1
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Liao S, Huang S, Yang G, Li B, Deng H, Tan Y, He G. Efficacy of underwater endoscopic intermuscular dissection in the management of a rectal neuroendocrine tumor. Endoscopy 2024; 56:E524-E526. [PMID: 38889894 PMCID: PMC11188761 DOI: 10.1055/a-2333-9660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Affiliation(s)
- Suhuan Liao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Silin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Guang Yang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Bo Li
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Huizhao Deng
- Department of Nephrology and Rheumatology, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Yi Tan
- Department of Anesthesiology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Guifa He
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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2
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Olabintan O, Voulgaris T, Ayubi H, Thrumurthy S, Haji A, Hayee B. Endoscopic sutured purse-string resection: a novel technique for resection of large gastric subepithelial lesions. Endoscopy 2024; 56:E352-E353. [PMID: 38657668 PMCID: PMC11042879 DOI: 10.1055/a-2299-1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Olaolu Olabintan
- Gastroenterology & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Theodoros Voulgaris
- Gastroenterology & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Homira Ayubi
- Gastroenterology & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sri Thrumurthy
- Gastroenterology & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Upper GI Surgery & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amyn Haji
- Gastroenterology & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Colorectal Surgery & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Bu'Hussain Hayee
- Gastroenterology & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Upper GI Surgery & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Colorectal Surgery & Advance Therapeutic Endoscopy Department, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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3
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Despott EJ, Lucaciu LA, Murino A, Rimondi A, Binmoeller K. First report of gastric endoscopic intermuscular dissection. Endoscopy 2024; 56:E132-E133. [PMID: 38452804 PMCID: PMC10920017 DOI: 10.1055/a-2233-2914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Edward J. Despott
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Laura A. Lucaciu
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Alberto Murino
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Alessandro Rimondi
- Royal Free Unit for Endoscopy, The Royal Free Hospital, University College London Institute for Liver and Digestive Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Kenneth Binmoeller
- Interventional Endoscopy, California Pacific Medical Center, San Francisco, United States
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4
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Jiang SX, Shahidi N. Large non-pedunculated colorectal polyp management: The elephant in the room. World J Gastroenterol 2024; 30:3126-3131. [PMID: 39006383 PMCID: PMC11238671 DOI: 10.3748/wjg.v30.i25.3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/19/2024] [Accepted: 06/11/2024] [Indexed: 07/01/2024] Open
Abstract
Minimally invasive innovations have transformed coloproctology. Specific to colorectal cancer (CRC), there has been a shift towards less invasive surgical techniques and use of endoscopic resection as an alternative for low risk T1 CRC. The role of endoscopic resection is however much more extensive: It is now considered the first line management strategy for most large (≥ 20 mm) non-pedunculated colorectal polyps, the majority of which are benign. This is due to the well-established efficacy, safety, and cost-effectiveness of endoscopic techniques compared to surgery. Multiple endoscopic modalities now exist with distinct risk-benefit profiles and their outcomes are further improved by site-specific technical modifications, auxiliary techniques, and adverse event mitigation strategies. Endoscopic capacity continues to evolve with emerging endoscopic techniques and expanding applications, particularly in the confines of a multi-disciplinary setting.
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Affiliation(s)
- Shirley X Jiang
- Department of Medicine, University of British Columbia, Vancouver V6Z 2K5, BC, Canada
| | - Neal Shahidi
- Department of Medicine, University of British Columbia, Vancouver V6Z 2K5, BC, Canada
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5
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Watanabe J, Ichimasa K, Kudo SE, Mochizuki K, Tan KK, Kataoka Y, Tahara M, Kubota T, Takashina Y, Yeoh KG. Risk factors for lymph node metastasis in T2 colorectal cancer: a systematic review and meta-analysis. Int J Clin Oncol 2024; 29:921-931. [PMID: 38709424 DOI: 10.1007/s10147-024-02547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Lymph node metastasis (LNM) occurs in 20-25% of patients with T2 colorectal cancer (CRC). Identification of risk factors for LNM in T2 CRC may help identify patients who are at low risk and thereby potential candidates for endoscopic full-thickness resection. We examined risk factors for LNM in T2 CRC with the goal of establishing further criteria of the indications for endoscopic resection. METHODS MEDLINE, CENTRAL, and EMBASE were systematically searched from inception to November 2023. Studies that investigated the association between the presence of LNM and the clinical and pathological factors of T2 CRC were included. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Certainty of evidence (CoE) was assessed using the GRADE approach. RESULTS Fourteen studies (8349 patients) were included. Overall, the proportion of LNM was 22%. The meta-analysis revealed that the presence of lymphovascular invasion (OR, 5.5; 95% CI 3.7-8.3; high CoE), high-grade tumor budding (OR, 2.4; 95% CI 1.5-3.7; moderate CoE), poor differentiation (OR, 2.2; 95% CI 1.8-2.7; moderate CoE), and female sex (OR, 1.3; 95% CI 1.1-1.7; high CoE) were associated with LNM in T2 CRC. Lymphatic invasion (OR, 5.0; 95% CI 3.3-7.6) was a stronger predictor of LNM than vascular invasion (OR, 2.4; 95% CI 2.1-2.8). CONCLUSIONS Lymphovascular invasion, high-grade tumor budding, poor differentiation, and female sex were risk factors for LNM in T2 CRC. Endoscopic resection of T2 CRC in patients with very low risk for LNM may become an alternative to conventional surgical resection. TRIAL REGISTRATION PROSPERO, CRD42022316545.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
- Division of Community and Family Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Kenichi Mochizuki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, National University Hospital, Singapore, Singapore
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine / School of Public Health, Kyoto University, Kyoto, Japan
| | - Makiko Tahara
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takafumi Kubota
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yuki Takashina
- Digestive Disease Center, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-chuo, Tsuzuki, Yokohama, 224-8503, Japan
| | - Khay Guan Yeoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
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6
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Cocomazzi F, Carparelli S, Labarile N, Capogreco A, Gentile M, Maselli R, Dhar J, Samanta J, Repici A, Hassan C, Perri F, Facciorusso A. Is there a best choice of equipment for colorectal endoscopic submucosal dissection? Expert Rev Med Devices 2024; 21:561-577. [PMID: 38829122 DOI: 10.1080/17434440.2024.2364022] [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: 02/11/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
INTRODUCTION Endoscopic submucosal dissection (ESD) is a widely used technique to remove early neoplastic lesions. It was primarily used in the initial days to treat gastric lesions, but recently, the horizon of this endoscopic procedure has expanded, which has allowed us to manage other technically more complex locations, such as the colorectum. AREAS COVERED There has been an exponential growth regarding the wide range of devices available in the market for performing colorectal ESD. As a result, the aim of this review is to highlight the indication of this endoscopic technique, which device is best suited for which indication, as well as future trajectories in this field. EXPERT OPINION Although some devices have proven to be more advantageous than others in this area, very often the choice is still subjective, which is commonly attributed to individual preferences and experience. However, an accurate knowledge of the available tools and their functioning, with their pros and cons, is fundamental for any endoscopist venturing into the field of third space endoscopy. In this way, one can choose which device best suits a particular situation, along with simultaneously having the wealth of knowledge related to therapeutic armamentarium at our disposal in the endoscopy suite.
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Affiliation(s)
- Francesco Cocomazzi
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Sonia Carparelli
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Nunzia Labarile
- Department of Gastroenterology, National Institute of Gastroenterology - IRCCS "Saverio de Bellis" - Castellana Grotte, Bari, Italy
| | - Antonio Capogreco
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
| | - Marco Gentile
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Jahnvi Dhar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Cesare Hassan
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS - Rozzano, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University - Rozzano, Foggia, Italy
| | - Francesco Perri
- Gastroenterology and Endoscopy Unit, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Foggia, Italy
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7
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Mandarino FV, Danese S, Uraoka T, Parra-Blanco A, Maeda Y, Saito Y, Kudo SE, Bourke MJ, Iacucci M. Precision endoscopy in colorectal polyps' characterization and planning of endoscopic therapy. Dig Endosc 2024; 36:761-777. [PMID: 37988279 DOI: 10.1111/den.14727] [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: 08/25/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023]
Abstract
Precision endoscopy in the management of colorectal polyps and early colorectal cancer has emerged as the standard of care. It includes optical characterization of polyps and estimation of submucosal invasion depth of large nonpedunculated colorectal polyps to select the appropriate endoscopic resection modality. Over time, several imaging modalities have been implemented in endoscopic practice to improve optical performance. Among these, image-enhanced endoscopy systems and magnification endoscopy represent now well-established tools. New advanced technologies, such as endocytoscopy and confocal laser endomicroscopy, have recently shown promising results in predicting the histology of colorectal polyps. In recent years, artificial intelligence has continued to enhance endoscopic performance in the characterization of colorectal polyps, overcoming the limitations of other imaging modes. In this review we retrace the path of precision endoscopy, analyzing the yield of various endoscopic imaging techniques in personalizing management of colorectal polyps and early colorectal cancer.
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Affiliation(s)
- Francesco Vito Mandarino
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Hospital IRCSS, Milan, Italy
- Department of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, NSW, Australia
| | - Silvio Danese
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Hospital IRCSS, Milan, Italy
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gumma, Japan
| | - Adolfo Parra-Blanco
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Yasuharu Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Michael J Bourke
- Department of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, NSW, Australia
| | - Marietta Iacucci
- Department of Gastroenterology, University College Cork, Cork, Ireland
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8
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Djinbachian R, Rex DK, Chiu HM, Fukami N, Aihara H, Bastiaansen BAJ, Bechara R, Bhandari P, Bhatt A, Bourke MJ, Byeon JS, Cardoso D, Chino A, Chiu PWY, Dekker E, Draganov PV, Elkholy S, Emura F, Goldblum J, Haji A, Ho SH, Jung Y, Kawachi H, Khashab M, Khomvilai S, Kim ER, Maselli R, Messmann H, Moons L, Mori Y, Nakanishi Y, Ngamruengphong S, Parra-Blanco A, Pellisé M, Pinto RC, Pioche M, Pohl H, Rastogi A, Repici A, Sethi A, Singh R, Suzuki N, Tanaka S, Vieth M, Yamamoto H, Yang DH, Yokoi C, Saito Y, von Renteln D. International consensus on the management of large (≥20 mm) colorectal laterally spreading tumors: World Endoscopy Organization Delphi study. Dig Endosc 2024. [PMID: 38934243 DOI: 10.1111/den.14826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/07/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES There have been significant advances in the management of large (≥20 mm) laterally spreading tumors (LSTs) or nonpedunculated colorectal polyps; however, there is a lack of clear consensus on the management of these lesions with significant geographic variability especially between Eastern and Western paradigms. We aimed to provide an international consensus to better guide management and attempt to homogenize practices. METHODS Two experts in interventional endoscopy spearheaded an evidence-based Delphi study on behalf of the World Endoscopy Organization Colorectal Cancer Screening Committee. A steering committee comprising six members devised 51 statements, and 43 experts from 18 countries on six continents participated in a three-round voting process. The Grading of Recommendations, Assessment, Development and Evaluations tool was used to assess evidence quality and recommendation strength. Consensus was defined as ≥80% agreement (strongly agree or agree) on a 5-point Likert scale. RESULTS Forty-two statements reached consensus after three rounds of voting. Recommendations included: three statements on training and competency; 10 statements on preresection evaluation, including optical diagnosis, classification, and staging of LSTs; 14 statements on endoscopic resection indications and technique, including statements on en bloc and piecemeal resection decision-making; seven statements on postresection evaluation; and eight statements on postresection care. CONCLUSIONS An international expert consensus based on the current available evidence has been developed to guide the evaluation, resection, and follow-up of LSTs. This may provide guiding principles for the global management of these lesions and standardize current practices.
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Affiliation(s)
- Roupen Djinbachian
- Montreal University Hospital Research Center, Montreal, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Norio Fukami
- Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, USA
- Department of Medicine, Harvard Medical School, Boston, USA
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Bechara
- Division of Gastroenterology, Kingston Health Sciences Centre, Queen's University, Kingston General Hospital, Kingston, ON, Canada
| | | | - Amit Bhatt
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, USA
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Daniela Cardoso
- Institute of Digestive Apparatus, Oncological Surgery, Goiâsnia, Brazil
| | - Akiko Chino
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Philip W Y Chiu
- Division of Upper GI Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter V Draganov
- Division of Gastroenterology and Hepatology, University of Florida, Gainesville, USA
| | - Shaimaa Elkholy
- Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Fabian Emura
- Gastroenterology Division, de La Sabana University, Chia, Colombia
- Advanced GI Endoscopy, EmuraCenter LatinoAmerica, Bogotá, Colombia
| | - John Goldblum
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, USA
| | - Amyn Haji
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Shiaw-Hooi Ho
- Department of Medicine, Malaya University, Kuala Lumpur, Malaysia
| | - Yunho Jung
- Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Hiroshi Kawachi
- Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mouen Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, USA
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Leon Moons
- Departments of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
- Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | - Adolfo Parra-Blanco
- NHR Nottingham Biomedical Research Centre, Department of Gastroenterology, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Division of Gastroenterology, University of Nottingham, Nottingham, UK
| | - María Pellisé
- Department of Gastroenterology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Hospital Clinic of Barcelona, Biomedical Research Center in Hepatic and Digestive Diseases (CIBERehd), University of Barcelona, Barcelona, Spain
| | | | - Mathieu Pioche
- Endoscopic Division, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Heiko Pohl
- Department of Gastroenterology, VA Medical Center, White River Junction, USA
- Dartmouth-Hitchcock Medical Center, White River Junction, USA
| | - Amit Rastogi
- Division of Gastroenterology, University of Kansas Medical Center, Kansas City, USA
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Amrita Sethi
- Division of Digestive and Liver Disease, Columbia University Irving Medical Center, New York City, USA
| | - Rajvinder Singh
- Gastroenterology Unit, Division of Surgery, Northern Adelaide Local Health Area Network, Adelaide, Australia
- Department of Gastroenterology, University of Adelaide, Adelaide, Australia
| | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St. Mark's Hospital, London, UK
| | - Shinji Tanaka
- Gastroenterology Division, JA Onomichi General Hospital, Hiroshima, Japan
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Tochigi, Japan
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chizu Yokoi
- Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Daniel von Renteln
- Montreal University Hospital Research Center, Montreal, Canada
- Division of Gastroenterology, Montreal University Hospital Center (CHUM), Montreal, Canada
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9
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Jiang SX, Zarrin A, Shahidi N. T1 colorectal cancer management in the era of minimally invasive endoscopic resection. World J Gastrointest Oncol 2024; 16:2284-2294. [PMID: 38994167 PMCID: PMC11236244 DOI: 10.4251/wjgo.v16.i6.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 06/13/2024] Open
Abstract
T1 colorectal cancer (CRC), defined by tumor invasion confined to the submucosa, has historically been managed by surgery. Improved understanding of recurrence and lymph node metastases risk, coupled with advances in endoscopic resection techniques, have led to an increasing capacity for organ-sparing local excision. Minimally invasive management of T1 CRC begins with optical evaluation of the lesion to diagnose invasive disease and quantify depth of invasion, which informs therapeutic decision making. Modality selection between various available endoscopic resection techniques depends upon lesion characteristics, technique risk-benefit profiles, and location-specific implications. Following endoscopic resection, established histopathology features determine the risk of recurrence and subsequent management including surveillance or adjuvant surgical excision. The management of non-operative candidates deviates from conventional recommendations with emerging treatment strategies in select populations.
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Affiliation(s)
- Shirley Xue Jiang
- Department of Medicine, University of British Columbia, Vancouver V6Z2K5, British Columbia, Canada
| | - Aein Zarrin
- Department of Medicine, University of British Columbia, Vancouver V6Z2K5, British Columbia, Canada
| | - Neal Shahidi
- Department of Medicine, University of British Columbia, Vancouver V6Z2K5, British Columbia, Canada
- Division of Gastroenterology, St. Paul’s Hospital, Vancouver V6Z2K5, British Columbia, Canada
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10
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Meulen LWT, Haasnoot KJC, Vlug MS, Wolfhagen FHJ, Baven-Pronk MAMC, van der Voorn MPJA, Schwartz MP, Vogelaar L, de Vos Tot Nederveen Cappel WH, Seerden TCJ, Hazen WL, Schrauwen RWM, Alvarez-Herrero L, Schreuder RM, van Nunen AB, Stoop E, de Bruin GJ, Bos P, Marsman WA, Kuiper E, de Bièvre M, Alderlieste YA, Roomer R, Groen J, Bigirwamungu-Bargeman M, Siersema PD, Elias SG, Masclee AAM, Moons LMG. Effect of optical diagnosis training on recognition and treatment of submucosal invasive colorectal cancer in community hospitals: a prospective multicenter intervention study. Endoscopy 2024. [PMID: 38657659 DOI: 10.1055/a-2313-4996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Recognition of submucosal invasive colorectal cancer (T1 CRC) is difficult, with sensitivities of 35 %-60 % in Western countries. We evaluated the real-life effects of training in the OPTICAL model, a recently developed structured and validated prediction model, in Dutch community hospitals. METHODS In this prospective multicenter study (OPTICAL II), 383 endoscopists from 40 hospitals were invited to follow an e-learning program on the OPTICAL model, to increase sensitivity in detecting T1 CRC in nonpedunculated polyps. Real-life recognition of T1 CRC was then evaluated in 25 hospitals. Endoscopic and pathologic reports of T1 CRCs detected during the next year were collected retrospectively, with endoscopists unaware of this evaluation. Sensitivity for T1 CRC recognition, R0 resection rate, and treatment modality were compared for trained vs. untrained endoscopists. RESULTS 1 year after e-learning, 528 nonpedunculated T1 CRCs were recorded for endoscopies performed by 251 endoscopists (118 [47 %] trained). Median T1 CRC size was 20 mm. Lesions were mainly located in the distal colorectum (66 %). Trained endoscopists recognized T1 CRCs more frequently than untrained endoscopists (sensitivity 74 % vs. 62 %; mixed model analysis odds ratio [OR] 2.90, 95 %CI 1.54-5.45). R0 resection rate was higher for T1 CRCs detected by trained endoscopists (69 % vs. 56 %; OR 1.73, 95 %CI 1.03-2.91). CONCLUSION Training in optical recognition of T1 CRCs in community hospitals was associated with increased recognition of T1 CRCs, leading to higher en bloc and R0 resection rates. This may be an important step toward more organ-preserving strategies.
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Affiliation(s)
- Lonne W T Meulen
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Krijn J C Haasnoot
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marije S Vlug
- Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, The Netherlands
| | - Frank H J Wolfhagen
- Department of Gastroenterology and Hepatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Lauran Vogelaar
- Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands
| | | | - Tom C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Wouter L Hazen
- Department of Gastroenterology and Hepatology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Ruud W M Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven, Uden, The Netherlands
| | - Lorenza Alvarez-Herrero
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - Ramon-Michel Schreuder
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Annick B van Nunen
- Department of Gastroenterology and Hepatology, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Esther Stoop
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Gijs J de Bruin
- Department of Gastroenterology and Hepatology, Tergooi Hospital, Hilversum, The Netherlands
| | - Philip Bos
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Willem A Marsman
- Department of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Edith Kuiper
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Marc de Bièvre
- Department of Gastroenterology and Hepatology, Viecuri Medical Center, Venlo, The Netherlands
| | - Yasser A Alderlieste
- Department of Gastroenterology and Hepatology, Rivas, Gorinchem, The Netherlands
| | - Robert Roomer
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - John Groen
- Department of Gastroenterology and Hepatology, Sint Jansdal Hospital, Harderwijk, The Netherlands
| | | | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ad A M Masclee
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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11
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Rahman S, Becker S, Yu J, Tsikitis VL. Evaluation and Management of Malignant Colorectal Polyps. Surg Clin North Am 2024; 104:701-709. [PMID: 38677831 DOI: 10.1016/j.suc.2023.12.007] [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] [Indexed: 04/29/2024]
Abstract
The detection rate of dysplastic colorectal polyps has significantly increased with improved screening programs. Treatment of dysplastic polyps attempt to limit morbidity of a procedure while also considering the risk of occult lymph node metastasis. Therefore, a variety of methods have been developed to predict the rate of lymph node metastasis to help identify the optimal treatment of patients. These include both the endoscopic and pathologic assessment of the lesion. In order to reduce the morbidity of surgery for patients with low-risk lesions, multiple endoscopic therapies have been developed, including endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic intermuscular dissection, and transanal endoscopic surgery.
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Affiliation(s)
- Shahrose Rahman
- Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code: L223, Portland, OR 97239, USA.
| | - Sarah Becker
- School of Medicine, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code: L223, Portland, OR 97239, USA
| | - Jessica Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Digestive Health Center, 3485 South Bond Avenue, 8th Floor, Center for Health & Healing 2, Portland, OR 97239, USA
| | - Vassiliki Liana Tsikitis
- Department of Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Mail Code: L223, Portland, OR 97239, USA
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12
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Baral JEM, Kouladouros K. Completion Surgery after Non-Curative Local Resection of Early Rectal Cancer. Visc Med 2024; 40:144-149. [PMID: 38873629 PMCID: PMC11166898 DOI: 10.1159/000538840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background The expanding indications of local - endoscopic and transanal surgical - resection of early rectal cancer has led to their increased popularity and inclusion in the treatment guidelines. The accuracy of the current diagnostic tools in identifying the low-risk T1 tumors that can be curatively treated with a local resection is low, and thus several patients require additional oncologic surgery with total mesorectal excision (TME). An efficient clinical strategy which avoids overtreatment and obstacle surgical procedures is under debate between different disciplines. Summary Completion surgery has comparable outcomes to primary surgery regarding perioperative morbidity and mortality but also recurrence rates and overall survival. However, local scarring in the mesorectum can make mesorectal excision technically challenging, especially after full-thickness resections, and has been associated with increased rates of permanent ostomy and worse quality of the TME specimen. This risk seems to be lower after muscle-sparing procedures like endoscopic submucosal dissection, which seem to show a benefit in comparison to full-thickness resections. Key Messages Completion surgery after non-curative local resection of gastrointestinal malignancies is safe and feasible. Full-thickness resection techniques can cause scarring of the mesorectum; therefore, muscle-sparing procedures should be preferred.
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Affiliation(s)
| | - Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Department of Hepatology and Gastroenterology, Charité University Hospital Berlin – Campus Virchow Klinikum, Berlin, Germany
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13
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Masgnaux LJ, Grimaldi J, Jacques J, Rivory J, Pioche M. Technical Advances in Endoscopic Resection Techniques for Lower GI Malignancies. Visc Med 2024; 40:128-143. [PMID: 38873630 PMCID: PMC11166901 DOI: 10.1159/000538041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 02/25/2024] [Indexed: 06/15/2024] Open
Abstract
Background The management of bulky neoplastic lesions in the digestive tract has historically been a surgical pursuit. With advancements in endoscopic techniques, particularly endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), a paradigm shift toward organ preservation has been initiated. These endoscopic methods, developed incrementally since the 1980s, have progressively enabled curative management of lesions with minimal morbidity, challenging the previously unchallenged domain of surgery. Summary This review traces the evolution of endoscopic resection from snare polypectomy and EMR to sophisticated ESD, highlighting the technological innovations that have expanded the scope of endoscopic resection. It discusses the intricacies of various EMR techniques like underwater EMR, anchoring EMR, and hybrid EMR, alongside traction-assisted methods and the use of viscous solutions for submucosal injection. Additionally, the manuscript delves into the advancements in ESD, emphasizing traction strategies, knife technology, and the optimization of endoscopes. The benefits of these advancements are weighed against the challenges in anatomopathological interpretation posed by piecemeal resections. Key Messages The continuous amelioration of endoscopic resection techniques has significantly improved the outcomes of digestive tract lesion management, particularly in achieving R0 resections and reducing recurrence rates. These advancements represent a monumental step toward minimizing the invasiveness of lesion management. However, despite the progress, the necessity for early follow-up post-EMR remains due to the non-negligible recurrence rates, underscoring the need for a rigorous postoperative surveillance regimen. Furthermore, our review suggests that while ESD has transformed the therapeutic landscape, its widespread adoption hinges on further simplification, safety enhancement, and acceleration of the procedure, possibly through innovations like adaptive traction devices.
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Affiliation(s)
- Louis Jean Masgnaux
- Endoscopy Unit, Gastroenterology Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Jean Grimaldi
- Endoscopy Unit, Gastroenterology Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Jérémie Jacques
- Endoscopy Unit, Gastroenterology, Limoges University Hospital, Limoges, France
| | - Jérôme Rivory
- Endoscopy Unit, Gastroenterology Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - Mathieu Pioche
- Endoscopy Unit, Gastroenterology Pavillon L, Edouard Herriot Hospital, Lyon, France
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14
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Ebigbo A, Nagl S. Endoscopic Assessment of Local Resectability of Colorectal Malignancies. Visc Med 2024; 40:110-115. [PMID: 38873626 PMCID: PMC11166904 DOI: 10.1159/000538317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/11/2024] [Indexed: 06/15/2024] Open
Abstract
Background The endoscopic assessment of colorectal malignancies primarily aims at deciding on the local resectability. Local resectability is defined by the risk of lymphonodal metastasis. Summary The gross morphology as well as the surface and vessel patterns provide valuable information prior to endoscopic resection. Various classifications have been standardized to assist endoscopists during endoscopic assessment. Key Message The macroscopic assessment of colorectal malignancies should include the Paris and laterally spreading tumor (LST) classification as well as chromoendoscopic assessments such as Kudo's pit pattern and the Japanese NBI Expert Team classifications to describe the vessel and surface patterns.
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Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Nagl
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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15
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Shiina O, Kudo S, Ichimasa K, Takashina Y, Kouyama Y, Mochizuki K, Morita Y, Kuroki T, Kato S, Nakamura H, Matsudaira S, Misawa M, Ogata N, Hayashi T, Wakamura K, Sawada N, Baba T, Nemoto T, Ishida F, Miyachi H. Differentiation grade as a risk factor for lymph node metastasis in T1 colorectal cancer. DEN OPEN 2024; 4:e324. [PMID: 38155928 PMCID: PMC10753631 DOI: 10.1002/deo2.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/26/2023] [Accepted: 12/06/2023] [Indexed: 12/30/2023]
Abstract
Objectives Japanese guidelines include high-grade (poorly differentiated) tumors as a risk factor for lymph node metastasis (LNM) in T1 colorectal cancer (CRC). However, whether the grading is based on the least or most predominant component when the lesion consists of two or more levels of differentiation varies among institutions. This study aimed to investigate which method is optimal for assessing the risk of LNM in T1 CRC. Methods We retrospectively evaluated 971 consecutive patients with T1 CRC who underwent initial or additional surgical resection from 2001 to 2021 at our institution. Tumor grading was divided into low-grade (well- to moderately differentiated) and high-grade based on the least or predominant differentiation analyses. We investigated the correlations between LNM and these two grading analyses. Results LNM was present in 9.8% of patients. High-grade tumors, as determined by least differentiation analysis, accounted for 17.0%, compared to 0.8% identified by predominant differentiation analysis. A significant association with LNM was noted for the least differentiation method (p < 0.05), while no such association was found for predominant differentiation (p = 0.18). In multivariate logistic regression, grading based on least differentiation was an independent predictor of LNM (p = 0.04, odds ratio 1.68, 95% confidence interval 1.00-2.83). Sensitivity and specificity for detecting LNM were 27.4% and 84.1% for least differentiation, and 2.1% and 99.3% for predominant differentiation, respectively. Conclusions Tumor grading via least differentiation analysis proved to be a more reliable measure for assessing LNM risk in T1 CRC compared to grading by predominant differentiation.
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Affiliation(s)
- Osamu Shiina
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Katsuro Ichimasa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
- Department of MedicineNational University of SingaporeSingaporeSingapore
| | - Yuki Takashina
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuta Kouyama
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kenichi Mochizuki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuriko Morita
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takanori Kuroki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shun Kato
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hiroki Nakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shingo Matsudaira
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Noriyuki Ogata
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takemasa Hayashi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kunihiko Wakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Naruhiko Sawada
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toshiyuki Baba
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Tetsuo Nemoto
- Department of Diagnostic PathologyShowa University Northern Yokohama HospitalKanagawaJapan
| | - Fumio Ishida
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hideyuki Miyachi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
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16
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Ichimasa K, Kudo SE, Tan KK, Lee JWJ, Yeoh KG. Challenges in Implementing Endoscopic Resection for T2 Colorectal Cancer. Gut Liver 2024; 18:218-221. [PMID: 37842729 PMCID: PMC10938148 DOI: 10.5009/gnl230125] [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: 04/06/2023] [Revised: 07/06/2023] [Accepted: 08/15/2023] [Indexed: 10/17/2023] Open
Abstract
The current standard treatment for muscularis propria-invasive (T2) colorectal cancer is surgical colectomy with lymph node dissection. With the advent of new endoscopic resection techniques, such as endoscopic full-thickness resection or endoscopic intermuscular dissection, T2 colorectal cancer, with metastasis to 20%-25% of the dissected lymph nodes, may be the next candidate for endoscopic resection following submucosal-invasive (T1) colorectal cancer. We present a novel endoscopic treatment strategy for T2 colorectal cancer and suggest further study to establish evidence on oncologic and endoscopic technical safety for its clinical implementation.
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Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Surgery, National University Hospital, Singapore
| | - Jonathan Wei Jie Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Khay Guan Yeoh
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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17
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Albouys J, Manzah I, Schaefer M, Legros R, Masrour O, Henno S, Leclercq P, Dahan M, Guyot A, Charissoux A, Grainville T, Loustaud-Ratti V, Lepetit H, Geyl S, Carrier P, Pioche M, Wallenhorst T, Jacques J. Prevalence and clinical significance of the muscle retracting sign during endoscopic submucosal dissection of large macronodular colorectal lesions (with videos). Gastrointest Endosc 2024; 99:398-407. [PMID: 37866709 DOI: 10.1016/j.gie.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND AIMS The muscle retracting sign (MRS) can be present during endoscopic submucosal dissection (ESD) of macronodular colorectal lesions. The prevalence of MRS and its pathologic and clinical implications is unclear. This study evaluated the effect of MRS on the technical and clinical outcomes of ESD. METHODS All patients referred for ESD of protruding lesions or granular mixed lesions with >10 mm macronodule granular mixed laterally spreading tumors (LST-GMs) in 2 academic centers from January 2017 to October 2022 were prospectively included. Size of the macronodule was analyzed retrospectively. The primary outcome was the curative resection rate according to MRS status. Secondary outcomes were R0 resection, perforation, secondary surgery rate, and risk factors for MRS. RESULTS Of 694 lesions, 84 (12%) had MRS (MRS+). The curative resection rate was decreased by MRS (MRS+ 41.6% vs lesions without MRS [MRS-] 81.3%), whereas the perforation (MRS+ 22.6% vs MRS- 9.2%), submucosal cancer (MRS+ 34.9% vs MRS- 9.2%), and surgery (MRS+ 45.2% vs MRS- 6%) rates were increased. The R0 resection rate of MRS+ colonic lesions was lower than that of rectal lesions (53% vs 74.3%). In multivariate analysis, protruding lesions (odds ratio, 2.47; 95% confidence interval, 1.27-4.80) and macronodules >4 cm (odds ratio, 4.24; 95% confidence interval, 2.23-8.05) were risk factors for MRS. CONCLUSIONS MRS reduces oncologic outcomes and increases the perforation rate. Consequently, procedures in the colon should be stopped if MRS is detected, and those in the rectum should be continued due to the morbidity of alternative therapy.
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Affiliation(s)
- Jérémie Albouys
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France.
| | - Imane Manzah
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Marion Schaefer
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU de Nancy, Nancy, France
| | - Romain Legros
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Oumnia Masrour
- Service de gastroenterologie et endoscopie digestive, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | - Sebastien Henno
- Service d'anatomopathologie, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven and Clinique Montlegia, Liege, Belgium
| | - Martin Dahan
- Service de gastroenterologie et endoscopie digestive, Clinique mutualiste de Pessac, Pessac, France
| | - Anne Guyot
- Service d'anatomopathologie, Dupuytren University CHU Dupuytren, Limoges, France
| | - Aurélie Charissoux
- Service d'anatomopathologie, Dupuytren University CHU Dupuytren, Limoges, France
| | - Thomas Grainville
- Service de gastroenterologie et endoscopie digestive, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - Hugo Lepetit
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Sophie Geyl
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Paul Carrier
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
| | - Mathieu Pioche
- Service de gastroenterologie et endoscopie digestive, Hôpital universitaire Edouard Herriot, Lyon, France
| | - Timothee Wallenhorst
- Service de gastroenterologie et endoscopie digestive, Centre hospitalier Universitaire Pontchaillou, Rennes, France
| | - Jeremie Jacques
- Service d'Hepato Gastro Entérologie et endoscopie digestive, CHU Dupuytren, Limoges, France
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18
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Klimkowski R, Krzyzkowiak J, Pilonis ND, Bujko K, Kaminski MF. Endoscopic resection of residual rectal neoplasia after definitive chemoradiotherapy for rectal cancer. Best Pract Res Clin Gastroenterol 2024; 68:101896. [PMID: 38522889 DOI: 10.1016/j.bpg.2024.101896] [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: 08/31/2023] [Revised: 02/21/2024] [Accepted: 02/25/2024] [Indexed: 03/26/2024]
Abstract
The conventional approach to treating locally advanced rectal cancer, commonly defined as cT3 or cT4 primary tumors or with nodal metastases, involves chemoradiation (CRT) followed by surgical resection. There is a growing recognition of the potential for nonsurgical management following CRT or total neoadjuvant therapy (TNT), which allows for organ preservation. "Watch and wait" strategy may be considered if complete clinical response is achieved. In cases when adenoma or superficial cancer is present, a novel approach known as "salvage endoscopic resection of the residual disease" is emerging as a viable nonsurgical option for carefully selected patients. This review discusses available evidence and future potential for endoscopic management of residual neoplasia after oncological treatment of rectal cancer.
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Affiliation(s)
- Robert Klimkowski
- Department of Gastroenterological Oncology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland.
| | - Jakub Krzyzkowiak
- Department of Gastroenterological Oncology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Nastazja Dagny Pilonis
- Department of Gastroenterological Oncology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland; Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Bujko
- Department of Radiotherapy I, National Research Institute of Oncology, Warsaw, Poland
| | - Michal F Kaminski
- Department of Gastroenterological Oncology, M. Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland; Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Surgical Oncology Medical University of Gdansk, Gdansk, Poland
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19
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Dang H, Verhoeven DA, Boonstra JJ, van Leerdam ME. Management after non-curative endoscopic resection of T1 rectal cancer. Best Pract Res Clin Gastroenterol 2024; 68:101895. [PMID: 38522888 DOI: 10.1016/j.bpg.2024.101895] [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: 09/30/2023] [Revised: 02/03/2024] [Accepted: 02/15/2024] [Indexed: 03/26/2024]
Abstract
Since the introduction of population-based screening, increasing numbers of T1 rectal cancers are detected and removed by local endoscopic resection. Patients can be cured with endoscopic resection alone, but there is a possibility of residual tumor cells remaining after the initial resection. These can be located intraluminally at the resection site or extraluminally in the form of (lymph node) metastases. To decrease the risk of residual cells progressing towards more advanced disease, additional treatment is usually needed. However, with the currently available risk stratification models, it remains challenging to determine who should and should not be further treated after non-curative endoscopic resection. In this review, the different management strategies for patients with non-curatively treated T1 rectal cancers are discussed, along with the available evidence for each strategy and relevant considerations for clinical decision making. Furthermore, we provide practical guidance on the management and surveillance following non-curative endoscopic resection of T1 rectal cancer.
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Affiliation(s)
- Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Daan A Verhoeven
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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20
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Sekra A, Tan T. Endoscopic intermuscular dissection for locally advanced rectal cancer: A case report. World J Surg Proced 2023; 13:22-28. [DOI: 10.5412/wjsp.v13.i3.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection is considered curative for patients with early rectal cancer when level of submucosal invasion is < 1000 microns with favourable histopathological features. Recent data suggests even deeper submucosal invasion can potentially be curative if R0 resection can be achieved and when no high-risk histopathological features are seen in the resected specimen. To achieve R0 resection, deeper dissection is required.
CASE SUMMARY A 66 year old New Zealand European male presented with 3 mo history of per rectal bleeding. He was referred for a colonoscopy test to investigate this further. This revealed a malignant appearing lesion in the rectum. Biopsies however showed high grade dysplasia only. Given endoscopic appearances suspicious for deep submucosal invasion, patient was consented for endoscopic intermuscular dissection (EID). The case was successfully performed, and the presence of muscularis propria was confirmed in the resected specimen. There were no complications and total procedure time was 124 min. Lesion was clear of radial margins however deep margins were positive confirming it was at least a pT2 cancer. Patient was recommended to have further treatment but could not have radical surgery due to comorbidities and instead was referred for long course chemoradiotherapy.
CONCLUSION EID is a safe and feasible option for management of rectal cancer in highly selected patients.
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Affiliation(s)
- Anurag Sekra
- Department of Gastroenterology and Hepatology, Te Whatu Ora, Counties Manukau Health, Auckland 2025, New Zealand
| | - Tracy Tan
- Department of Pathology, Te Whatu Ora, Counties Manukau Health, Auckland 2025, New Zealand
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21
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Ramos-Zabala F, Pérez-Rodríguez FJ, Alzina-Pérez A, García-Mayor M, Moreno-Almazán L. Saline-tunneling endoscopic intermuscular dissection for the removal of rectal cancer using the hydrodissection method. Endoscopy 2023; 55:E987-E989. [PMID: 37604453 PMCID: PMC10442210 DOI: 10.1055/a-2142-4654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Felipe Ramos-Zabala
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte, Madrid, Spain
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Francisco J. Pérez-Rodríguez
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
- Servicio de Anatomía Patológica, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte, Madrid, Spain
| | - Alejandra Alzina-Pérez
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte, Madrid, Spain
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Marian García-Mayor
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte, Madrid, Spain
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Luis Moreno-Almazán
- Servicio de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte, Madrid, Spain
- Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
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22
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Tribonias G, Komeda Y, Leontidis N, Anagnostopoulos G, Palatianou M, Mpellou G, Pantoula P, Manola ME, Paspatis G, Tzouvala M, Kashida H. Endoscopic intermuscular dissection (EID) for removing early rectal cancers and benign fibrotic rectal lesions. Tech Coloproctol 2023; 27:1393-1400. [PMID: 37773471 DOI: 10.1007/s10151-023-02862-7] [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: 04/07/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023]
Abstract
In the current era of screening colonoscopy and increasing incidence of early rectal cancer, interventional endoscopy moves toward resections in deeper planes than the submucosal layer. Several reports support the use of endoscopic intermuscular dissection (EID) instead of endoscopic submucosal dissection (ESD) for the removal of deeply invasive rectal submucosal cancers. The resection plane into the intermuscular space, the space between the longitudinal (external) and circular (internal) muscle layer, allows radical removal of rectal invasive submucosal cancers. Furthermore, the technique offers the potential for dissection of scarred and severe fibrotic lesions in the rectum by cutting deeper and performing a partial myectomy avoiding the narrow submucosal space. We present 23 cases of EIDs both for deeply invasive rectal cancers and benign rectal lesions. This is the first report in the literature of EID resections for malignant and benign disease, including cases of severely fibrotic rectal lesions.
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Affiliation(s)
- G Tribonias
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Mantouvalou D.3, Nikaia, 18454, Athens, Greece.
| | - Y Komeda
- Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
| | - N Leontidis
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Mantouvalou D.3, Nikaia, 18454, Athens, Greece
| | - G Anagnostopoulos
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Mantouvalou D.3, Nikaia, 18454, Athens, Greece
| | - M Palatianou
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Mantouvalou D.3, Nikaia, 18454, Athens, Greece
| | - G Mpellou
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Mantouvalou D.3, Nikaia, 18454, Athens, Greece
| | - P Pantoula
- Pathology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Nikaia, Athens, Greece
| | - M-E Manola
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Mantouvalou D.3, Nikaia, 18454, Athens, Greece
| | - G Paspatis
- Gastroenterology Department, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - M Tzouvala
- Gastroenterology Department, General Hospital of Nikaia - Piraeus "Agios Panteleimon", Mantouvalou D.3, Nikaia, 18454, Athens, Greece
| | - H Kashida
- Department of Gastroenterology and Hepatology, Kindai University, Osaka, Japan
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23
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Liao S, Li B, Huang L, Qiu Q, Yang G, Ren J, Huang S. Endoscopic intermuscular dissection in the management of a rectal neuroendocrine tumor. Endoscopy 2023; 55:E977-E979. [PMID: 37604447 PMCID: PMC10442200 DOI: 10.1055/a-2139-4310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Affiliation(s)
- Suhuan Liao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, GuangDong, China
| | - Bo Li
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, GuangDong, China
| | - Longbin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, GuangDong, China
| | - Qiuping Qiu
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, GuangDong, China
| | - Guang Yang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, GuangDong, China
| | - Jianzhen Ren
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, GuangDong, China
| | - Silin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, GuangDong, China
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24
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Schaefer M, Albouys J, Geyl S, Legros R, Wallenhorst T, Pioche M, Jacques J. Endoscopic intermuscular dissection of a residual rectal neuroendocrine tumor with high-pressure injection and double-clip traction. Endoscopy 2023; 55:E1126-E1127. [PMID: 37935431 PMCID: PMC10630080 DOI: 10.1055/a-2173-7103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Affiliation(s)
- Marion Schaefer
- Hepatogastroenterology, Nancy Regional University Hospital Center, Nancy, France
| | | | - Sophie Geyl
- Hepatogastroenterology, Dupuytren Hospital, Limoges, France
| | - Romain Legros
- Hepatogastroenterology, Dupuytren Hospital, Limoges, France
| | | | - Mathieu Pioche
- Endoscopy and Gastroenterology, Edouard Herriot Hospital, Lyon, France
| | - Jérémie Jacques
- Hepatogastroenterology, Dupuytren Hospital, Limoges, France
- BioEM, XLim, UMR 7252, CNRS, Limoges, France
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25
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Tribonias G, Christoulakis M, Zachou M, Zacharopoulou E, Varytimiadis K, Tzouvala M. Endoscopic intermuscular dissection (EID) of a severely fibrotic benign rectal lesion in an area affected by radiation proctitis. Endosc Int Open 2023; 11:E733-E734. [PMID: 37564337 PMCID: PMC10411155 DOI: 10.1055/a-2109-8166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/02/2023] [Indexed: 08/12/2023] Open
Affiliation(s)
- George Tribonias
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | - Michail Christoulakis
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | - Maria Zachou
- Gastroenterology, Geniko Nosokomeio Attikes Sismanogleio Amalia Phlemink, Athens, Greece
| | - Eirini Zacharopoulou
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | | | - Maria Tzouvala
- Gastroenterology, General Hospital of Nikaia Peiraia Agios Panteleimon, Athens, Greece
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26
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van Bokhorst QNE, Houwen BBSL, Hazewinkel Y, Fockens P, Dekker E. Advances in artificial intelligence and computer science for computer-aided diagnosis of colorectal polyps: current status. Endosc Int Open 2023; 11:E752-E767. [PMID: 37593158 PMCID: PMC10431975 DOI: 10.1055/a-2098-1999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/08/2023] [Indexed: 08/19/2023] Open
Affiliation(s)
- Querijn N E van Bokhorst
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Britt B S L Houwen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Tergooi Medical Center, Hilversum, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
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27
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Metter K, Weißinger SE, Várnai-Händel A, Grund KE, Dumoulin FL. Endoscopic Treatment of T1 Colorectal Cancer. Cancers (Basel) 2023; 15:3875. [PMID: 37568691 PMCID: PMC10417475 DOI: 10.3390/cancers15153875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
Commonly accepted criteria for curative resection of T1 colorectal cancer include R0 resection with horizontal and vertical clear margins (R0), absence of lympho-vascular or vessel infiltration (L0, V0), a low to moderate histological grading (G1/2), low tumor cell budding, and limited (<1000 µm) infiltration into the submucosa. However, submucosal infiltration depth in the absence of other high-risk features has recently been questioned as a high-risk situation for lymph-node metastasis. Consequently, endoscopic resection techniques should focus on the acquisition of qualitatively and quantitively sufficient submucosal tissue. Here, we summarize the current literature on lymph-node metastasis risk after endoscopic resection of T1 colorectal cancer. Moreover, we discuss different endoscopic resection techniques with respect to the quality of the resected specimen.
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Affiliation(s)
- Klaus Metter
- Klinik für Gastroenterologie, Hepatologie und Diabetologie, Alb Fils Kliniken, Klinik am Eichert, Eichertstraße 3, D-73035 Göppingen, Germany
| | - Stephanie Ellen Weißinger
- Institut für Pathologie, Alb Fils Kliniken, Klinik am Eichert, Eichertstraße 3, D-73035 Göppingen, Germany;
| | | | - Karl-Ernst Grund
- Experimentelle Chirurgische Endoskopie (CETEX), Universitätsklinikum Tübingen, Waldhörnlestraße 22, D-72072 Tübingen, Germany;
| | - Franz Ludwig Dumoulin
- Innere Medizin/Gastroenterologie, Gemeinschaftskrankenhaus Bonn, Prinz Albert Str. 40, D-53113 Bonn, Germany;
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28
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Moreira P, Cardoso PM, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review. J Clin Med 2023; 12:4777. [PMID: 37510892 PMCID: PMC10381236 DOI: 10.3390/jcm12144777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that now play a crucial role in the treatment of colorectal lesions. ESD is a minimally invasive endoscopic procedure that allows for the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it is a complex technique, requiring high endoscopic skills, expertise, and specialized training, with higher rates of adverse events expected compared with EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It is a faster and more accessible procedure, with fewer adverse events, although it only allows for an en-bloc resection of lesions measuring 15-20 mm. TAMIS is a minimally invasive surgical technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing for a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, in search for the most adequate treatment for the removal of lesions in the rectum and anorectal junction, as these locations possess distinct characteristics that demand a more specific approach.
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Affiliation(s)
- Pedro Moreira
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Pedro Marílio Cardoso
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - João Santos-Antunes
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4099-030 Porto, Portugal
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, 4200-450 Porto, Portugal
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29
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Zaffalon D, Daca-Alvarez M, Saez de Gordoa K, Pellisé M. Dilemmas in the Clinical Management of pT1 Colorectal Cancer. Cancers (Basel) 2023; 15:3511. [PMID: 37444621 DOI: 10.3390/cancers15133511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Implementation of population-based colorectal cancer screening programs has led to increases in the incidence of pT1 colorectal cancer. These incipient invasive cancers have a very good prognosis and can be treated locally, but more than half of these cases are treated with surgery due to the presence of histological high-risk criteria. These high-risk criteria are suboptimal, with no consensus among clinical guidelines, heterogeneity in definitions and assessment, and poor concordance in evaluation, and recent evidence suggests that some of these criteria considered high risk might not necessarily affect individual prognosis. Current criteria classify most patients as high risk with an indication for additional surgery, but only 2-10.5% have lymph node metastasis, and the residual tumor is present in less than 20%, leading to overtreatment. Patients with pT1 colorectal cancer have excellent disease-free survival, and recent evidence indicates that the type of treatment, whether endoscopic or surgical, does not significantly impact prognosis. As a result, the protective role of surgery is questionable. Moreover, surgery is a more aggressive treatment option, with the potential for higher morbidity and mortality rates. This article presents a comprehensive review of recent evidence on the clinical management of pT1 colorectal cancer. The review analyzes the limitations of histological evaluation, the prognostic implications of histological risk status and the treatment performed, the adverse effects associated with both endoscopic and surgical treatments, and new advances in endoscopic treatment.
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Affiliation(s)
- Diana Zaffalon
- Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
- Gastroenterology Department, Consorci Sanitari de Terrassa, Torrebonica, s/n, 08227 Terrassa, Spain
| | - Maria Daca-Alvarez
- Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Karmele Saez de Gordoa
- Pathology Department, Centre de Diagnostic Biomèdic, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - María Pellisé
- Gastroenterology Department, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain
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30
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Gibiino G, Sbrancia M, Binda C, Coluccio C, Fabbri S, Giuffrida P, Gallo G, Saragoni L, Maselli R, Repici A, Fabbri C. Usefulness of Contrast-Enhanced Endoscopic Ultrasound (CH-EUS) to Guide the Treatment Choice in Superficial Rectal Lesions: A Case Series. Diagnostics (Basel) 2023; 13:2267. [PMID: 37443660 DOI: 10.3390/diagnostics13132267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/17/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION Large rectal lesions can conceal submucosal invasion and cancer nodules. Despite the increasing diffusion of high-definition endoscopes and the importance of an accurate morphological evaluation, a complete assessment in this setting can be challenging. Endoscopic ultrasound (EUS) plays an established role in the locoregional staging of rectal cancer, although this technique has a tendency toward the over-estimation of the loco-regional (T) staging. However, there are still few data on contrast-enhanced endoscopic ultrasound (CH-EUS), especially if this ancillary technique may increase the accuracy for predicting invasive nodules among large rectal lesions. MATERIAL AND METHODS Consecutive large (≥20 mm) superficial rectal lesions with high-definition endoscopy, characterized by focal areas suggestive for invasive cancer/2B type according to JNET classification, were considered for additional standardized evaluation via CH-EUS with Sonovue ©. RESULTS From 2020 to 2023, we evaluated 12 consecutive superficial rectal lesions with sizes ranging from 20 to 180 mm. This evaluation provided additional elements to support the therapeutic decision made. Lesions were treated with surgical (3/12) or endoscopic treatment (9/12) according to their morphology and CH-EUS evaluation. CONCLUSION Contrast-enhanced endoscopic ultrasound can provide an additional evaluation for large and difficult-to-classify rectal lesions. In our experience, CH-EUS staging corresponded to the final pathological stages in 9/12 (75%) lesions, improving the distinction between T1 and T2 lesions. Larger prospective studies and randomized trials should be conducted to support and standardize this approach.
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Affiliation(s)
- Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Monica Sbrancia
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Cecilia Binda
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Chiara Coluccio
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Stefano Fabbri
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
| | - Paolo Giuffrida
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
- Section of Gastroenterology & Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | - Graziana Gallo
- Pathology Department, M. Bufalini Hospital, Emilia Romagna, 47521 Cesena, Italy
| | - Luca Saragoni
- Pathology Department, G.B. Morgagni-L. Pierantoni Hospital, Emilia-Romagna, 47121 Forlì, Italy
| | - Roberta Maselli
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, 20089 Rozzano, Italy
| | - Carlo Fabbri
- Gastroenterology and Digestive Endoscopy Unit, 47121 Forlì, Italy
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31
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Marin FS, Abou Ali E, Belle A, Beuvon F, Coriat R, Chaussade S. "Transanal endoscopic microsurgery" with a flexible colonoscope (F-TEM): a new endoscopic treatment for suspicious deep submucosal invasion T1 rectal carcinoma. Surg Endosc 2023:10.1007/s00464-023-10141-7. [PMID: 37231174 DOI: 10.1007/s00464-023-10141-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/16/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Endoscopic techniques allow resections of deep submucosal invasion rectal carcinoma, but mostly are facing issues such as costs, follow-up care or size limit. Our aim was to design a new endoscopic technique, which retains the advantages over surgical resections while eliminating the disadvantages mentioned above. PATIENTS AND METHODS We propose a technique for the resection of the superficial rectal tumours, with highly suspicious deep submucosal invasion. It combines steps of endoscopic submucosal dissection, muscular resection and edge-to-edge suture of the muscular layers, finally performing the equivalent of a "transanal endoscopic microsurgery" with a flexible colonoscope (F-TEM). RESULTS A 60-year-old patient was referred to our unit, following the discovery of a 15 mm distal rectum adenocarcinoma. The computed tomography and the endoscopic ultrasound examination revealed a T1 tumour, without secondary lesions. Considering that the initial endoscopic evaluation highlighted a depressed central part of the lesion, with several avascular zones, an F-TEM was performed, without severe complication. The histopathological examination revealed negative resection margins, without risk factors for lymph node metastasis, no adjuvant therapy being proposed. CONCLUSION F-TEM allows endoscopic resection of highly suspicious deep submucosal invasion T1 rectal carcinoma and it proves to be a feasible alternative to surgical resection or other endoscopic treatments as endoscopic submucosal dissection or intermuscular dissection.
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Affiliation(s)
- Flavius-Stefan Marin
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France.
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Frédéric Beuvon
- Faculty of Medicine, Paris Cité University, Paris, France
- Department of Pathology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue du Faubourg Saint Jacques, 75014, Paris, France
- Faculty of Medicine, Paris Cité University, Paris, France
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Bak MTJ, Albéniz E, East JE, Coelho-Prabhu N, Suzuki N, Saito Y, Matsumoto T, Banerjee R, Kaminski MF, Kiesslich R, Coron E, de Vries AC, van der Woude CJ, Bisschops R, Hart AL, Itzkowitz SH, Pioche M, Moons LMG, Oldenburg B. Endoscopic management of patients with high-risk colorectal colitis-associated neoplasia: a Delphi study. Gastrointest Endosc 2023; 97:767-779.e6. [PMID: 36509111 DOI: 10.1016/j.gie.2022.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Current guidelines recommend endoscopic resection of visible and endoscopically resectable colorectal colitis-associated neoplasia (CAN) in patients with inflammatory bowel disease (IBD). However, patients with high-risk CAN (HR-CAN) are often not amenable to conventional resection techniques, and a consensus approach for the endoscopic management of these lesions is presently lacking. This Delphi study aims to reach consensus among experts on the endoscopic management of these lesions. METHODS A 3-round modified Delphi process was conducted to reach consensus among worldwide IBD and/or endoscopy experts (n = 18) from 3 continents. Consensus was considered if ≥75% agreed or disagreed. Quality of evidence was assessed by the criteria of the Cochrane Collaboration group. RESULTS Consensus was reached on all statements (n = 14). Experts agreed on a definition for CAN and HR-CAN. Consensus was reached on the examination of the colon with enhanced endoscopic imaging before resection, the endoscopic resectability of an HR-CAN lesion, and endoscopic assessment and standard report of CAN lesions. In addition, experts agreed on type of resections of HR-CAN (< 20 mm, >20 mm, with or without good lifting), endoscopic success (technical success and outcomes), histologic assessment, and follow-up in HR-CAN. CONCLUSIONS This is the first step in developing international consensus-based recommendations for endoscopic management of CAN and HR-CAN. Although the quality of available evidence was considered low, consensus was reached on several aspects of the management of CAN and HR-CAN. The present work and proposed standardization might benefit future studies.
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Affiliation(s)
- Michiel T J Bak
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eduardo Albéniz
- Endoscopy Unit, Gastroenterology Department, Hospital Universitario de Navarra Navarrabiomed, Universidad Pública de Navarra, IdiSNA, Pamplona, Spain
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, University of Oxford, and Oxford NIHR Biomedical Research Centre, Oxford, UK; Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | | | - Noriko Suzuki
- Wolfson Unit for Endoscopy, St Mark's Hospital and Academic Institute, London, UK
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Iwate, Japan
| | - Rupa Banerjee
- Inflammatory Bowel Disease Center, Asian Institute of Gastroenterology, Hyderabad, India
| | - Michal F Kaminski
- Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Ralf Kiesslich
- Department of Internal Medicine and Gastroenterology, Helios Clinic Wiesbaden, Wiesbaden, Germany
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva, Geneva, Switzerland
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Belgium
| | - Ailsa L Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Steven H Itzkowitz
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
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Libânio D, Pimentel-Nunes P, Bastiaansen B, Bisschops R, Bourke MJ, Deprez PH, Esposito G, Lemmers A, Leclercq P, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, Fuccio L, Bhandari P, Dinis-Ribeiro M. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55:361-389. [PMID: 36882090 DOI: 10.1055/a-2031-0874] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.
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Affiliation(s)
- Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal.,Gastroenterology, Unilabs, Portugal
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianluca Esposito
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy. Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.,University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
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34
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Masgnaux LJ, Yzet C, Rivory J, Wallenhorst T, Legros R, Jacques J, Pioche M. Endoscopic intermuscular dissection of rectal T1 cancer with adaptive traction: use of additional loops to improve traction directly on the circular muscular layer. Endoscopy 2023; 55:E410-E411. [PMID: 36758626 PMCID: PMC9911298 DOI: 10.1055/a-2011-5546] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Louis-Jean Masgnaux
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Gastroenterology and Endoscopy Unit, Pontchaillou University Hospital, Rennes, France
| | - Romain Legros
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Gastroenterology and Endoscopy Unit, Dupuytren University Hospital, Limoges, France
| | - Mathieu Pioche
- Gastroenterology and Endoscopy Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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35
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Patenotte A, Yzet C, Wallenhorst T, Subtil F, Leblanc S, Schaefer M, Walter T, Lambin T, Fenouil T, Lafeuille P, Chevaux JB, Legros R, Rostain F, Rivory J, Jacques J, Lépilliez V, Pioche M. Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion. Endoscopy 2023; 55:192-197. [PMID: 35649429 DOI: 10.1055/a-1866-8080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion. METHODS In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15 mm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). RESULTS 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2 %) and, where possible, the en bloc and R0 resection rates were 95.8 % (115/120) and 76.7 % (92/120), respectively. Thirty-three resections (26.2 %) were for very low risk tumors, so considered curative, and 38 (30.2 %) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; n = 8), or significant budding (n = 9), and LVI + budding combination (n = 4). CONCLUSION ESD is feasible and safe for colorectal lesions with an FDIP ≤ 15 mm. It was curative in 26.6 % of patients and could be a valid option for a further 30.6 % of patients with low risk T1 cancers, especially for frail patients with co-morbidities.
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Affiliation(s)
- Adrien Patenotte
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon and CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France
| | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Brabois Hospitals, Nancy, France
| | - Thomas Walter
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Lambin
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Tanguy Fenouil
- Institute of Pathology - East site, Groupement hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lafeuille
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Romain Legros
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Florian Rostain
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Vincent Lépilliez
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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36
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Piao Z, Ge R, Wang C. A proposal for grading the risk of lymph node metastasis after endoscopic resection of T1 colorectal cancer. Int J Colorectal Dis 2023; 38:25. [PMID: 36701000 DOI: 10.1007/s00384-023-04319-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
PURPOSE At present, for patients with early colorectal cancer as long as having any one risk factor of lymph node metastasis (LNM) after endoscopic resection (ER), additional surgery will be considered, regardless of the degree of LNM risk; however, most patients are free of LNM. This study aimed to further grade these patients according to LNM risk. METHODS We assessed 271 patients with T1 colorectal cancers treated initially with ER to analyze the correlation between LNM-associated risk factors and LNM rate. Differences in this rate between groups were estimated using the χ2 test or Fisher's exact test. RESULTS Poorly differentiated adenocarcinoma (Por) (3.4% vs. 40%, p < 0.001) and lymphovascular infiltration (LV) (1.6% vs. 29.0%, p < 0.001) were the only parameters correlated with LNM. When we divided the cases into LV-negative (LV(-)) and LV-positive (LV(+)) groups, we found a significantly higher LNM rate in the LV(+) group (29.0% vs. 1.6%, p < 0.001). Additionally, the rate of LNM in those positive for each parameter did not differ from the control rate in the same group, except in the Por subgroup. When the cases were divided into four groups based on the presence of LV infiltration and Por, the LNM rate in each group was 2/233 cases (0.8%) in the LV(-)Por(-) group, 2/7 cases (28.5%) in the LV(-)Por(+) group, 7/28 cases (25.0%) in the LV(+)Por(-) group, and 2/3 cases (66.6%) in the LV(+)Por(+) group. CONCLUSIONS Based on LV and histological differentiation, patients were classified into three LNM risk grades: low (LNM, 0.8%), moderate (LNM, 25.0-28.5%), and high (LNM, 66.6%).
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Affiliation(s)
- Zhenghua Piao
- Department of Pathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, 315031, China.
| | - Rong Ge
- Department of Pathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, 315031, China
| | - Chunnian Wang
- Department of Pathology, Ningbo Clinical Pathology Diagnosis Center, Ningbo, 315031, China
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Falt P, Uricová D, Fejfar T, Šembera Š, Tachecí I. News in gastroenterology, hepatology and digestive endoscopy. VNITRNI LEKARSTVI 2023; 69:198-206. [PMID: 37468316 DOI: 10.36290/vnl.2023.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Gastroenterology, hepatology and digestive endoscopy are rapidly evolving disciplines with significant advances in the diagnostics and treatment in the entire gastrointestinal tract. The aim of our article was to summarize new perspectives on relevant situations in gastroenterology and hepatology like acute pancreatitis, functional dyspepsia, rational indication of proton pump inhibitors, inflammatory bowel diseases (IBD), cholestatic liver diseases, alcohol induced hepatitis, non-alcoholic fatty live disease (NAFLD) and patophysiology of bilirubin and bile acids. Digestive endoscopy represents an interventional part of gastroenterology and key recent topics are mentioned like pancreatic cancer screening, arteficial intelligence, resection of low-risk neoplastic lesions, enteroscopy techniques, cholangio- and pancreatiscopy and extraluminal expansion of endoscopy techniques by means of endoscopic submucosal and transmural dissection, endoscopic myotomy and lumen apposing stents.
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Dang H, Dekkers N, Hardwick JC, Boonstra JJ. Endoscopic adventitial dissection of a rectal GI stromal cell tumor. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2022; 8:84-88. [PMID: 36820260 PMCID: PMC9938369 DOI: 10.1016/j.vgie.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Video 1Demonstration of endoscopic adventitial dissection.
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39
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Ichita C, Sasaki A, Kawachi J, Hirose H, Kamiishi H, Kubota J, Nagayama M. Endoscopic intermuscular dissection for a lower rectal gastrointestinal stromal tumor. Endoscopy 2022; 55:E258-E259. [PMID: 36427499 PMCID: PMC9831778 DOI: 10.1055/a-1974-8823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Chikamasa Ichita
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Akiko Sasaki
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Jun Kawachi
- Department of Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Haruto Hirose
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Hideki Kamiishi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Jun Kubota
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Miki Nagayama
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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40
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Longcroft-Wheaton G. Endoscopic intermuscular dissection for deep submucosal invasive cancer in the rectum. Is this the dawn of the endoscopic cancer surgeon? Endoscopy 2022; 54:999-1000. [PMID: 35613921 DOI: 10.1055/a-1835-2403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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41
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Dang H, Hardwick JCH, Boonstra JJ. Endoscopic intermuscular dissection with intermuscular tunneling for local resection of rectal cancer with deep submucosal invasion. VideoGIE 2022; 7:273-277. [PMID: 36034064 PMCID: PMC9414055 DOI: 10.1016/j.vgie.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - James C H Hardwick
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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