Effect of Preceding Biopsy on the Results of Endoscopic Submucosal Dissection for Colorectal Laterally Spreading Tumor

The number of biopsy specimens can influence the non-lifting sign in colorectal laterally spreading tumors

BACKGROUND

 Although the problem of whether to perform a biopsy before endoscopic treatment for colorectal laterally spreading tumor (LST) troubles clinicians, about 50 % of lesions still undergo a preceding biopsy. We aimed to explore factors affecting the non-lifting sign in LST and examine the influence of "biopsy-related factors", such as the number of biopsy specimens and the interval after biopsy on non-lifting sign in cases with a history of biopsy.

METHODS

 Clinical data of 159 LSTs regarding age, gender, history of biopsy, tumor location, tumor size, the depth of submucosal invasion, tumor configuration, histologic type, location with respect to the fold, and result of non-lifting sign testing were investigated retrospectively. For patients with a history of biopsy, the period after biopsy and the number of biopsy specimens also were analyzed.

RESULTS

 Among 159 cases of LST, 112 were positive and 47 were negative for lifting signs. Biopsy history (p = 0.008), tumor size (p = 0.010), and location with respect to the fold (p = 0.022) were identified as factors affecting the non-lifting sign in multivariate analyses. In 75 LST cases with a history of biopsy, only the number of biopsies (p = 0.003) was identified as a factor affecting the non-lifting sign in multivariate analyses.

CONCLUSIONS

 For LST, lesions with larger size, being across the fold, and biopsy history were predictive factors for non-lifting signs. Reducing the number of biopsies would reduce the occurrence of non-lifting signs when biopsy is necessary. The impact of the interval after the biopsy on the non-lifting sign will require further study.

Application value of pre-cutting endoscopic mucosal resection in treatment of colorectal laterally spreading tumors

BACKGROUND

Endoscopic mucosal resection (EMR) with precutting (Pre-cut-EMR) is an improvement on the basis of EMR, which combines the technical advantages of EMR and endoscopic submucosal dissection (ESD) to form a new endoscopic resection method and is more and more widely used in clinical practice. This study preliminarily explored the clinical value of Pre-cut-EMR in the treatment of colorectal laterally spreading tumors (LSTs) through retrospective analysis.

AIM

To explore the application value of Pre-cut-EMR in the treatment of colorectal LSTs.

METHODS

A total of 84 patients with colorectal LSTs who were treated at our department from January 2016 to December 2019 were selected as the research subjects. The clinical data of all patients were retrospectively analyzed to summarize the clinical characteristics of colorectal LSTs. All patients underwent Pre-cut-EMR, and the average operation time, overall resection rate, complete resection rate, and the incidence of complications were recorded. Colonoscopy was performed at 3, 6, and 12 mo after the operation to evaluate the recurrence. The relevant literature on ESD treatment of colorectal LSTs was retrieved through China HowNet and Wanfang Database, and the pre-cut-EMR group and ESD group were compared for the curative effect on colorectal LSTs.

RESULTS

The average diameter of colorectal LSTs in the 84 cases was 25.6 mm. The endoscopic morphological classification was mainly granular. According to Kudo pit classification, types Ⅲ and Ⅳ were common, with type ⅢL being the most common. Tubular adenoma and villous adenoma were common pathological types. All 84 patients with colorectal LSTs underwent endoscopic resection successfully. One of them converted to ESD and one to EPMR. The pre-cut-EMR resection rate was 97.6%, and the average operation time was 24.5 min. There were three cases with positive basal margins, and the complete resection rate was 96.4%. Two cases of bleeding and one case of perforation occurred during the operation, and the complication rate was 3.6%. None of the 78 patients who were followed had recurrence, and the recurrence rate was 0%. Compared with the research data obtained by Xu et al, Yu et al, and Qiuhai et al, the operation time of the Pre-cut-EMR group was significantly lower than that of the ESD group (χ² = 21.037, P = 0.001), but there was no statistical difference in the overall resection rate, complication rate, complete resection rate, or recurrence rate compared with the ESD group (P > 0.05).

CONCLUSION

Pre-cut-EMR is effective and safe for colorectal LST treatment, and has high clinical value. This surgical method deserves to be widely promoted due to its simplicity, being easy to learn, and low equipment requirements.