the detection of aspiration, penetration, and pharyngeal residues by FEES. A cohort of consecutively evaluated patients suspected of experiencing oropharyngeal dysphagia undergoing FEES at a tertiary care university hospital were prospectively followed up on to assess mortality. The FEES findings, comorbidities, and potential confounders were studied as predictors of death using a Cox multivariate regression analysis. A total of 148 patients were included, 85 of whom were male (57.4%). The mean age (± standard deviation) was 52.7 years (± 22.1). The median of the follow-up time was 4.5 years. The most frequent conditions were stroke in 50 patients (33.8%), brain and spine traumas in 27 (18.2%), and neurodegenerative diseases in 19 (12.8%). Variables associated with mortality in bivariate analyses were age > 65 years ( p < 0.001), pneumonia ( p = 0.046), aspiration of any consistency ( p < 0.001), and pharyngeal residues ( p = 0.017). Variables independently associated with mortality in the Cox multivariate model were age (> 65 years) [adjusted hazard ratio (HR) 5.76; 95% CI 2.72 to 17.19; p = 0.001] and aspiration (adjusted HR: 3.96; 95% CI 1.82 to 14.64; p = 0.003). Aspiration detected by FEES and an age > 65 years are independent predictors of mortality in patients with oropharyngeal dysphagia.

High prevalence of house dust mite sensitization in children with severe asthma living at high altitude in a tropical country

Pediatric Pulmonology

Some studies, mainly in Europe, have shown a low level of sensitization to house dust mite (HDM) ... more Some studies, mainly in Europe, have shown a low level of sensitization to house dust mite (HDM) allergens at high altitude (HA). Differently, some others in tropical countries have shown a higher level. The aim of this study was to evaluate allergens sensitization, including HDM, in children with severe asthma (SA), residents at HA in a tropical middle‐income developing country.

Accuracy of a Laryngopharyngeal Endoscopic Esthesiometer (LPEER) for Evaluating Laryngopharyngeal Mechanosensitivity: A Validation Study in a Prospectively Recruited Cohort of Patients

Dysphagia, Feb 27, 2017

Recent studies have shown an association between alterations in laryngopharyngeal mechanosensitiv... more Recent studies have shown an association between alterations in laryngopharyngeal mechanosensitivity (LPMS) and dysphagia, obstructive sleep apnea, and chronic cough hypersensitivity syndrome. A previous reliability study of a new laryngopharyngeal endoscopic esthesiometer and rangefinder (LPEER) showed high intra- and inter-rater reliability; however, its accuracy has not been tested. We performed an accuracy study of the LPEER in a prospectively and consecutively recruited cohort of 118 patients at two tertiary care university hospitals. Most of the patients were suffering from dysphagia, and all of them underwent a standard clinical evaluation and fiberoptic endoscopic evaluation of swallowing with sensory testing (FEESST) using a new sensory testing protocol. The sensory test included determinations of the laryngeal adductor reflex threshold (LART), the cough reflex threshold (CRT) and the gag reflex threshold (GRT). Abnormalities on these reflex thresholds were evaluated for as...

Reliability of a laryngo-pharyngeal esthesiometer and a method for measuring laryngo-pharyngeal mechano-sensitivity in a prospectively recruited cohort of patients

There are not reliable methods for measuring laryngo-pharyngeal mechano-sensitivity (LPMS). We ai... more There are not reliable methods for measuring laryngo-pharyngeal mechano-sensitivity (LPMS). We aimed to determine the reliability of a new method for measuring LPMS using a new laryngo-pharyngeal esthesiometer (LPEER) in a prospective cohort of dysphagic stroke and non-dysphagic patients. The patients underwent clinical and endoscopic evaluations of swallowing (FESSST). The LPMS assessments consisted of measurements by an expert and a novel rater of the laryngeal-adductor reflex threshold (LART), cough reflex threshold (CRT) and gag reflex threshold (GRT) using the LPEER. We assessed the Bland–Altman limits of agreement, the intraclass correlation coefficients (ICCs) and Spearman correlation coefficients (SCCs). For the inter-rater comparisons, we contrasted the expert and novel raters. A total of 1608 measurements were obtained from 34 dysphagic stroke patients and 33 non-dysphagic patients. The intra-rater ICCs for all reflex thresholds were >0.90. The inter-rater ICCs were 0.87 for the LART, 0.79 for the CRT and 0.70 for the GRT. The intra-rater SCCs for all reflex thresholds were above 0.88 (P < 0.0001). The inter-rater SCC were 0.80 for the LART, 0.79 for the CRT and 0.70 for the GRT (all P < 0.0001). The Bland–Altman plots revealed good agreement for the LART and CRT and moderate agreement for the GRT. The median normal value was 0.14 mN for the LART, 4.4 mN for the CRT and 11.9 mN for the GRT. The median thresholds values in patients with aspiration were LART: 1.31 mN; CRT: 32.9 mN and GRT: 32.9 mN (all P < 0.006 vs normal thresholds). The LPEER exhibited substantial to excellent intra- and inter-rater reliability.

Background: Laryngo‑pharyngeal mechano‑sensitivity (LPMS) is involved in dyspha‑ gia, sleep apnea... more Background: Laryngo‑pharyngeal mechano‑sensitivity (LPMS) is involved in dyspha‑ gia, sleep apnea, stroke, irritable larynx syndrome and cough hypersensitivity syndrome among other disorders. These conditions are associated with a wide range of airway reflex abnormalities. However, the current device for exploring LPMS is limited because it assesses only the laryngeal adductor reflex during fiber‑optic endoscopic evalua‑ tions of swallowing and requires a high degree of expertise to obtain reliable results, introducing intrinsic expert variability and subjectivity. Methods: We designed, developed and validated a new air‑pulse laryngo‑pharyngeal endoscopic esthesiometer with a built‑in laser range‑finder (LPEER) based on the eval‑ uation and control of air‑pulse variability determinants and on intrinsic observer vari‑ ability and subjectivity determinants of the distance, angle and site of stimulus impact. The LPEER was designed to be capable of delivering precise and accurate stimuli with a wide range of intensities that can explore most laryngo‑pharyngeal reflexes. Results: We initially explored the potential factors affecting the reliability of LPMS tests and included these factors in a multiple linear regression model. The following factors significantly affected the precision and accuracy of the test (P < 0.001): the tube con‑ ducting the air‑pulses, the supply pressure of the system, the duration of the air‑pulses, and the distance and angle between the end of the tube conducting the air‑pulses and the site of impact. To control all of these factors, an LPEER consisting of an air‑pulse generator and an endoscopic laser range‑finder was designed and manufactured. We assessed the precision and accuracy of the LPEER's stimulus and range‑finder accord‑ ing to the coefficient of variation (CV) and by looking at the differences between the measured properties and the desired values, and we performed a pilot validation on ten human subjects. The air‑pulses and range‑finder exhibited good precision and accuracy (CV < 0.06), with differences between the desired and measured properties at <3 % and a range‑finder measurement error of <1 mm. The tests in patients demonstrated obtain‑ able and reproducible thresholds for the laryngeal adductor, cough and gag reflexes. Conclusions: The new LPEER was capable of delivering precise and accurate stimuli for exploring laryngo‑pharyngeal reflexes.

Therapeutic outcomes of endoscopic submucosal dissection of differentiated early gastric cancer in a Western endoscopy setting (with video)

Gastrointestinal Endoscopy, 2015

Large multicenter gastric cancer endoscopic submucosal dissection (ESD) studies conducted at majo... more Large multicenter gastric cancer endoscopic submucosal dissection (ESD) studies conducted at major Japanese institutions have reported en bloc resection, en bloc tumor-free margin resection, and curative resection rates of 92.7% to 96.1%, 82.6% to 94.5%, and 73.6% to 85.4%, respectively, with delayed bleeding and perforation rates of 0.6% to 6.0% and 3.6% to 4.7%, respectively. Although ESD is currently an alternative treatment in some countries, particularly in Asia, it remains uncertain whether ESD therapeutic outcomes in Western endoscopy settings can be comparable to those achieved in Japan. To evaluate the ESD therapeutic outcomes for differentiated early gastric cancer (EGC) in a Western endoscopy setting. Consecutive case series performed by an expertly trained Western endoscopist. Fifty-three patients with 54 lesions. ESD for early gastric cancers (T1) satisfying expanded inclusion criteria. En bloc resection, en bloc tumor-free margin resection, and curative resection rates were 98%, 93%, and 83%, respectively. The delayed bleeding rate was 7%, and the perforation rate was 4%. The mean patient age was 67 years, and the mean tumor size was 19.8 mm, with 54% of the lesions located in the lesser curvature. The median procedure time was 61 minutes, with ESD procedures 60 minutes or longer associated with submucosal fibrosis (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001) and tumor size 25 mm or larger (P = .03). In every ESD procedure, both circumferential incision and submucosal dissection were performed by using a single knife. Two of the 4 delayed bleeding cases required surgery, and all perforations were successfully managed by using endoscopic clips. Long-term outcome data are currently unavailable. ESD for differentiated EGC resulted in favorable therapeutic outcomes in a Western endoscopy setting comparable to those achieved at major Japanese institutions.