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Justiniano CF, Ozgur I, Liska D, Valente MA, Steele SR, Gorgun E. The role of advanced endoscopy in appendiceal polyp management and outcomes. Surg Endosc 2024; 38:2267-2272. [PMID: 38438673 PMCID: PMC10978627 DOI: 10.1007/s00464-024-10726-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/28/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Appendiceal orifice lesions are often managed operatively with limited or oncologic resections. The aim is to report the management of appendiceal orifice mucosal neoplasms using advanced endoscopic interventions. METHODS Patients with appendiceal orifice mucosal neoplasms who underwent advanced endoscopic resections between 2011 and 2021 with either endoscopic mucosal resection (EMR), endoscopic mucosal dissection (ESD), hybrid ESD, or combined endoscopic laparoscopic surgery (CELS) were included from a prospectively collected dataset. Patient and lesion details and procedure outcomes are reported. RESULTS Out of 1005 lesions resected with advanced endoscopic techniques, 41 patients (4%) underwent appendiceal orifice mucosal neoplasm resection, including 39% by hybrid ESD, 34% by ESD, 15% by EMR, and 12% by CELS. The median age was 65, and 54% were male. The median lesion size was 20 mm. The dissection was completed piecemeal in 49% of patients. Post-procedure, one patient had a complication within 30 days and was admitted with post-polypectomy abdominal pain treated with observation for 2 days with no intervention. Pathology revealed 49% sessile-serrated lesions, 24% tubular adenomas, and 15% tubulovillous adenomas. Patients were followed up for a median of 8 (0-48) months. One patient with a sessile-serrated lesion experienced a recurrence after EMR which was re-resected with EMR. CONCLUSION Advanced endoscopic interventions for appendiceal orifice mucosal neoplasms can be performed with a low rate of complications and early recurrence. While conventionally lesions at the appendiceal orifice are often treated with surgical resection, advanced endoscopic interventions are an alternative approach with promising results which allow for cecal preservation.
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Affiliation(s)
- Carla F Justiniano
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Ilker Ozgur
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - David Liska
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Michael A Valente
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Scott R Steele
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Zhang YX, Liu X, Gu F, Ding SG. Planned Hybrid Endoscopic Submucosal Dissection as Alternative for Colorectal Neoplasms: A Propensity Score-Matched Study. Dig Dis Sci 2024; 69:949-960. [PMID: 38218733 DOI: 10.1007/s10620-023-08195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/09/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND AND AIMS Hybrid endoscopic submucosal dissection (H-ESD), a modified ESD with a snare, has become increasingly utilized to overcome the limitations of conventional ESD (C-ESD). This study aimed to compare the efficacy and safety of Planned H-ESD and C-ESD for colorectal lesions. METHODS Propensity score matching was performed to control for confounding variables in this retrospective study. Outcomes included en bloc resection and complete resection (R0) rates, procedure time, adverse event rates, and local recurrence rate. RESULTS 1286 lesions were enrolled in the study. After matching, 263 lesions were assigned to each group. The Planned H-ESD group has lower en bloc rate but similar R0 resection rate compared to the C-ESD group (90.9% vs 98.1%, P = 0.001; 77.2% vs 77.9%, P = 0.917). The median procedure time was shorter in the Planned H-ESD group (27.0 min vs 35.0 min, P = 0.001). There were no significant differences in adverse events rates or local recurrence rate. Subgroup analysis based on lesion size revealed that a significantly lower en bloc resection rate in the Planned H-ESD group compared to the C-ESD group for lesions ≥ 40 mm (71.0% vs 94.3%, P = 0.027), but there was no significant difference for lesions < 40 mm. CONCLUSION The Planned H-ESD has a lower en bloc resection rate but a similar R0 resection rate, adverse event rates, local recurrence rate, and shorter procedure duration. Compared to C-ESD, Planned H-ESD presents advantages for managing colorectal neoplasms below 40 mm.
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Affiliation(s)
- Yu-Xin Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing, 100191, China
| | - Xun Liu
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing, 100191, China
| | - Fang Gu
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing, 100191, China
| | - Shi-Gang Ding
- Department of Gastroenterology, Peking University Third Hospital, Beijing, 100191, China.
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing, 100191, China.
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Yamaguchi H, Fukuzawa M, Kawai T, Muramatsu T, Matsumoto T, Uchida K, Koyama Y, Madarame A, Morise T, Kono S, Naito S, Nagata N, Sugimoto M, Itoi T. Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases. Clin Endosc 2023; 56:778-789. [PMID: 37491992 PMCID: PMC10665627 DOI: 10.5946/ce.2022.268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND/AIMS Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). METHODS We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. RESULTS Resection time was significantly shorter in the following order: RH-ESD (149 [90-197] minutes) >C-ESD (90 [60-140] minutes) >SH-ESD (52 [29-80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%-30%]) than in the en bloc resection group (40% [20%-60%]). CONCLUSION RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.
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Affiliation(s)
- Hayato Yamaguchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Kawai
- Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takahiro Muramatsu
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Taisuke Matsumoto
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Kumiko Uchida
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Yohei Koyama
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Akira Madarame
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Morise
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Shin Kono
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Sakiko Naito
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Naoyoshi Nagata
- Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
| | | | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Sun J, Xie X, Liu Y, Hao X, Yang G, Zhang D, Nan Q. Complications after endoscopic submucosal dissection for early colorectal cancer (Review). Oncol Lett 2023; 25:264. [PMID: 37216158 PMCID: PMC10193368 DOI: 10.3892/ol.2023.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Colorectal cancer (CRC) is a gastrointestinal malignancy that seriously threatens human life and health, resulting in a heavy disease burden. Endoscopic submucosal dissection (ESD) is widely used in clinical practice and is an effective treatment for early CRC (ECC). Colorectal ESD is a challenging operation, and the incidence of postoperative complications is relatively high because of the thin intestinal wall and limited space for endoscopic operations. Systematic reports on the postoperative complications of colorectal ESD, such as fever, bleeding and perforation, from both China and elsewhere are lacking. In the present review, progress in research on postoperative complications after ESD for ECC is summarized.
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Affiliation(s)
- Jianhui Sun
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Xinyuan Xie
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Yangcheng Liu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
| | - Xianglin Hao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Gang Yang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
| | - Dan Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
- Graduate School of Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, P.R. China
- Yunnan Provincial Clinical Research Center for Digestive Diseases, Kunming, Yunnan 650032, P.R. China
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5
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Wu X, Ye C, Cao Z, Hu X, Pan W, Jing J. Comparison of the Effectiveness and Safety of Different Methods of Colorectal Endoscopic Submucosal Dissection: A Systematic Review and Network Meta-Analysis. Dig Dis 2021; 40:796-809. [PMID: 34937035 DOI: 10.1159/000521377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Traditional endoscopic submucosal dissection (ESD) has developed different methods, such as pocket method (P-ESD), traction-assisted method (T-ESD), and hybrid method (H-ESD). In this meta-analysis, the benefits and drawbacks of different ESD methods were discussed and ranked. STUDY DESIGN Studies comparing different methods of colorectal ESD were searched by using PubMed, EMBASE, and Cochrane Library databases. The study was conducted for five endpoints: en bloc resection rate, R0 resection rate, operation time, dissection speed, and adverse events rate. Pairwise and network meta-analyses were performed through Rev Man 5.4 and Stata 16.0. The quality of all included studies was assessed using the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale. RESULTS Twenty-six studies met the inclusion criteria, including 7 RCTs and 19 non-RCTs, with a total of 3,002 patients. The pooled analysis showed that the en bloc resection rate of H-ESD was significantly lower than that of C-ESD, P-ESD, and T-ESD (RR = 0.28, 95% CI [0.12, 0.65]; RR = 0.11, 95% CI [0.03, 0.44]; RR = 8.28, 95% CI [2.50, 27.42]). Compared with C-ESD, the operation time of H-ESD and T-ESD was significantly shorter (MD = -21.83, 95% CI [-34.76, -8.90]; MD = -23.8, 95% CI [-32.55, -15.06]). Meanwhile, the operation time of T-ESD was also significantly shorter than that of P-ESD (MD = -18.74, 95% CI [-31.93, -5.54]). The dissection speed of T-ESD was significantly faster than that of C-ESD (MD = 6.26, 95% CI [2.29, 10.23]). CONCLUSION P-ESD and T-ESD are probably the two best methods of colorectal ESD at present. The advantages of P-ESD are high en bloc resection rate and low incidence of adverse events. The advantages of T-ESD are rapid dissection and short operation time.
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Affiliation(s)
- Xueping Wu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenglong Ye
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhongsheng Cao
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangcheng Hu
- Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wensheng Pan
- Zhejiang Chinese Medical University, Hangzhou, China.,Department of Gastroenterology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiyong Jing
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
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Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study. Surg Endosc 2021; 36:1894-1902. [PMID: 33847798 DOI: 10.1007/s00464-021-08471-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Hybrid endoscopic submucosal dissection (ESD) is a colorectal lesion resection procedure that includes both planned and salvage procedures. Previous colorectal hybrid ESD studies have involved single institutions or few operators over a short timeframe, and the size for indication has not been established. In this multicentre study, we investigated the clinical outcomes of hybrid ESD for colorectal tumors that met the 30 mm lesion size criterion. METHODS From January 2008 to December 2018, colorectal hybrid ESD was performed for 172 lesions (diameter range, ≥ 20- < 30 mm) at Hiroshima GI Endoscopy Research Group. We compared clinicopathological characteristics and outcomes between 56 and 116 lesions in planned and salvage groups, respectively. We also compared data between 2008 and 2013 (the first period) and 2014 and 2018 (the second period) to assess operator experience. RESULTS No significant difference was found in the complete en bloc resection rate between the planned and salvage groups (92.9% vs. 83.6%, respectively). Procedure time was shorter in the planned group (44.5 min) than in the salvage group (72.0 min, p < 0.01). The perforation rate was higher in the salvage group (21.6%) than in the planned group (0%, p < 0.01); however, the perforation rate during snaring in the salvage group was 1.8%. During the second period relative to the first period, we recorded a significantly higher complete en bloc resection rate (95.7% vs. 75.6%, respectively, p < 0.01) and experienced operator rate (75.5% vs. 53.9%, respectively, p < 0.01). Furthermore, no significant difference was found in the complete en bloc resection rate between the planned and salvage groups during the second period (100% vs. 94.4%, respectively). CONCLUSION Colorectal hybrid ESD, especially salvage hybrid ESD performed by experienced operators, is adoptable and safe for lesions with diameters ranging from ≥ 20 to < 30 mm.
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Pushing the Envelope in Endoscopic Submucosal Dissection: Is It Feasible and Safe in Scarred Lesions? Dis Colon Rectum 2021; 64:343-348. [PMID: 33395142 DOI: 10.1097/dcr.0000000000001870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection is an established advanced polypectomy technique to manage large colorectal polyps. OBJECTIVE The purpose of this study was to evaluate patients who had endoscopic submucosal dissection in the setting of significant scarring attributed to a previous intervention to determine whether this is safe and feasible. DESIGN The study used a prospectively maintained database. SETTINGS A scarred lesion was defined as a nonlifting polyp with a history of previous attempted removal with endoscopic mucosal resection, snare, or biopsy where there was no suspicion of malignancy. PATIENTS All consecutive patients in the previous 14 months were included. INTERVENTION Endoscopic submucosal dissection was the study intervention. MAIN OUTCOME MEASURES Thirty-day morbidity and mortality, readmission, length of stay, and recurrence were measured. RESULTS Ninety-one patients had endoscopic submucosal dissection over a 14-month period with a median polyp size of 31.5 mm (range, 20-45 mm). Eleven patients (12%) were confirmed as having significant scar. There were significantly more previous endoscopic mucosal resections in the scarred group (scarred: 63.6% vs nonscarred: 2.5%; p < 0.001). Significantly more of the scarred patients had their endoscopic submucosal dissection in the operating room versus the endoscopy suite (scarred: 82.0% vs nonscarred: 17.5%; p < 0.001). The 30-day morbidity rate was 18.7%. There were no mortalities. There was no difference in 30-day morbidity between scarred and nonscarred lesions (scarred: 9% vs nonscarred: 20%; p = 0.4). There were more day-case procedures in the nonscarred group (nonscarred: 93.7% vs scarred: 36.4%; p < 0.001). There was no malignancy on final pathology in the scarred group. There was no difference in readmission rate between the scarred and nonscarred lesions. The overall follow-up colonoscopy rate was 53%, and there were no polyp recurrences identified. LIMITATIONS The study was limited by its small sample size, single institute, surgeon experience, and short follow-up. CONCLUSIONS Not only is endoscopic submucosal dissection in patients who have scarred lesions technically feasible and safe, it avoids a bowel resection in the majority of patients who have exhausted other advanced endoscopy techniques. See Video Abstract at http://links.lww.com/DCR/B427. EMPUJAR EL SOBRE EN LA DISECCIN ENDOSCPICA SUBMUCOSA ES FACTIBLE Y SEGURO EN LESIONES CICATRIZADAS ANTECEDENTES:La disección endoscópica submucosa es una técnica de polipectomía avanzada establecida para tratar pólipos colorrectales grandes.OBJETIVO:Evaluar a pacientes que se sometieron a disección submucosa endoscópica en el contexto de cicatrices significativas debido a una intervención previa para determinar si esto es seguro y factible.DISEÑO:Base de datos mantenida prospectivamente.AJUSTE:Una lesión cicatrizada se definió como un pólipo que no se levanta con antecedentes de intento de extirpación previa con resección endoscópica de la mucosa, lazo o biopsia, donde no había sospecha de malignidad.PACIENTES:Todos los pacientes consecutivos en los últimos 14 meses.INTERVENCIÓN:Disección submucosa endoscópica.MEDIDAS DE RESULTADOS PRINCIPALES:Morbilidad y mortalidad a 30 días, reingreso, duración de la estadía, recurrencia.RESULTADOS:Noventa y un pacientes tuvieron disección submucosa endoscópica durante un período de 14 meses con tamaño de pólipo mediana de 31,5 mm (rango, 20 - 45 mm). Se confirmó que once pacientes (12%) tenían una cicatriz significativa. Hubo significativamente más resecciones de mucosa endoscópica previas en el grupo con cicatrices (con cicatrices: 63,6% vs. sin cicatrices: 2,5%, p <0,001). Significativamente más de los pacientes con cicatrices tuvieron su disección submucosa endoscópica en el quirófano en comparación con la sala de endoscopia (con cicatrices: 82% vs. sin cicatrices: 17.5%, p <0.001). La tasa de morbilidad a 30 días fue del 18,7%. No hubo muertes. No hubo diferencia en la morbilidad a 30 días entre las lesiones cicatrizadas y no cicatrizadas (cicatrizadas: 9% frente a no cicatrizadas: 20%, p = 0,4). Hubo más procedimientos ambulatorios en el grupo sin cicatrices (sin cicatrices: 93,7% frente a cicatrices: 36,36%, p <0,001). No hubo malignidad en la patología final en el grupo con cicatrices. No hubo diferencia en la tasa de reingreso entre las lesiones cicatrizadas y no cicatrizadas. La tasa general de colonoscopia de seguimiento fue del 53% y no se identificaron recurrencias de pólipos.LIMITACIONES:Tamaño de muestra pequeño, experiencia de un solo instituto y cirujanos y seguimiento corto.CONCLUSIÓN:La disección endoscópica submucosa en pacientes con lesiones cicatrizadas no solo es técnicamente factible y segura, sino que evita una resección intestinal en la mayoría de los pacientes que han agotado otras técnicas endoscópicas avanzadas. Consulte Video Resumen en http://links.lww.com/DCR/B427.
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Bang CS, Lee JJ, Baik GH. The Most Influential Publications on Endoscopic Submucosal Dissection: A Bibliometric Analysis. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2020. [DOI: 10.7704/kjhugr.2020.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background/Aims: Endoscopic submucosal dissection (ESD) is the first-line treatment for superficial gastrointestinal neoplasms with negligible lymph node metastasis. It has evolved through improvements in expertise and equipment, increased understanding of indications and short- and long-term outcomes, and better management of complications. This study aimed to assess and characterize the most influential publications in ESD research.Materials and Methods: We searched the top 50 most cited articles using Web of Science Core Collection (WoSCC) and Google Scholar (GS) from the inception of these services to January 2019. The top 50 Altmetric Attention Score (AAS) articles based on online media mentions were also searched. Each article was evaluated for the number of citations, title, journal, and publication year.Results: The number of citations for the top 50 WoSCC articles on ESD ranged from 37 to 199; Endoscopy published the most articles (20%). Among the top 50 GS articles, Gastrointestinal Endoscopy published the most ESD articles (34%) and the most shared AAS articles (42.6%). PubMed Central article citations in WoSCC or GS showed significant correlation with those from each metric, unlike AAS. The words with the highest relevance scores were “submucosal tunnel dissection,” “guideline,” “novel submucosal gel,” “adhesive material,” “cell sheet,” “esophageal ulcer,” “hemospray,” and “endoscopic closure,” while the following words were influential: “meta-analysis,” “esophageal stricture,” “perforation,” “bleeding,” “fibrin glue,” “artificial ulcer,” “porcine model” and “esophageal squamous cell neoplasia,” excluding “ESD.”Conclusions: This study presents a detailed list of influential articles, journals, and topic words.
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Vanella G, Coluccio C, Antonelli G, Angeletti S, Micheli F, Barbato A, De Rossi G, Marchetti A, Mereu E, Pepe P, Corleto VD, D’Ambra G, Ruggeri M, Di Giulio E. Improving assessment and management of large non-pedunculated colorectal lesions in a Western center over 10 years: lessons learned and clinical impact. Endosc Int Open 2020; 8:E1252-E1263. [PMID: 33015326 PMCID: PMC7508662 DOI: 10.1055/a-1220-6261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/28/2020] [Indexed: 11/02/2022] Open
Abstract
Background and study aims Outcomes of endoscopic assessment and management of large colorectal (CR) non-pedunculated lesions (LNPLs) are still under evaluation, especially in Western settings. We analyzed the clinical impact of changes in LNPL management over the last decade in a European center. Patients and methods All consecutive LNPLs ≥ 20 mm endoscopically assessed (2008-2019) were retrospectively included. Lesion, patient, and resection characteristics were compared among clinically relevant subgroups. Multivariate logistic regression (for predictors of submucosal invasion [SMI] and recurrence), Kaplan-Meier curves and ROC curves (for temporal cut-offs in trends analyses) were used. Results A total of 395 LNPLs were included (30 mm [range 20-40]; SMI = 9.6 %; primary endoscopic resection [ER] = 88.4 %). Pseudo-depression and JNET classification independently predicted SMI beyond single morphologies/location. After complete ER, involvement of ileocecal valve/dentate line, piece-meal resection and high-grade dysplasia independently predicted recurrence. Rates of 5-year recurrence-free, surgery-free and cancer-free survival were 77.5 %, 98.6 % and 100 %, respectively, with 93.8 % recurrences endoscopically managed and no death attributable to ER or CR cancer (versus 3.4 % primary surgery mortality). ROC curves identified the period ≥ 2015 (following Endoscopic Submucosal Dissection [ESD] introduction and education on pre-resective lesion assessment) as associated with improved lesions' characterization, increased en-bloc resection of SMI lesions (87.5 % vs 37.5 %; p = 0.0455), reduced primary surgery (7.5 % vs 16.7 %; p = 0.0072), surgical referral of benign lesions (5.1 % vs 14.8 %; p = 0.0019), and recurrences. Conclusions ESD introduction and educational interventions allowed ER of more complex lesions, offset by increased complementary surgery for complications or intrinsic histological risk. Nevertheless, overall, they have reduced surgery demand and increased appropriateness and safety of LNPL management in our center.
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Affiliation(s)
- Giuseppe Vanella
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Chiara Coluccio
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Giulio Antonelli
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Stefano Angeletti
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Federica Micheli
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Antonio Barbato
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Gaia De Rossi
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Alessandro Marchetti
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Elena Mereu
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Paola Pepe
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Vito Domenico Corleto
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Giancarlo D’Ambra
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Maurizio Ruggeri
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Emilio Di Giulio
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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10
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Wang XY, Chai NL, Linghu EQ, Li HK, Zhai YQ, Feng XX, Zhang WG, Zou JL, Li LS, Xiang JY. Efficacy and safety of hybrid endoscopic submucosal dissection compared with endoscopic submucosal dissection for rectal neuroendocrine tumors and risk factors associated with incomplete endoscopic resection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:368. [PMID: 32355812 PMCID: PMC7186704 DOI: 10.21037/atm.2020.02.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Neuroendocrine tumors (NETs) are rising in prevalence, particularly with the rectal area. This study evaluated and compared the safety and effectiveness of hybrid endoscopic submucosal dissection (ESD) with those of ESD for rectal NETs and risk factors associated with incomplete endoscopic resection. Methods A total of 272 consecutive patients who underwent ESD or hybrid ESD for rectal NETs at the Chinese PLA General Hospital in the period from February 2011 to September 2018 were involved in this study. Data were collected from clinical and endoscopic databases. The procedure time, en bloc resection, complete resection, complication, and recurrence rates were evaluated. Results In the hybrid ESD group were 111 patients (who had 119 lesions between them), with a further 161 patients (164 lesions) in the ESD group. No significance was found in baseline characteristics between the two groups. Hybrid ESD had a significantly shorter mean procedure time than ESD (13.2±8.3 vs. 18.1±9.7 min, P=0.000). Hybrid ESD showed similar en bloc resection (99.2% vs. 98.2%; P=0.373), complete resection (94.1% vs. 90.9%, P=0.641), and postprocedural bleeding (2.5% vs. 0.6%, P=0.313) rates to ESD. Univariate and multivariate analysis showed that higher histopathological grade was associated with incomplete resection. Conclusions For rectal NET, both ESD and hybrid ESD are effective and safe forms of treatment. Hybrid ESD provides an alternative option in the treatment of rectal NETs. Further developments are needed to improve the complete resection rate, especially concerning tumors with higher histopathological grade.
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Affiliation(s)
- Xiang-Yao Wang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ning-Li Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - En-Qiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Hui-Kai Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ya-Qi Zhai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiu-Xue Feng
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Wen-Gang Zhang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jia-Le Zou
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Long-Song Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
| | - Jing-Yuan Xiang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
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11
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Arribas Anta J, Cañete Ruiz Á, Álvarez-Nava Torrego T, Piedracoba-Cadahía C, Rafael de la Cruz Esteban D, Rodríguez Carrasco M, Romero Romero E, Del Pozo-García AJ, Rodríguez Muñoz S, Díaz-Tasende J, Marín-Gabriel JC. Long-term follow-up after endoscopic submucosal dissection of colorectal lesions in a Spanish cohort. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:172-177. [PMID: 32054276 DOI: 10.17235/reed.2020.6268/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION ESD in the colon is an increasingly important technique in Western countries. There are few studies that include long term follow-up. AIM to analyze the long term recurrence free survival rate after ESD and to compare recurrence rates according to different variables. METHODS this was a prospective observational study of patients with a planned ESD from September 2008 to December 2015. When it was not possible to achieve an ESD, hybrid ESD was performed, either en bloc or piecemeal. Kaplan-Meier survival curves were used to assess the five year local recurrence free survival rate and the recurrence rate. The results were compared according to different factors. RESULTS of the 89 patients scheduled for ESD who were initially enrolled in the study, 69 were finally included for follow-up. ESD was performed in 31 (45%) patients, KAR in eleven (16%) and pKAR in 27 (39%). The median follow-up was 27 months (range 6-60). The five year disease free survival rate was 81%. The average number of endoscopies needed to eliminate recurrence was two (range 2-7) and no patient required surgery for this reason. The recurrence rate was significantly higher in piecemeal resections vs en bloc resections (27% vs 15%, p = 0.036) and R1 resections vs R0 resections (26% vs 0%, p = 0.034). The presence of affected or unknown lateral margins in en bloc resections without other poor prognosis factors had higher recurrence rates but the difference was not statistically significant (28% vs 0%, p = 0.09). CONCLUSIONS in our study, the five year disease free survival rate was 81% and no patient required surgery during follow-up. Piecemeal and R1 resections had significantly higher recurrence rates, as well as LM involvement, although this was not statistically significant.
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Affiliation(s)
- Julia Arribas Anta
- Medicina Aparato Digestivo. Unidad de Endoscopia, Hospital Universitario 12 de Octubre, España
| | - Ángel Cañete Ruiz
- Medicina Aparato Digestivo. Unidad de Endoscopia, Hospital Universitario 12 de Octubre, España
| | | | | | | | | | - Esteban Romero Romero
- Medicina Aparato Digestivo. Unidad de Endoscopia, Hospital Universitario 12 de Octubre
| | | | | | - José Díaz-Tasende
- Medicina Aparato Digestivo. Unidad de Endoscopia, Hospital Universitario 12 de Octubre, España
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12
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Thorlacius H, Rönnow CF, Toth E. European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety. Acta Oncol 2019; 58:S10-S14. [PMID: 30724676 DOI: 10.1080/0284186x.2019.1568547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is an advanced method allowing en bloc resection of large and complex lesions in colon and rectum. Herein, the European experience of colorectal ESD was systematically reviewed in the medical literature to determine the clinical efficacy and safety of colorectal ESD in Europe. MATERIAL AND METHODS A systematic search of PubMed for full-text studies including more than 20 cases of colorectal ESD emanating from European centres was performed. Data were independently extracted by two authors using predefined data fields, including efficacy and safety. RESULTS We included 15 studies containing a total of 1404 colorectal ESD cases (41% in the colon) performed between 2007 and 2018. Lesion size was 40 mm (range 24-59 mm) and procedure time was 102 min (range 48-176 min). En bloc resection rate was 83% (range 67-93%) and R0 resection rate was 70% (range 35-91%). Perforation rate was 7% (range 0-19%) and bleeding rate was 5% (range 0-12%). The percentage of ESD cases undergoing emergency surgery was 2% (range 0-6%). Additional elective surgery was performed in 3% of all cases due to histopathological findings showing deep submucosal invasion or more advanced cancer. The recurrence rate was 4% (range 0-12%) after a median follow-up time of 12 months (range 3-24 months). CONCLUSIONS This review shows that ESD is effective and safe for treating large and complex colorectal lesions in Europe although there is room for improvement. Thus, it is important to develop standardized and high-quality educational programs in colorectal ESD in Europe.
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Affiliation(s)
- Henrik Thorlacius
- Department of Clinical Sciences, Section of Surgery Skåne University Hospital Lund University, Malmö, Sweden
| | - Carl-Fredrik Rönnow
- Department of Clinical Sciences, Section of Surgery Skåne University Hospital Lund University, Malmö, Sweden
| | - Ervin Toth
- Department of Clinical Sciences, Section of Gastroenterology, Skåne University Hospital Lund University, Malmö, Sweden
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