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Zhang Y, Gu F, Liu X, Ding S. A novel nomogram for the prediction of perforation during endoscopic submucosal dissection for colorectal neoplasms. Saudi J Gastroenterol 2024; 30:228-235. [PMID: 38708876 PMCID: PMC11379254 DOI: 10.4103/sjg.sjg_417_23] [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: 12/13/2023] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND High perforation risk hinders the widespread adoption of ESD for colorectal neoplasms. This study was performed to determine the risk factors of colorectal endoscopic submucosal dissection (ESD)-induced perforation and develop a predictive model. METHODS A total of 1046 colorectal neoplasms in 1011 patients were retrospectively enrolled from January 2011 to December 2021, in a single tertiary center as the derivation cohort. We identified independent risk factors for perforation using univariate analysis and multi-variate logistic regression. A nomogram was developed based on the logistic regression model and prospectively applied to 266 colorectal neoplasms as the validation cohort. The performance of the predictive model was evaluated with the receiver operating characteristic curve, calibration plot, and decision curve analysis. RESULTS Independent pre-operative factors for colorectal ESD-induced perforation were tumor located in the left colon [odds ratio (OR) 2.39, P = 0.040], size ≥ 40 mm (OR 3.36, P < 0.001), ≥2/3 circumference (OR 7.55, P = 0.004), located across folds (OR 6.26, P < 0.001), and laterally spreading tumor (non-granular type, OR 2.34, P = 0.029; granular type, OR 2.46, P = 0.021). The nomogram model incorporating the pre-operative factors performed well in both the derivation and validation cohorts (areas under the curve of 0.750 and 0.806, respectively). Decision curve analysis demonstrated that the clinical benefit of the nomogram was favorable. CONCLUSIONS The novel nomogram, developed and prospectively validated, incorporating tumor size, location, and morphology can successfully predict perforation during ESD for colorectal neoplasms.
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Affiliation(s)
- Yuxin Zhang
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
| | - Fang Gu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
| | - Xun Liu
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
| | - Shigang Ding
- Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory for Helicobacter Pylori Infection and Upper Gastrointestinal Diseases, Beijing 100191, China
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Nakatsugawa Y, Okuyama Y, Fukui A, Tanaka M, Inada Y, Nishimura T, Fujii H, Tomatsuri N, Sato H, Urata Y. A case of disseminated peritoneal metastases after 2-year conservative treatment for intramucosal colon carcinoma due to a perforation during endoscopic submucosal dissection. Clin J Gastroenterol 2024; 17:441-446. [PMID: 38368579 DOI: 10.1007/s12328-024-01925-y] [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: 11/04/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024]
Abstract
A 70-year-old man was admitted to our hospital for the treatment of a large granular-type laterally spreading tumor in the splenic flexure of the descending colon. The preoperative diagnosis was intramucosal colon carcinoma and endoscopic submucosal dissection was performed. During treatment, a small perforation occurred accidentally. After conservative treatment with endoscopic suturing, the patient was discharged without additional surgery. The pathological diagnosis was an intramucosal carcinoma. One year after treatment, no local recurrence was observed on endoscopy, and abdominal computed tomography showed no obvious metastasis. Two years later, fluorodeoxyglucose-positron emission tomography/computed tomography, laparoscopic findings, and histopathologic findings by experimental excision of omentum revealed several disseminated peritoneal metastases from previously treated colon carcinoma. To the best of our knowledge, this is the first report of peritoneal dissemination after a small perforation during endoscopic submucosal dissection and conservative therapy for early-stage colon carcinoma. This report suggests the possibility of tumor dissemination in patients with small perforations during endoscopic procedures. Endoscopists should be aware of these rare potential risks and perform later surveillance carefully.
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Affiliation(s)
- Yoshikazu Nakatsugawa
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
- Nakatsugawa Medical Clinic, 117-1, Fushimi-ku, Kyomachi, Kyoto-shi, Kyoto, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan.
| | - Akifumi Fukui
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Makoto Tanaka
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Takeshi Nishimura
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Hideki Fujii
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Naoya Tomatsuri
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Hideki Sato
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
| | - Yoji Urata
- Department of Clinical Pathology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749, Honmachi Higashiyama-ku, Kyoto-shi, Kyoto, Japan
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Ito S, Nagasaka K, Komatsu H, Palai D, Nishiguchi A, Taguchi T. Improved hydration property of tissue adhesive/hemostatic microparticle based on hydrophobically-modified Alaska pollock gelatin. BIOMATERIALS ADVANCES 2024; 159:213834. [PMID: 38518390 DOI: 10.1016/j.bioadv.2024.213834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024]
Abstract
The management of bleeding is an important aspect of endoscopic surgery to avoid excessive blood loss and minimize pain. In clinical settings, sprayable hemostatic particles are used for their easy delivery, adaptability to irregular shapes, and rapid hydration. However, conventional hemostatic particles present challenges associated with tissue adhesion. In a previous study, we reported tissue adhesive microparticles (C10-sa-MPs) derived from Alaska pollock gelatin modified with decyl groups (C10-sa-ApGltn) using secondary amines as linkages. The C10-sa-MPs adhere to soft tissues through a hydration mechanism. However, their application as a hemostatic agent was limited by their long hydration times, attributed to their high hydrophobicity. In this study, we present a new type microparticle, C10-am-MPs, synthesized by incorporating decanoyl group modifications into ApGltn (C10-am-ApGltn), using amide bonds as linkages. C10-am-MPs exhibited enhanced hydration characteristics compared to C10-sa-MPs, attributed to superior water absorption facilitated by amide bonds rather than secondary amines. Furthermore, C10-am-MPs demonstrated comparable tissue adhesion properties and underwater adhesion stability to C10-sa-MPs. Notably, C10-am-MPs exhibited accelerated blood coagulation in vitro compared to C10-sa-MPs. The application of C10-am-MPs in an in vivo rat liver hemorrhage model resulted in a hemostatic effect comparable to a commercially available hemostatic particle. These findings highlight the potential utility of C10-am-MPs as an effective hemostatic agent for endoscopic procedures and surgical interventions.
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Affiliation(s)
- Shima Ito
- Biomaterials field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Kazuhiro Nagasaka
- Biomaterials field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Hiyori Komatsu
- Biomaterials field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Debabrata Palai
- Biomaterials field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Akihiro Nishiguchi
- Biomaterials field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Tetsushi Taguchi
- Biomaterials field, Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan.
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Kim M, Choi CW, Kim ER, Chang DK, Hong SN. Risk Prediction of Post-Endoscopic Submucosal Dissection Coagulation Syndrome. Dig Dis 2024; 42:309-318. [PMID: 38648736 PMCID: PMC11250405 DOI: 10.1159/000539007] [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: 12/04/2023] [Accepted: 04/17/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Endoscopic submucosal dissection (ESD) has been popular worldwide to treat laterally spreading tumors and large polyps. Post-ESD coagulation syndrome (PECS) is more common than the two major ESD-related complications, perforation, and bleeding. The aim of this study was to assess the prevalence of PECS, identify the risk factors for PECS, and create a risk prediction model for PECS. METHODS Retrospective cross-sectional study analyzed a total of 986 patients who underwent colorectal ESD. Logistic regression models were used to assess risk factors with PECS. Each risk factor was scored, and the 3-step risk stratification index of prediction model was assessed. RESULTS The prevalence of PECS was 21.4% (95% confidence interval [CI] = 18.9-24.1%). The risk factors of PECS in the multivariate logistic regression were tumor size (+1 cm: odds ratio [OR], 1.29; 95% CI, 1.16-7.09), cecal lesion (OR, 1.96; 95% CI, 1.09-1.53), procedure time (+30 min: OR, 1.19; 95% CI, 1.02-1.39), and ESD with snaring (OR, 0.64; 95% CI, 0.43-0.95). Applying a simplified weighted scoring system based on adjusted OR increments of 1, the risk of PECS was 12.3% (95% CI, 0.3-16.0%) for the low-risk group (score ≤4) and was 36.0% (95% CI = 29.4-43.2%) for the high-risk group (score ≥8). Overall discrimination (C-statistic = 0.629; 95% CI = 0.585-0.672) and calibration (p = 0.993) of the model were moderate to good. CONCLUSION PECS occurs frequently, and the prediction model can be helpful for effective treatment and prevention of PECS.
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Affiliation(s)
- Minjee Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Wan Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Kyung Chang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Okumura T, Hayashi T, Kudo S, Mochizuki K, Abe M, Sakurai T, Kouyama Y, Ogawa Y, Maeda Y, Toyoshima N, Misawa M, Kudo T, Wakamura K, Baba T, Ishida F, Miyachi H. Endoscopic submucosal dissection for colorectal neoplasms: Risk factors for local recurrence and long-term surveillance. DEN OPEN 2024; 4:e269. [PMID: 37404727 PMCID: PMC10315643 DOI: 10.1002/deo2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/08/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) is an effective procedure for the en bloc resection of colorectal neoplasms. However, risk factors for local recurrence after ESD have not been identified. This study aimed to evaluate such risk factors after ESD for colorectal neoplasms. Methods This retrospective study included 1344 patients with 1539 consecutive colorectal lesions who underwent ESD between September 2003 and December 2019. We investigated various factors associated with local recurrence in these patients. The main outcomes were the incidence of local recurrence and its relationship with clinicopathological factors during long-term surveillance. Results The en bloc resection rate was 98.6%, the R0 resection rate was 97.2%, and the histologically complete resection rate was 92.7%. Local recurrence was observed in 7/1344 (0.5%) patients and the median follow-up period was 72 months (range 4-195 months). The incidence of local recurrence was significantly higher in lesions ≥40 mm in diameter (hazard ratio [HR] 15.68 [1.88-130.5]; p = 0.011), piecemeal resection (HR 48.42 [10.7-218.7]; p < 0.001), non-R0 resection (HR 41.05 [9.025-186.7]; p < 0.001), histologically incomplete resection (HR 16.23 [3.627-72.63]; p<0.001), and severe fibrosis (F2; HR 9.523 [1.14-79.3]; p = 0.037). Conclusions Five risk factors for local recurrence after ESD were identified. Patients with such factors should undergo careful surveillance colonoscopy.
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Affiliation(s)
- Taishi Okumura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takemasa Hayashi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kenichi Mochizuki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masahiro Abe
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Tatsuya Sakurai
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuta Kouyama
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yushi Ogawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yasuharu Maeda
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Naoya Toyoshima
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toyoki Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kunihiko Wakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toshiyuki Baba
- Digestive Disease CenterShowa 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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Kawashima K, Hikichi T, Onizawa M, Gunji N, Watahiki Y, Sakuma C, Mochimaru T, Murakami M, Suzuki O, Hashimoto Y, Kobayakawa M, Ohira H. Characteristics of positive horizontal margins in patients who underwent colorectal endoscopic submucosal dissection. DEN OPEN 2024; 4:e300. [PMID: 37841650 PMCID: PMC10569401 DOI: 10.1002/deo2.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/14/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) enables en bloc resection of colorectal neoplasms, but occasionally results in positive horizontal margins (HMs). However, the site of the resected specimen that tends to be positive for HM has not been investigated. We aimed to clarify the characteristics associated with HMs in lesions resected en bloc with ESD. Methods Patients with colorectal neoplasms who underwent en bloc resection with ESD were included in this study. The patients were divided into negative HMs (HM0) and positive or indeterminate HMs (HM1) groups. The characteristics associated with HM1 resection were investigated. In addition, the local recurrence rate during endoscopic follow-up for >6 months after ESD was observed. Results In total, 201 lesions were analyzed in 189 patients (HM0, 189 lesions; HM1, 12 lesions). The HM1 group had a significantly larger median lesion diameter (25 vs. 55 mm; p < 0.001) and more lesions with >50% circumference than did the HM0 group (p < 0.001). Furthermore, the prevalence of severe fibrosis was significantly higher in the HM1 group than in the HM0 group (p < 0.001). Positive horizontal sites of the resected specimens were more frequent at the oral and anal sites than at the lateral sites. No local recurrences were observed in either group. Conclusions The characteristics associated with HM1 depended on lesion size, particularly lesions with >50% circumference, and submucosal fibrosis.
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Affiliation(s)
- Kazumasa Kawashima
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Takuto Hikichi
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
| | - Michio Onizawa
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Naohiko Gunji
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Yu Watahiki
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Chiharu Sakuma
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Tomoaki Mochimaru
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Mai Murakami
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
| | - Osamu Suzuki
- Department of Diagnostic PathologyFukushima Medical UniversityFukushimaJapan
| | - Yuko Hashimoto
- Department of Diagnostic PathologyFukushima Medical UniversityFukushimaJapan
| | - Masao Kobayakawa
- Department of EndoscopyFukushima Medical University HospitalFukushimaJapan
- Medical Research CenterFukushima Medical UniversityFukushimaJapan
| | - Hiromasa Ohira
- Department of GastroenterologyFukushima Medical UniversityFukushimaJapan
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Fang Z, Xu Y, Huang X. Impact of prophylactic wound closure in colorectal ESD on postoperative wound complications: A meta-analysis. Int Wound J 2024; 21:e14783. [PMID: 38472107 PMCID: PMC10932785 DOI: 10.1111/iwj.14783] [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: 01/22/2024] [Accepted: 02/02/2024] [Indexed: 03/14/2024] Open
Abstract
Endoscopic submucosa dissection (ESD) has been applied extensively in the treatment of large intestine tumours due to its high total excision ratio. Nevertheless, there is a high incidence of adverse reactions in colon ESD, and the efficacy of prophylactic ESD following ESD in prevention of postoperative haemorrhage is still disputed. The purpose of this meta-analysis is to evaluate the effectiveness of prophylaxis of wound closure in large intestine ESD after operation. For eligibility, we looked through three databases: PubMed, Embase and Cochrane Library. Heterogenity was measured by means of a chi-square method of Q-statistic and an I2 test. Fixed or random effects models were used for data processing. Based on the retrieval policy, we found a total of 1286 papers, and then we collected nine papers to extract the data. Regarding postoperative haemorrhage, there was a significant reduction in the risk of wound haemorrhage in the wound closure group than in the control group (OR, 0.29; 95% CI, 0.19-0.44 p < 0.0001). No statistical significance was found in the incidence of perforation in the wound closure and the control group (OR, 0.45; 95% CI, 0.19-1.03 p = 0.06). There was a significant reduction in the incidence of postoperation fever among those in the wound closure group than in the control group (OR, 0.37; 95% CI, 0.15-0.93 p = 0.04). Preventive endoscopic closure decreased the rate of ESD in colon disease, but did not significantly decrease the rate of postoperation perforation and postoperative fever. Future research will be required to clarify the risk factors and classify high-risk individuals in order to formulate a cost-effective prevention strategy.
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Affiliation(s)
- Zhengdong Fang
- Department of Critical Care MedicineSir Run Run Shaw Hospital, School of Medicine, Zhejiang UniversityHangzhouChina
| | - Yan Xu
- Department of Endoscopic CenterWenzhou Hospital of Intergrated Traditional Chinese Western MedicineWenzhouChina
| | - Xiaolin Huang
- Department of Endoscopic CenterWenzhou Hospital of Intergrated Traditional Chinese Western MedicineWenzhouChina
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Morimoto S, Tanaka H, Takehara Y, Yamamoto N, Tanino F, Kamigaichi Y, Yamashita K, Takigawa H, Yuge R, Urabe Y, Oka S. Hybrid endoscopic submucosal dissection as a salvage option for difficult colorectal conventional endoscopic submucosal dissection. Surg Endosc 2024; 38:222-228. [PMID: 37968384 DOI: 10.1007/s00464-023-10544-6] [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: 05/20/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND When total submucosal dissection is difficult to achieve during conventional colorectal endoscopic submucosal dissection (C-ESD), the lesion can be resected by final snaring through salvage hybrid ESD (SH-ESD). This study aimed to examine the outcomes of SH-ESD and identify its indications that could achieve en bloc resection. METHODS We recruited 1039 consecutive patients with colorectal lesions that underwent ESD at Hiroshima University Hospital between January 2015 and December 2020. C-ESD was attempted thoroughly in 924 lesions (C-ESD group, including 9 lesions in which ESD was discontinued), and SH-ESD was performed owing to some difficulties in 115 lesions (SH-ESD group). Risk factors for incomplete resection by SH-ESD and ESD discontinuation were evaluated using multivariate analysis. The outcomes were compared between cases with remaining undissected submucosa of < 20 mm in diameter in the SH-ESD and C-ESD groups, using propensity score matching. RESULTS Multivariate analysis revealed that a procedure time > 80 min and remaining undissected submucosa ≥ 20 mm in diameter were significant risk factors for incomplete resection after SH-ESD and ESD discontinuation. By propensity score matching analysis, procedure time was significantly shorter in the SH-ESD group with remaining undissected submucosa < 20 mm in diameter than in the C-ESD group (71 min vs. 90 min, p = 0.0053), although no significant difference was found in the en bloc resection rate (94% vs. 87%, p = 0.0914). CONCLUSION SH-ESD can be an alternative surgical method when conventional ESD is difficult to continue in cases in which the remaining undissected submucosa is < 20 mm in diameter.
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Affiliation(s)
- Shin Morimoto
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Yudai Takehara
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Noriko Yamamoto
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Fumiaki Tanino
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuki Kamigaichi
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Ken Yamashita
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hidehiko Takigawa
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Ryo Yuge
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuji Urabe
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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9
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Jacques J, Neuhaus H, Enderle MD, Biber U, Linzenbold W, Schenk M, Khalaf K, Repici A. Colorectal Endoscopic Submucosal Dissection: Performance of a Novel Hybrid-Technology Knife in an Animal Trial. Diagnostics (Basel) 2023; 13:3347. [PMID: 37958243 PMCID: PMC10650536 DOI: 10.3390/diagnostics13213347] [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: 09/25/2023] [Revised: 10/18/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) was developed for the removal of benign and early malignant lesions in the gastrointestinal tract. We aimed to evaluate the performance and safety of a novel high-pressure waterjet-assisted ESD knife in colorectal applications. Six female German Landrace pigs with an average weight of 62 kg (range 60-65 kg) were used in this prospective, randomized, and controlled study. Twenty-four ESDs were performed by three endoscopists: Twelve each with the new Erbe HYBRIDknife® flex T-Type (HK-T) and the Olympus DualKnife® J (DK-J), including six rectal and six colonic ESDs per instrument. The order of performance was randomized regarding anatomic position and instrument. As the primary endpoint, ESD knife performance characteristics were combined and rated on a 5-point Likert scale, with 5 Likert points (LP) representing the best response (5 = very good). The HK-T was rated significantly better than the DK-J (4.7 LP versus 4.4 LP, p = 0.0295), mainly because of HK-T injection ability (5 LP versus 3 LP, p < 0.0001) and hemostasis (5 LP versus 4 LP, p = 0.0452). There was no difference in procedure time (HK-T: 35 min versus DK-J: 34 min, p = 0.8005), resection diameter (3.1 cm versus 2.8 cm, p = 0.3492), injection volume (41 mL versus 46 mL, p = 0.5633), and complication rates. HK-T is as effective as DK-J in colorectal ESD in terms of dissection quality but has better injection and hemostatic properties. The impact of these technical advantages on the ESD treatment of patients with large superficial colorectal lesions remains to be clinically verified.
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Affiliation(s)
- Jérémie Jacques
- Department of Hepato-Gastro-Enterology, University Hospital Center, 87042 Limoges, France
| | - Horst Neuhaus
- Medical Clinic for Gastroenterology at the Hospital Duesseldorf, 40225 Duesseldorf, Germany
| | | | - Ulrich Biber
- Erbe Elektromedizin GmbH, 72072 Tuebingen, Germany
| | | | - Martin Schenk
- Department of Experimental Medicine, University Hospital Tuebingen, 72076 Tuebingen, Germany
| | - Kareem Khalaf
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Milan, Italy
- Department of Biomedical Science, Humanitas University, 20072 Milan, Italy
| | - Alessandro Repici
- Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, 20089 Milan, Italy
- Department of Biomedical Science, Humanitas University, 20072 Milan, Italy
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10
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Teoh JYC, D'Andrea D, Gallioli A, Yanagisawa T, MacLennan S, Nicoletti R, Fai NC, Maffei D, Hurle R, Lusuardi L, Malavaud B, Miki J, Kramer M, Mostafid H, Enikeev D, Babjuk M, Breda A, Shariat S, Gontero P, Herrmann T. En bloc resection of bladder tumour: the rebirth of past through reminiscence. World J Urol 2023; 41:2599-2606. [PMID: 37584691 PMCID: PMC10581917 DOI: 10.1007/s00345-023-04547-0] [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: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To learn about the history and development of en bloc resection of bladder tumour (ERBT), and to discuss its future directions in managing bladder cancer. METHODS In this narrative review, we summarised the history and early development of ERBT, previous attempts in overcoming the tumour size limitation, consolidative effort in standardising the ERBT procedure, emerging evidence in ERBT, evolving concepts in treating large bladder tumours, and the future directions of ERBT. RESULTS Since the first report on ERBT in 1980, there has been tremendous advancement in terms of its technique, energy modalities and tumour retrieval methods. In 2020, the international consensus statement on ERBT has been developed and it serves as a standard reference for urologists to practise ERBT. Recently, high-quality evidence on ERBT has been emerging. Of note, the EB-StaR study showed that ERBT led to a reduction in 1-year recurrence rate from 38.1 to 28.5%. An individual patient data meta-analysis is currently underway, and it will be instrumental in defining the true value of ERBT in treating non-muscle-invasive bladder cancer. For large bladder tumours, modified approaches of ERBT should be accepted, as the quality of resection is more important than a mere removal of tumour in one piece. The global ERBT registry has been launched to study the value of ERBT in a real-world setting. CONCLUSION ERBT is a promising surgical technique in treating bladder cancer and it has gained increasing interest globally. It is about time for us to embrace this technique in our clinical practice.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Urothelial Cancer Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU, Amsterdam, Netherlands.
| | - David D'Andrea
- Urothelial Cancer Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU, Amsterdam, Netherlands
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrea Gallioli
- Urothelial Cancer Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU, Amsterdam, Netherlands
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Rossella Nicoletti
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Ng Chi Fai
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Davide Maffei
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Lukas Lusuardi
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, 5020, Salzburg, Austria
| | - Bernard Malavaud
- Institut Universitaire du Cancer Toulouse-Oncopôle, Toulouse, France
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mario Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Hugh Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Marek Babjuk
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Shahrokh Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Paolo Gontero
- Department of Urology, Città Della Salute e Della Scienza, University of Torino School of Medicine, Turin, Italy
| | - Thomas Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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11
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Okimoto K, Matsumura T, Matsusaka K, Inaba Y, Ishikawa T, Akizue N, Kaneko T, Ota M, Ohta Y, Taida T, Saito K, Ogasawara S, Maruoka D, Kato J, Ikeda JI, Kato N. Outcomes for Underwater Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection of 21-30-mm Colorectal Polyps: A Feasible Study. Dig Dis Sci 2023; 68:3963-3973. [PMID: 37658209 DOI: 10.1007/s10620-023-08093-y] [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: 04/29/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND AND AIMS This randomized controlled trial (RCT) was designed to evaluate the short-term outcomes of underwater endoscopic mucosal resection (UEMR) and endoscopic submucosal dissection (ESD) of 21-30 mm colonic polyps. METHOD We conducted a single-center RCT. Patients diagnosed with suspected colorectal intramucosal carcinoma (21-30 mm and adaptable for both UEMR and ESD) were randomly assigned to the UEMR and ESD groups at a 1:1 ratio. The primary endpoint was the R0 resection rate. We independently performed one-sample tests against the set threshold for each treatment. The significance level was set at p = 0.224. RESULT Eleven polyps each in the UEMR and ESD groups, respectively, were analyzed. The R0 resection rate (%) was 36 (95% confidence interval 11-69) and 100 (72-100) for UEMR and ESD, respectively, with a significant difference between the two groups (p = 0.002). The p-value against the set threshold for UEMR was 0.743, whereas that for ESD was < 0.001 (one-sample binomial test). The en bloc resection rates (%) were 82 (48-97) and 100 (72-100) for UEMR and ESD, respectively; however, no significant difference was observed (p = 0.167). The mean treatment time (min) was significantly shorter in the UEMR group (8 ± 6) than in the ESD group (48 ± 29) (p = 0.001). CONCLUSION ESD could achieve a high R0 resection rate, while the en bloc resection rate was comparable between the two treatment techniques with less burden on patients undergoing UEMR for 21-30-mm colorectal polyps. CLINICAL TRIAL REGISTRATION The study was registered at the Japan Registry of Clinical Trial as jRCT1030210015 and jRCT1030210177.
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Affiliation(s)
- Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan.
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | | | - Yosuke Inaba
- Biostatistics Section, Chiba University Hospital Clinical Research Center, Chiba, Japan
| | - Tsubasa Ishikawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Tatsuya Kaneko
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Masayuki Ota
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Takashi Taida
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Daisuke Maruoka
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
- Kameido Endoscopy and Gastroenterology Clinic, Tokyo, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
| | - Jun-Ichiro Ikeda
- Department of Pathology, Chiba University Hospital, Chiba, Japan
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chiba, 260-8670, Japan
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12
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Keihanian T, Zabad N, Khalaf M, Abdel-Jaber W, Kim YI, Jawaid SA, Abidi WM, Marginean EC, Othman MO. Safety and efficacy of a novel suturing device for closure of large defects after endoscopic submucosal dissection (with video). Gastrointest Endosc 2023; 98:381-391. [PMID: 37061137 DOI: 10.1016/j.gie.2023.04.006] [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: 11/06/2022] [Revised: 01/14/2023] [Accepted: 04/08/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND AIMS Endoscopic suturing enables full closure of large defects after endoscopic submucosal dissection (ESD). However, its use is limited by the need for a double-channel endoscope. A novel closure system, the OverStitch Sx (Apollo Endosurgery, Austin, Tex, USA), compatible with any single-channel endoscope, was introduced to address these shortcomings. The aim of this study was to assess the safety and feasibility of OverStitch Sx for the closure of large defects after ESD. METHODS This is a prospective single-center feasibility study of patients who underwent closure of large defects after ESD using the OverStitch Sx system. Main outcomes of the study are technical and clinical success, same-day discharge rate, and adverse event rate. RESULTS Thirty-three patients were enrolled. The mean diameter of included lesions was 5.38 ± 2.52 cm. The defect occupied ≥50% of the lumen circumference in 70% of the cases. En-bloc resection, R0 resection, and curative resection were achieved in 97%, 87.5%, and 78.8% of patients, respectively. Technical success and clinical success were seen in 93.9% and 90.9% of the cases, respectively. Same-day hospital discharge was achieved in 77.4% of patients. Total adverse event rate was 35.7%, including delayed bleeding in 1 patient after rectal ESD that was managed conservatively, self-resolving rectal pain in 7 patients, rectal stricture requiring dilation in 1 patient, and temporary dysphagia in 1 patient. No immediate or delayed perforation was reported. CONCLUSIONS OverStitch Sx enabled safe and effective closure of large defects after ESD. Future trials are needed to determine its superiority over OverStitch for the closure of defects in challenging locations. (Clinical trial registration number: NCT04361227.).
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Affiliation(s)
| | - Noor Zabad
- Department of Medicine, Division of Gastroenterology
| | - Mai Khalaf
- Department of Medicine, Division of Gastroenterology
| | | | - Young-Il Kim
- Department of Medicine, Division of Gastroenterology
| | | | - Wasif M Abidi
- Department of Medicine, Division of Gastroenterology
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13
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Ito S, Nishiguchi A, Taguchi T. Effect of particle size on the tissue adhesion and particle floatation of a colloidal wound dressing for endoscopic treatments. Acta Biomater 2023; 159:83-94. [PMID: 36706853 DOI: 10.1016/j.actbio.2023.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/09/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023]
Abstract
Endoscopic submucosal dissection (ESD) is a minimally invasive technique that is widely used to remove gastrointestinal tumors. However, because the walls of the duodenum and large intestine are thin, perforation can easily occur after ESD. We have previously reported that alkyl group-modified Alaska pollock gelatin-based microparticles (C10Ps) formed a colloidal gel that could adhere to defects and close perforations, driven by hydrophobic interactions. The present study focused on the effect of particle size on the colloidal gel properties and the floatation of C10Ps in the air in the delivery of C10Ps. We prepared C10Ps with different particle sizes from 0.1 to 100 µm. The storage modulus and adhesion strength of the C10P colloidal gel increased with decreasing particle size. All the C10Ps formed a colloidal gel layer on duodenum tissue after being sprayed from an endoscopic device. The underwater stability and burst strength of C10Ps with a particle size of 0.1 and 1 µm were higher than for larger C10Ps. Floating of the small-sized C10Ps in the air was observed. The results indicated that C10Ps with a size of 1 µm had suitable properties for use in endoscopic treatments. STATEMENT OF SIGNIFICANCE: We previously reported tissue adhesive microparticles as a spray-deliverable wound dressing in gastrointestinal tissues. However, their functions depending on particle size have not yet been clarified. In the present study, we prepared decyl group-modified Alaska pollock gelatin nano and microparticles (C10Ps) with different particle sizes from 0.1 to 100 µm and evaluated the effect of particle size on the colloidal gel properties (rheological property, underwater stability and perforation-closing ability) and the floatation of C10Ps in the air in the delivery of C10Ps.
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Affiliation(s)
- Shima Ito
- Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Akihiro Nishiguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Tetsushi Taguchi
- Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan; Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan.
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14
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Wu D, Jia M, Zhou S, Xu X, Wu M. Studies on endoscopic submucosal dissection in the past 15 years: A bibliometric analysis. Front Public Health 2022; 10:1014436. [PMID: 36238233 PMCID: PMC9552180 DOI: 10.3389/fpubh.2022.1014436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023] Open
Abstract
Background and aims Endoscopic submucosal dissection (ESD) is an advanced minimally invasive technique for en bloc resection of superficial gastrointestinal lesions, which is drawn an increasing attention from its emergence. This bibliometric analysis is to evaluate the origin, current hotspots, and research trends on ESD. Methods A total of 2,131 publications on ESD from 2006 to 2020 were obtained from the Web of Science Core Collection (WoSCC) database. Bibliometric visualization analyses of countries/regions, institutes, authors, journals, references and keywords were performed by CiteSpace V.5.8.R3. Results The quantity of publications on ESD increased significantly during the past 15 years. Japan occupied the leading position in terms of research power. Professor Yutaka Saito, together with the institute he belongs, the Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan, were the most productive author and institute, respectively. Colorectal ESD led the main thematic concentrations in ESD research. The most prolific journal was Gastrointestinal Endoscopy. European ESD Guideline was the most frequently co-cited reference. Guideline, meta-analysis, endoscopic resection, poly-glycolic acid sheet, Barrett's esophagus, fibrin glue, risk and colorectal neoplasm will be the active research hotspots in the future. Conclusions These findings provide the trends and frontiers in the field of ESD, as well as valuable information for clinicians and scientists to discover the future perspectives with potential collaborators.
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Affiliation(s)
- Deqing Wu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengyu Jia
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shu Zhou
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaorong Xu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Meiqin Wu
- Shanghai Key Laboratory of Maternal Fetal Medicine, School of Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, Tongji University, Shanghai, China,*Correspondence: Meiqin Wu
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15
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Hong J, Wang Y, Deng J, Qi M, Zuo W, Hao Y, Wang A, Tu Y, Xu S, Zhou X, Zhou X, Li G, Zhu L, Shu X, Zhu Y, Lv N, Chen Y. Potential Factors Predicting Histopathologically Upgrade Discrepancies between Endoscopic Forceps Biopsy of the Colorectal Low-Grade Intraepithelial Neoplasia and Endoscopic Resection Specimens. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1915458. [PMID: 35707387 PMCID: PMC9192244 DOI: 10.1155/2022/1915458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/21/2022] [Indexed: 12/24/2022]
Abstract
Background It was gradually accepted that endoscopic fragment biopsy (EFB) diagnosis cannot accurately guarantee the absence of higher-grade neoplasms within the lesion of the digestive tract. There are no well-established predictors for histopathologically upgrade discrepancies between EFB diagnosing colorectal low-grade intraepithelial neoplasia (LGIN) and endoscopic resection (ER) specimens. Methods A total of 918 colorectal LGINs was histopathologically diagnosed by EFB, including 162 cases with upgrade discrepancy and 756 concordant cases. We compared clinicopathological data of EFB and ER specimens between these two groups. Multivariate analysis was performed to identify predictors for this upgrade histopathology. Results The predominant upgrade discrepancy of LGINs diagnosed by EFB was upgrades to high-grade dysplasia (114/918, 12.4%), followed by upgrades to intramucosal carcinoma (33/918, 3.6%), submucosal adenocarcinoma (10/918, 1.1%), and advanced adenocarcinoma (5/918, 0.5%). NSAID history (OR 4.83; 95% CI, 2.27-10.27; p < 0.001), insufficient EFB number (OR 2.99; 95% CI, 1.91-4.68; p < 0.001), maximum diameter ≥ 1.0 cm (OR 6.18; 95% CI, 1.32-28.99; p = 0.021), lobulated shape (OR 2.68; 95% CI, 1.65-4.36; p < 0.001), erythema (OR 2.42; 95% CI, 1.50-3.91; p < 0.001), erosion (OR 7.12; 95% CI, 3.91-12.94; p < 0.001), surface unevenness (OR 2.31; 95% CI, 1.33-4.01; p = 0.003), and distal location of the target adenoma (OR 3.29; 95% CI, 1.68-6.41; p < 0.001) were associated with the histologically upgrade discrepancies. Conclusion NSAID history, insufficient EFB number, adenoma size and location, and abnormal macroscopic patterns are potential predictors for upgrade histopathology of LGINs diagnosed by EFBs. The standardization of EFB number and advanced imaging techniques could minimize the risk of neglecting the potential of this upgrade histopathology.
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Affiliation(s)
- Junbo Hong
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yining Wang
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jiangshan Deng
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Miao Qi
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Zuo
- Department of Respiratory Medicine, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Yuanzheng Hao
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Anjiang Wang
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yi Tu
- Department of Pathology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Shan Xu
- Department of Pathology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China
| | - Xiaodong Zhou
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaojiang Zhou
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Guohua Li
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Liang Zhu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yin Zhu
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Nonghua Lv
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Youxiang Chen
- Department of Gastroenterology, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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16
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Tan DJH, Ng CH, Lim XC, Lim WH, Yuen LZH, Koh JH, Nistala KRY, Ho KY, Chong CS, Muthiah MD. Is underwater endoscopic mucosal resection of colon polyps superior to conventional techniques? A network analysis of endoscopic mucosal resection and submucosal dissection. Endosc Int Open 2022; 10:E154-E162. [PMID: 35047346 PMCID: PMC8759939 DOI: 10.1055/a-1633-3230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background and study aims Evidence from recent trials comparing conventional endoscopic mucosal resection (EMR) to underwater EMR (UEMR) have matured. However, studies comparing UEMR to endoscopic submucosal dissection (ESD) are lacking. Hence, we sought to conduct a comprehensive network meta-analysis to compare the efficacy of UEMR, ESD, and EMR. Methods Embase and Medline databases were searched from inception to December 2020 for articles comparing UEMR with EMR and ESD. Outcomes of interest included rates of en bloc and complete polyp resection, risk of perforation and bleeding, and local recurrence. A network meta-analysis comparing all three approaches was conducted. In addition, a conventional comparative meta-analysis comparing UEMR to EMR was performed. Analysis was stratified according to polyp sizes (< 10 mm, ≥ 10 mm, and ≥ 20 mm). Results Twenty-two articles were included in this study. For polyps ≥ 10 mm, UEMR was inferior to ESD in achieving en bloc resection ( P = 0.02). However, UEMR had shorter operating time for polyps ≥ 10 mm ( P < 0.001), and ≥20 mm ( P = 0.019) with reduced perforation risk for polyps ≥ 10 mm ( P = 0.05) compared to ESD. In addition, en bloc resection rates were similar between UEMR and EMR, although UEMR had reduced recurrence for polyps ≥ 10 mm ( P = 0.013) and ≥ 20 mm ( P = 0.014). UEMR also had shorter mean operating than EMR for polyps ≥ 10 mm ( P < 0.001) and ≥ 20 mm ( P < 0.001). Risk of bleeding and perforation with UEMR and EMR were similar for polyp of all sizes. Conclusions UEMR has demonstrated technical and oncological outcomes comparable to ESD and EMR, along with a desirable safety profile. UEMR appears to be a safe and effective alternative to conventional methods for resection of polyps ≥ 10 mm.
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Affiliation(s)
- Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiong Chang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Linus Zhen Han Yuen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jin Hean Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Khek-Yu Ho
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Mark D. Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
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17
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Jeon HJ, Choi HS, Bang EJ, Lee KW, Kim SH, Lee JM, Kim ES, Keum B, Tae Jeen Y, Lee HS, Chun HJ, Jeong S, Kim JH. Efficacy and safety of a thermosensitive hydrogel for endoscopic submucosal dissection: An in vivo swine study. PLoS One 2021; 16:e0260458. [PMID: 34882721 PMCID: PMC8659419 DOI: 10.1371/journal.pone.0260458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Injectable thermo-sensitive chitosan hydrogels have recently been developed for the use of submucosal fluids in endoscopic submucosal dissections (ESD). This study aimed to investigate the efficacy and safety of chitosan hydrogels during ESD. Submucosal fluids were administered as follows: 0.9% normal saline (NS), 0.4% hyaluronic acid (HA) and chitosan/β-glycerophosphate (CS/GP) hydrogel. Each solution was administered twice into the stomach and colon of a pig, with a total of 72 ESD procedures performed on 12 pigs. The injected volume and procedure-related parameters were recorded and analyzed. ESDs that created ulcers after 7 days were histologically compared. All ESD specimens were resected en bloc. The total injected volumes during ESD of the stomach (NS, 16.09±3.27 vs. HA, 11.17±2.32 vs. CS/GP, 9.44±2.33; p<0.001) and colon (NS, 9.17±1.80 vs. HA, 6.67±1.50 vs. CS/GP, 6.75±1.57; p = 0.001) were significantly different. Hydrogel showed significant differences from normal saline in terms of fluid power (mm2/vol; NS, 35.70±9.00 vs. CS/GP 57.48±20.77; p = 0.001) and consumption rate (vol/min; NS, 2.59±0.86 vs. CS/GP, 1.62±0.65; p = 0.013) in the stomach. Histological examination revealed preserved muscularis propria, although the chitosan hydrogel resulted in a partial inflammatory response, with a hypertrophied submucosal layer. Chitosan hydrogel was found to be superior to normal saline, with an efficacy similar to that of hyaluronic acid. Nonetheless, long-term histological changes should be evaluated before clinical implementation.
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Affiliation(s)
- Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| | - Eun Ju Bang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kang Won Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung Jeong
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Jong Hyuk Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States of America
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States of America
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18
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Arimoto J, Chiba H, Okada N, Kuwabara H, Nakaoka M. Freestyle endoscopic submucosal dissection using a multifunctional snare. VideoGIE 2021; 6:501-502. [PMID: 34765842 PMCID: PMC8573580 DOI: 10.1016/j.vgie.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Naoya Okada
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
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Nagl S, Ebigbo A, Goelder SK, Roemmele C, Neuhaus L, Weber T, Braun G, Probst A, Schnoy E, Kafel AJ, Muzalyova A, Messmann H. Underwater vs Conventional Endoscopic Mucosal Resection of Large Sessile or Flat Colorectal Polyps: A Prospective Randomized Controlled Trial. Gastroenterology 2021; 161:1460-1474.e1. [PMID: 34371000 DOI: 10.1053/j.gastro.2021.07.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Conventional endoscopic mucosal resection (CEMR) with submucosal injection is the current standard for the resection of large, nonmalignant colorectal polyps. We investigated whether underwater endoscopic mucosal resection (UEMR) is superior to CEMR for large (20-40mm) sessile or flat colorectal polyps. METHODS In this prospective randomized controlled study, patients with sessile or flat colorectal polyps between 20 and 40 mm in size were randomly assigned to UEMR or CEMR. The primary outcome was the recurrence rate after 6 months. Secondary outcomes included en bloc and R0 resection rates, number of resected pieces, procedure time, and adverse events. RESULTS En bloc resection rates were 33.3% in the UEMR group and 18.4% in the CEMR group (P = .045); R0 resection rates were 32.1% and 15.8% for UEMR vs CEMR, respectively (P = .025). UEMR was performed with significantly fewer pieces compared to CEMR (2 pieces: 45.5% UEMR vs 17.7% CEMR; P = .001). The overall recurrence rate did not differ between both groups (P = .253); however, subgroup analysis showed a significant difference in favor of UEMR for lesions of >30 mm to ≤40 mm in size (P = .031). The resection time was significantly shorter in the UEMR group (8 vs 14 minutes; P < .001). Adverse events did not differ between both groups (P = .611). CONCLUSIONS UEMR is superior to CEMR regarding en bloc resection, R0 resection, and procedure time for large colorectal lesions and shows significantly lower recurrence rates for lesions >30 mm to ≤40 mm in size. UEMR should be considered for the endoscopic resection of large colorectal polyps.
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Affiliation(s)
- Sandra Nagl
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Karl Goelder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Roemmele
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Lukas Neuhaus
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Weber
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | | | - Anna Muzalyova
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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20
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Nishimura T, Oka S, Tanaka S, Kamigaichi Y, Tamari H, Shimohara Y, Okamoto Y, Inagaki K, Matsumoto K, Tanaka H, Yamashita K, Ninomiya Y, Kitadai Y, Arihiro K, Chayama K. Long-term prognosis after endoscopic submucosal dissection for colorectal tumors in patients aged over 80 years. BMC Gastroenterol 2021; 21:324. [PMID: 34425746 PMCID: PMC8381532 DOI: 10.1186/s12876-021-01899-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background In Japan, endoscopic submucosal dissection (ESD) is standardized for large colorectal tumors. However, its validity in the elderly population is unclear. We aimed to evaluate the safety and efficacy of ESD for colorectal tumors in elderly patients aged over 80 years.
Methods ESD was performed on 178 tumors in 165 consecutive patients aged over 80 years between December 2008 and December 2018. We retrospectively evaluated the clinicopathological characteristics and clinical outcomes of ESD. We also assessed the prognosis of 160 patients followed up for more than 12 months. Results The mean patient age was 83.7 ± 3.1 years. The number of patients with comorbidities was 100 (62.5%). Among all patients, 106 (64.2%) were categorized as class 1 or 2 according to the American Society of Anesthesiologists classification of physical status (ASA-PS), and 59 (35.8%) were classified as class 3. The mean procedure time was 97.7 ± 79.3 min. The rate of histological en bloc resection was 93.8% (167/178). Delayed bleeding in 11 cases (6.2%) and perforation in 7 cases (3.9%) were treated conservatively. The 5-year survival rate was 89.9%. No deaths from primary disease (mean follow-up time: 35.3 ± 27.5 months) were observed. Overall survival rates were significantly lower in the non-curative resection group that did not undergo additional surgery than in the curative resection group (P = 0.0152) and non-curative group that underwent additional surgery (P = 0.0259). Overall survival rates were higher for ASA-PS class 1 or 2 patients than class 3 patients (P = 0.0105). Metachronous tumors (> 5 mm) developed in 9.4% of patients. Conclusions ESD for colorectal tumors in patients aged over 80 years is safe. Colorectal cancer-associated deaths were prevented although comorbidities pose a high risk of poor prognosis.
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Affiliation(s)
- Tomoyuki Nishimura
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, 1-2-3, Kasumi, Hiroshima, 734-8551, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, 1-2-3, Kasumi, Hiroshima, 734-8551, Japan.
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Kamigaichi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirosato Tamari
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Yuki Okamoto
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Katsuaki Inagaki
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenta Matsumoto
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Ninomiya
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasuhiko Kitadai
- Department of the Faculty of Human Culture and Science, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, 1-2-3, Kasumi, Hiroshima, 734-8551, Japan
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21
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Lim XC, Nistala KRY, Ng CH, Lin SY, Tan DJH, Ho KY, Chong CS, Muthiah M. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal polyps: A meta-analysis and meta-regression with single arm analysis. World J Gastroenterol 2021; 27:3925-3939. [PMID: 34321855 PMCID: PMC8291020 DOI: 10.3748/wjg.v27.i25.3925] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/21/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has shown to be effective in management of colorectal neoplasm in the Asian countries, while its implementation in Western countries where endoscopic mucosal resection (EMR) is preferred is still debatable.
AIM To compare the surgical, histological, and oncological outcomes between ESD and EMR in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world.
METHODS Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc, complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR.
RESULTS Of 281344 colorectal polyps from 21 studies were included. When compared to EMR, the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate, and lower lateral margin involvement and recurrence. ESD led to increased procedural time, need for additional surgery, and perforation risk. No significant difference in bleeding risk was found between the two groups. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD. Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate, bleeding risk and recurrence. In subgroup analysis, Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4% and 0.0002%, respectively, as compared to perforation risk of 8% and 1%, respectively, in reports coming from rest of the world.
CONCLUSION ESD resulted in better resection outcomes and lower recurrence compared to EMR. With appropriate training, ESD is preferred over EMR as the first-line therapy for resection of colorectal polyps, without restricting to lesions greater than 20 mm and those with high suspicion of submucosal invasion.
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Affiliation(s)
- Xiong Chang Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | | | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Khek-Yu Ho
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
| | - Choon-Seng Chong
- Department of Surgery, National University Hospital, Singapore 119074, Singapore
| | - Mark Muthiah
- Department of Medicine, National University Hospital, Singapore 119074, Singapore
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22
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Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study. Surg Endosc 2021; 36:1894-1902. [PMID: 33847798 DOI: 10.1007/s00464-021-08471-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Hybrid endoscopic submucosal dissection (ESD) is a colorectal lesion resection procedure that includes both planned and salvage procedures. Previous colorectal hybrid ESD studies have involved single institutions or few operators over a short timeframe, and the size for indication has not been established. In this multicentre study, we investigated the clinical outcomes of hybrid ESD for colorectal tumors that met the 30 mm lesion size criterion. METHODS From January 2008 to December 2018, colorectal hybrid ESD was performed for 172 lesions (diameter range, ≥ 20- < 30 mm) at Hiroshima GI Endoscopy Research Group. We compared clinicopathological characteristics and outcomes between 56 and 116 lesions in planned and salvage groups, respectively. We also compared data between 2008 and 2013 (the first period) and 2014 and 2018 (the second period) to assess operator experience. RESULTS No significant difference was found in the complete en bloc resection rate between the planned and salvage groups (92.9% vs. 83.6%, respectively). Procedure time was shorter in the planned group (44.5 min) than in the salvage group (72.0 min, p < 0.01). The perforation rate was higher in the salvage group (21.6%) than in the planned group (0%, p < 0.01); however, the perforation rate during snaring in the salvage group was 1.8%. During the second period relative to the first period, we recorded a significantly higher complete en bloc resection rate (95.7% vs. 75.6%, respectively, p < 0.01) and experienced operator rate (75.5% vs. 53.9%, respectively, p < 0.01). Furthermore, no significant difference was found in the complete en bloc resection rate between the planned and salvage groups during the second period (100% vs. 94.4%, respectively). CONCLUSION Colorectal hybrid ESD, especially salvage hybrid ESD performed by experienced operators, is adoptable and safe for lesions with diameters ranging from ≥ 20 to < 30 mm.
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23
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Ito S, Nishiguchi A, Sasaki F, Maeda H, Kabayama M, Ido A, Taguchi T. Robust closure of post-endoscopic submucosal dissection perforation by microparticle-based wound dressing. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 123:111993. [PMID: 33812615 DOI: 10.1016/j.msec.2021.111993] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/18/2021] [Indexed: 12/13/2022]
Abstract
Endoscopic submucosal dissection (ESD) has been used as a minimally invasive cancer treatment for early-stage gastrointestinal cancer. However, cancer dissection in thin tissues, such as the duodenum and large intestine, often cause post-ESD and delayed perforation, which elicit severe complications. In this study, we report a microparticle-based wound dressing with hydrophobically-modified gelatin that can close the perforation after ESD. Hydrophobized microparticles were prepared using a coacervation method in a water/ethanol mixed solvent. The optimized alkyl chain length and degree of substitution of hydrophobic groups improved the mechanical strength of the hydrogel formed by hydration and fusion of the microparticles. The hydrogels formed on tissue defects revealed higher burst strength in ex vitro perforation models using duodenum, large intestine, and stomach under wet conditions compared with hydrogels without hydrophobic modification. The particle fusion was determined to be a crucial step to yield a high burst strength. An in vivo degradability evaluation showed that microparticle hydrogels subcutaneously implanted in rats degraded within 14 days. The microparticle wound dressing is expected to be applicable to post-ESD perforation and prevent delayed perforation.
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Affiliation(s)
- Shima Ito
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan
| | - Akihiro Nishiguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan
| | - Fumisato Sasaki
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hidehito Maeda
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masayuki Kabayama
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Akio Ido
- Digestive and Lifestyle Diseases, Department of Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Tetsushi Taguchi
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki, 305-0044, Japan; Graduate School of Science and Technology, Degree Programs in Pure and Applied Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577, Japan.
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24
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Vaganov YE, Nagudov MA, Khomyakov EA, Achkasov SI. Endoscopic submucosal dissection versus endoscopic mucosal resection for colorectal tumors: a systematic review and meta-analysis. Khirurgiia (Mosk) 2021:77-84. [PMID: 34480459 DOI: 10.17116/hirurgia202109177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare early (resection quality, complication rate, surgery time) and long-term (recurrence rate) outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection. MATERIAL AND METHODS A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. Data were analyzed using the Rewiew Manager 5.3 software. RESULTS The study included 8 manuscripts including 6 retrospective trials, 1 case-control and only 1 prospective study. These studies comprised the results of endoscopic resection of 1989 colonic tumors (EMR - 748, ESD - 1241). ESD is associated with higher incidence of en-bloc resection (OR 0.13; 95% CI 0.03 0.49; p=0.003) and R0 resection (OR 0.23; 95% CI 0.05 1.02; p=0.05) compared to EMR. Local recurrence rate is 13 times higher after EMR compared to ESD (OR 13.94; 95% CI 6.3 30.8; p=0.00001). However, ESD is followed by 4 times higher risk of colon wall perforation (OR 0.25; 95% CI 0.08 0.81; p=0.02). CONCLUSION ESD is more advisable regarding resection quality compared to EMR. However, higher incidence of perforations, surgery time and technical features of ESD do not allow us to unambiguously interpret the results of our meta-analysis and determine the optimal surgical approach.
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Affiliation(s)
- Yu E Vaganov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - M A Nagudov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
| | - E A Khomyakov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - S I Achkasov
- Ryzhikh National Medical Research Centre for Coloproctology, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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25
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Zhao HJ, Yin J, Ji CY, Wang X, Wang N. Endoscopic mucosal resection versus endoscopic submucosal dissection for colorectal laterally spreading tumors: a meta-analysis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:941-947. [PMID: 33207885 DOI: 10.17235/reed.2020.6681/2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to assess the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of colorectal laterally spreading tumors (LSTs). METHODS a systematic literature search was performed in PubMed, Embase, the Cochrane Library, CNKI and WANFANG databases. The related references were selected according to certain inclusion and exclusion criteria. The Cochrane Collaboration's Revman 5.3 software was used for data analysis. RESULTS a total of 12 studies were included in the analysis. The total number of lesions was 3,062 (EMR: 1,906; ESD: 1,156). The en-bloc resection rate of ESD was 95 % (1,098/1,156), which was significantly higher than that of EMR (42.8 %, 815/1,906) (OR = 0.07, 95 % CI [0.02, 0.07], p < 0.00001). The complete resection rate of ESD was 93.2 % (109/117), which was significantly higher than that of EMR as well (71.9 %, 92/128) (OR = 0.12, 95 % CI [0.05, 0.29], p < 0.00001). The bleeding rate showed no significant difference between EMR and ESD (4.2 % vs 3.5 %) (OR = 1.04, 95 % CI [0.68, 1.60], p = 0.85). The perforation rates of EMR and ESD were 1.8 % and 2.4 %, respectively, which displayed a significant difference (OR = 0.56, 95 % CI [0.32, 0.97], p = 0.04). Nevertheless, the recurrence rate of EMR was significantly higher than that of ESD (15.9 % vs 0.5 %) (OR = 23.06, 95 % CI [11.11, 47.85], p < 0.00001). CONCLUSIONS endoscopic resection of LSTs is safe and effective. As compared with EMR, ESD has higher en-bloc and complete resection rates but a lower recurrence rate. Therefore, ESD is highly recommended for the treatment of LSTs.
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Affiliation(s)
- Hong-Jing Zhao
- Gastroenterology, The Second Hospital of Hebei Medical University, China
| | - Jie Yin
- Gastroenterology, The Second Hospital of Hebei Medical University,
| | - Cui-Ying Ji
- Gastroenterology, The Second Hospital of Hebei Medical University,
| | - Xin Wang
- Gastroenterology, The Second Hospital of Hebei Medical University,
| | - Na Wang
- Gastroenterology, The Second Hospital of Hebei Medical University,
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Ishigaki T, Kudo SE, Miyachi H, Hayashi T, Minegishi Y, Toyoshima N, Misawa M, Mori Y, Kudo T, Wakamura K, Baba T, Sawada N, Ishida F, Hamatani S. Treatment policy for colonic laterally spreading tumors based on each clinicopathologic feature of 4 subtypes: actual status of pseudo-depressed type. Gastrointest Endosc 2020; 92:1083-1094.e6. [PMID: 32335123 DOI: 10.1016/j.gie.2020.04.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/07/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Laterally spreading tumors (LSTs) are originally classified into 4 subtypes. Pseudo-depressed nongranular types (LSTs-NG-PD) are gaining attention because of their high malignancy potential. Previous studies discussed the classification of nongranular (LST-NG) and granular types (LST-G); however, the actual condition or indication for endoscopic treatment of LSTs-NG-PD remains unclear. We aimed to compare the submucosal invasion pattern of LSTs-NG-PD with the other 3 subtypes. METHODS A total of 22,987 colonic neoplasms including 2822 LSTs were resected endoscopically or surgically at Showa University Northern Yokohama Hospital. In these LSTs, 322 (11.4%) were submucosal invasive carcinomas. We retrospectively evaluated the clinicopathologic features of LSTs divided into 4 subtypes. In 267 LSTs resected en bloc, their submucosal invasion site was further evaluated. RESULTS The frequency of LSTs in all colonic neoplasms was significantly higher in women (14.9%) than in men (11.0%). Rates of submucosal invasive carcinoma were .8% in the granular homogenous type (LSTs-G-H), 15.2% in the granular nodular mixed type (LSTs-G-M), 8.0% in the nongranular flat elevated type (LSTs-NG-F), and 42.5% in LSTs-NG-PD. Tumor size was associated with submucosal invasion rate in LSTs-NG-F and LSTs-NG-PD (P < .001). The multifocal invasion rate of LSTs-NG-PD (46.9%) was significantly higher than that of LSTs-G-M (7.9%) or LSTs-NG-F (11.8%). In LSTs-NG-PD, the invasion was significantly deeper (≥1000 μm) if observed in 1 site. CONCLUSIONS For LSTs-G-M and LSTs-NG-F that may have invaded the submucosa, en bloc resection could be considered. Considering that LSTs-NG-PD had a higher submucosal invasion rate, more multifocal invasive nature, and deeper invasion tendency, regardless if invasion was only observed in 1 site, than LSTs-NG-F, we should endoscopically distinguish LSTs-NG-PD from LSTs-NG-F and strictly adopt en bloc resection by endoscopic submucosal dissection or surgery for LSTs-NG-PD. (Clinical trial registration number: UMIN 000020261.).
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Affiliation(s)
- Tomoyuki Ishigaki
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Takemasa Hayashi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yosuke Minegishi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Naoya Toyoshima
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toyoki Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kunihiko Wakamura
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Toshiyuki Baba
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Naruhiko Sawada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shigeharu Hamatani
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
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Takamaru H, Goto R, Yamada M, Sakamoto T, Matsuda T, Saito Y. Predicting and managing complications following colonoscopy: risk factors and management of advanced interventional endoscopy with a focus on colorectal ESD. Expert Rev Med Devices 2020; 17:929-936. [PMID: 32901531 DOI: 10.1080/17434440.2020.1819788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Colorectal endoscopic submucosal dissection (ESD) has been introduced widely in Western and Asian countries. The management of the perforation during ESD is crucial. AREAS COVERED The rate of intraprocedural perforation, risk factors, prevention, and management of perforation during ESD and EMR were discussed in this review. The perforation rate in ESD and EMR depending on the lesion size is also discussed. EXPERT OPINION The knowledge regarding the risk factor and techniques to manage perforation is important during colorectal ESD and EMR. The development of novel suturing techniques devices is key for colorectal ESD in the future.
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Affiliation(s)
| | - Rina Goto
- Endoscopy Division, National Cancer Center Hospital , Tokyo, Japan.,Department of Internal Medicine, The Medical City , Pasig, Philippines
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital , Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital , Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital , Tokyo, Japan.,Screening Center, National Cancer Center Hospital , Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital , Tokyo, Japan
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Zhou GYJ, Hu JL, Wang S, Ge N, Liu X, Wang GX, Sun SY, Guo JT. Delayed perforation after endoscopic resection of a colonic laterally spreading tumor: A case report and literature review. World J Clin Cases 2020; 8:3608-3615. [PMID: 32913871 PMCID: PMC7457092 DOI: 10.12998/wjcc.v8.i16.3608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/29/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been widely used for the treatment of early gastrointestinal cancer. Endoscopic piecemeal mucosal resection (EPMR) is derived from the combination of EMR and ESD. Delayed perforation with peritonitis after colonic EPMR is a rare but severe complication, sometimes requiring surgery. There are some associated risk factors, including patient- (location, diameter, and presence of fibrosis) and procedure-related factors. Early recognition and timely treatment are crucial for its management.
CASE SUMMARY We report a case in which delayed perforation with peritonitis was treated using endoscopic closure. A 54-year-old man was diagnosed with a 30-mm-diameter laterally spreading tumor in the colonic hepatic curvature. Fifteen hours after endoscopic resection, peritonitis caused by delayed perforation occurred and gradually aggravated. Conservative treatment was ineffective and no obvious perforation was observed. After timely endoscopic closure, the patient was discharged on postoperative day 4.
CONCLUSION In occasion of localized peritonitis aggravating without macroscopic perforation, endoscopic closure is an effective treatment for delayed perforation with stable vital signs in the early stage.
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Affiliation(s)
- Ge-Yu-Jia Zhou
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jin-Long Hu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Sheng Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Nan Ge
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Xiang Liu
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Guo-Xin Wang
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Si-Yu Sun
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Jin-Tao Guo
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Abstract
PURPOSE OF REVIEW To discuss endoscopic resection techniques of early gastrointestinal malignancy. The review will focus on the indications and outcomes of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). RECENT FINDINGS EMR is indicated for upper GI lesions less than 20 mm provided they can be easily lifted and have a low risk of submucosal invasion (SMI). ESD should be considered for esophageal and gastric lesions that are bulky, show intramucosal carcinoma, or have a risk of superficial submucosal invasion. With regard to colonic polyps, EMR is acceptable for the removal of large colonic polyps using a piecemeal technique. ESD can be reserved for rectal neuroendocrine tumors, fibrotic polyps, or polyps harboring early malignancy. In selected cases, particularly in lesions less than 2 cm in size, EMR can be safe and effective. For larger lesions or lesions with submucosal invasion, ESD is effective and curative. Choosing the best approach can be tailored for each patient depending on lesion size, pathology, and availability of local expertise.
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Affiliation(s)
- Yahya Ahmed
- Baylor St Luke's Medical Center, Houston, TX, USA
| | - Mohamed Othman
- Baylor St Luke's Medical Center, Houston, TX, USA. .,Division of Gastroenterology, Baylor College of Medicine, 7200 Cambridge St., 8th Floor, Suite 8B, Houston, TX, 77030, USA.
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Sako T, Toyonaga T, Nakano Y, Tanaka S, Takao T, Baba S, Takihara H, Morita Y, Umegaki E, Kodama Y. Endoscopic submucosal dissection involving the anal canal presents a risk factor for postoperative stricture. Surg Endosc 2020; 35:1307-1316. [PMID: 32215744 DOI: 10.1007/s00464-020-07508-5] [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: 05/29/2019] [Accepted: 03/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although postoperative strictures after endoscopic submucosal dissection (ESD) in the rectum are relatively rare, some rectal lesions require resection involving the anal canal, which is a narrow tract comprising squamous epithelium. To the best of our knowledge, no studies have investigated narrow anal canals when evaluating post-ESD strictures. This study aimed to evaluate the impact of resections involving the anal canal on postoperative stricture development. METHODS Between April 2005 and October 2017, 707 rectal lesions were treated with ESD. We retrospectively investigated 102 lesions that required ≥ 75% circumferential resection. Risk factors for post-ESD stricture and, among patients with strictures, obstructive symptoms, and number of dilation therapies required were investigated. RESULTS Post-ESD stricture occurred in 18 of 102 patients (17.6%). In the multivariate analysis, circumferential resection ≥ 90% and ESD involving the anal canal (ESD-IAC) were risk factors for postoperative strictures (P ≤ 0.0001 and 0.0115, respectively). Among the patients with strictures, obstructive symptoms were significantly related to anal strictures compared to rectal strictures (100% vs. 27.2%, P = 0.0041). Furthermore, the number of dilation therapies required was significantly greater among patients with anal strictures compared to those with rectal strictures (6.5 times vs. 2.7 times, P = 0.0263). CONCLUSION Not only circumferential resection ≥ 90% but also ESD-IAC was a significant risk factor for the stricture after rectal ESD. Furthermore, anal strictures were associated with a significantly higher frequency of obstructive symptoms and larger number of required dilation therapies than were rectal strictures.
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Affiliation(s)
- Tomoya Sako
- Department of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Takashi Toyonaga
- Department of Endoscopy, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan.
- Department of Endoscopy, Kishiwada Tokusyukai Hospital, Kishiwada, Japan.
| | - Yoshiko Nakano
- Department of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Shinwa Tanaka
- Department of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Toshitatsu Takao
- Department of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Shinichi Baba
- Department of Endoscopy, Kishiwada Tokusyukai Hospital, Kishiwada, Japan
| | - Hiroshi Takihara
- Department of Endoscopy, Kishiwada Tokusyukai Hospital, Kishiwada, Japan
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Eiji Umegaki
- Department of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Yuzo Kodama
- Department of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
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Okamoto Y, Oka S, Tanaka S, Inagaki K, Tanaka H, Matsumoto K, Boda K, Yamashita K, Sumimoto K, Ninomiya Y, Chayama K. Clinical usefulness of the S-O clip during colorectal endoscopic submucosal dissection in difficult-to-access submucosal layer. Endosc Int Open 2020; 8:E437-E444. [PMID: 32140559 PMCID: PMC7055622 DOI: 10.1055/a-1093-0681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/11/2018] [Indexed: 02/08/2023] Open
Abstract
Background and study aims In colorectal endoscopic submucosal dissection (ESD), the S-O clip improves the accessibility to the submucosal layer of the colon. However, its safety and usefulness in difficult colorectal ESDs are unclear. Thus, in this study, we aimed to assess the effectiveness of the S-O clip in colorectal ESD in the difficult-to-access submucosal layer. Patients and methods From January 2016 to December 2016, 189 consecutive cases of colorectal ESD were performed at Hiroshima University Hospital before the S-O clip was introduced. Between January 2017 and June 2018, among 271 consecutive colorectal ESD cases, 41 cases were performed colorectal ESD using the S-O clip. We compared outcomes between the two groups (41 cases with S-O clip [use group] and 189 cases without S-O clip [non-use group]) using propensity score matching. Results Prior to propensity score matching, 41 cases with the S-O clip (use group) and 189 cases without the S-O clip (non-use group) were extracted. The degree of submucosal fibrosis was more severe and the procedure time was longer in the use group than in the non-use group. In the use and non-use groups, en bloc resection (100 % vs. 94.7 %) and complete en bloc resection (100 % vs. 92.6 %) rates were satisfactory. After propensity score matching, 33 cases in each group were extracted. As a result, complete en bloc resection rate was significantly higher in the use group than in the non-use group (100 % vs. 84.9 %). Conclusion The S-O clip is effective and can be used safely in colorectal ESD in the difficult-to-access submucosal layer.
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Affiliation(s)
- Yuki Okamoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
| | - Katsuaki Inagaki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenta Matsumoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuki Boda
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoku Sumimoto
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
| | - Yuki Ninomiya
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Knoop RF, Wedi E, Petzold G, Bremer SC, Amanzada A, Ellenrieder V, Neesse A, Kunsch S. Endoscopic mucosal resection with an additional working channel (EMR+) in a porcine ex vivo model: a novel technique to improve en bloc resection rate of snare polypectomy. Endosc Int Open 2020; 8:E99-E104. [PMID: 32010740 PMCID: PMC6976338 DOI: 10.1055/a-0996-8050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Recently, a new external additional working channel (AWC) was introduced by which conventional endoscopic mucosal resection (EMR) can be improved to a technique termed "EMR+". We first evaluated this novel technique in comparison to classical EMR in flat lesions. Methods The trial was prospectively conducted in an ex vivo animal model with porcine stomachs placed into the EASIE-R simulator. Prior to intervention, standardized lesions were set by coagulation dots, measuring 1, 2, 3 or 4 cm. Results Overall, 152 procedures were performed. EMR and EMR+ were both very reliable in 1-cm lesions, each showing en bloc resection rates of 100 %. EMR+ en bloc resection rate was significantly higher in 2-cm lesions (95.44 % vs. 54.55 %, P = 0.02), in 3-cm lesions (86.36 % vs. 18.18 %, P < 0.01) and also in 4-cm lesions (60.00 % vs. 0 %, P < 0.01). Perforations occurred only in EMR+ procedures in 4-cm lesions (3 of 20; 15 %). Conclusions With its grasp-and-snare technique, EMR+ facilitates en bloc resection of larger lesions compared to conventional EMR. In lesions 2 cm and larger, EMR+ has demonstrated advantages, especially concerning en bloc resection rate. At 3 cm, EMR+ reaches its best discriminatory power whereas EMR+ has inherent limits at 4 cm and in lesions of that size, other techniques such as ESD or surgery should be considered.
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Affiliation(s)
- Richard F. Knoop
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Golo Petzold
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Sebastian C.B. Bremer
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Ahmad Amanzada
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Albrecht Neesse
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany
| | - Steffen Kunsch
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Goettingen, Germany,Corresponding author Steffen Kunsch Department of Gastroenterology and GI OncologyUniversity Medical Center GoettingenGeorg-August-UniversityD-37075 GoettingenGermany+0495513966327
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Wedi E, Knoop R, Jung C, Gromski M, Ho CN, Conrad G, Maiss J, Milenovic S, Klemme D, Baulain U, Seif Amir Hosseini A, Ellenrieder V, Koehler P. EMR + with the AWC improves endoscopic resection speed compared to ESD: a porcine ex-vivo pilot study. MINIM INVASIV THER 2019; 30:47-54. [PMID: 31597491 DOI: 10.1080/13645706.2019.1673778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION To improve resection speed and to reach higher en bloc resection rates in lesions ≥ 2 cm, a novel grasp and snare EMR technique termed "EMR+", accomplished by an additional working channel (AWC), was developed. Its use compared to endoscopic submucosal dissection (ESD) is evaluated for the first time. MATERIAL AND METHODS We prospectively conducted a randomized pre-clinical ex-vivo pilot study in explanted porcine stomachs for the comparison of EMR + with classical ESD of mucosal-based lesions. Prior to intervention, we set flat lesions with a standardized size of 3 × 3 cm. RESULTS The median time of procedure was significantly shorter in the EMR + group (median 10.5 min, range 4.4-24 min) than in the ESD group (median 32 min, range 14-61.6 min, p < .0001). The rate of en bloc resection was significantly lower in the EMR + group (38 % vs. 95 %) (p < .0001). Nevertheless, an improvement in the learning curve for EMR + was achieved after the first 12 procedures, with a subsequent en bloc resection rate of 100 %. CONCLUSIONS EMR + could improve the efficiency of mucosal resection procedures. Initial experience demonstrates a higher and satisfactory en bloc resection rate after going through the learning curve of EMR+.
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Affiliation(s)
- Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, Interdisciplinary Endoscopy, University Medical Center, Goettingen, Germany
| | - Richard Knoop
- Department of Gastroenterology and Gastrointestinal Oncology, Interdisciplinary Endoscopy, University Medical Center, Goettingen, Germany
| | - Carlo Jung
- Department of Gastroenterology and Gastrointestinal Oncology, Interdisciplinary Endoscopy, University Medical Center, Goettingen, Germany
| | - Mark Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, USA
| | | | | | - Juergen Maiss
- Department of Gastroenterology, Associate Prof. Maiss, Forchheim, Germany
| | - Sinisa Milenovic
- Department of Gastroenterology and Gastrointestinal Oncology, Interdisciplinary Endoscopy, University Medical Center, Goettingen, Germany
| | - David Klemme
- Department of Gastroenterology and Gastrointestinal Oncology, Interdisciplinary Endoscopy, University Medical Center, Goettingen, Germany
| | - Ulrich Baulain
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Mariensee, Germany
| | - Ali Seif Amir Hosseini
- Department of Diagnostic and Interventional Radiology, University Medical Center, Goettingen, Germany
| | - Volker Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, Interdisciplinary Endoscopy, University Medical Center, Goettingen, Germany
| | - Peter Koehler
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Mariensee, Germany
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Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS. Effect of Preceding Biopsy on the Results of Endoscopic Submucosal Dissection for Colorectal Laterally Spreading Tumor. Dig Dis Sci 2019; 64:2972-2981. [PMID: 31041637 DOI: 10.1007/s10620-019-05625-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/09/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Forceps biopsies are usually performed before endoscopic submucosal dissection (ESD) for colonic laterally spreading tumors (LSTs). However, preceding biopsy is commonly believed to possibly inhibit complete tumor resection by causing blurring of tumor borders and tissue fibrosis. AIMS The aims were to investigate whether the preceding biopsy of colorectal LST affects the complete endoscopic tumor resection and increases the risk of complications. METHODS We retrospectively reviewed the medical records of patients with colorectal LSTs who underwent ESD at our center during an 8-year period. Patients were divided into two groups according to whether they underwent biopsy of the tumor before ESD. In addition, the characteristics of patients and tumors, including the completeness of tumor resection, were investigated. RESULTS Of 288 patients (174 men) enrolled in this study, 194 (67.4%, preceding biopsy group) underwent biopsies before ESD, whereas 94 (32.6%, no biopsy group) did not. There were no significant differences in age, sex, comorbidity, medication history, tumor location, and final pathologic result between both groups. Tumor size was larger (p = 0.002) and LST-G tumor was more common (p = 0.003) in the preceding biopsy group than in the no biopsy group. No significant difference was seen in ESD outcomes, including procedure time, hospitalization period, incidence of complications, en bloc resection rate, resection margin status, and incidence of surgical operation, between both groups. CONCLUSIONS Biopsy of LST is commonly performed before endoscopic resection. Contrary to popular belief, it does not increase the incomplete tumor resection rate and incidence of complications. TRIAL REGISTRATION KCT0002321.
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Affiliation(s)
- Sang Pyo Lee
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea.
| | - Jeong Hwan Kim
- Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Sun-Young Lee
- Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Hyung Seok Park
- Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
| | - Chan Sup Shim
- Department of Internal Medicine, Digestive Disease Centre, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Korea
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Lee SP, Sung IK, Kim JH, Lee SY, Park HS. Effect of prophylactic endoscopic closure for an artificial ulceration after colorectal endoscopic submucosal dissection: a randomized controlled trial. Scand J Gastroenterol 2019; 54:1291-1299. [PMID: 31642718 DOI: 10.1080/00365521.2019.1674918] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objective: Endoscopic submucosal dissection (ESD) is now commonly performed as a treatment for not only gastric tumor but also colorectal tumor. However, colorectal ESD has a substantial risk of complications, including post-ESD electrocoagulation syndrome, bowel perforation and bleeding. This study aimed to investigate whether prophylactic endoscopic closure can reduce the occurrence of complications after colorectal ESD.Materials and methods: Patients who underwent colorectal ESD in our unit were randomly assigned to either of two groups. Prophylactic endoscopic closure for an artificial ulceration after ESD was performed in group I but not in group II. After the procedure, the incidence of complications, visual analog scale (VAS) score for abdominal pain, and laboratory findings were investigated.Results: Of the 220 patients (110 per group) enrolled in this study, 137 were men. No significant differences were found in age, sex, comorbidity, medication history, tumor location, size of resected specimen, and pathologic result between the two groups. No significant difference was found in ESD outcomes, including hospitalization period, laboratory findings, VAS score for abdominal pain, incidence of surgical operation, and incidence of post-ESD complications, between the two groups.Conclusions: Contrary to popular belief, prophylactic endoscopic closure after colorectal ESD does not decrease the incidence of complications, and it does not ameliorate inflammatory response and abdominal pain.Clinical trial registration number: KCT0001666.
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Affiliation(s)
- Sang Pyo Lee
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - In-Kyung Sung
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sun-Young Lee
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
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Enhancement of the safety and efficacy of colorectal endoscopic submucosal dissection using a CO2 laser. Lasers Med Sci 2019; 35:421-427. [DOI: 10.1007/s10103-019-02839-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 06/27/2019] [Indexed: 12/28/2022]
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Matsumoto S, Uehara T, Mashima H. Construction of a preoperative scoring system to predict the difficulty level of colorectal endoscopic submucosal dissection. PLoS One 2019; 14:e0219096. [PMID: 31247005 PMCID: PMC6597108 DOI: 10.1371/journal.pone.0219096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 06/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background We attempted to examine the factors contributing to the difficulty in performance of colorectal ESD, with the aim of constructing a scoring system that could help in prediction of the difficulty level of the procedure. Methods and materials The data were analyzed from two viewpoints: to determine the factors contributing to 1) non-en bloc resection and the factors contributing to 2) a slow resection speed. Factors falling under these two categories contributing to difficulty in performance of ESD were extracted and used to construct a scoring system. The validity of this scoring system was evaluated by calculating the correlation between the score and the resection speed in a different dataset. Results Based on the results of our analysis, we assigned scores for various factors as follows: 4 points for EMR of a scarred lesion, 1 point for tumors with a diameter of ≥ 30 mm, 2 points for lesions located in the liver/splenic flexure, 1 point for lesions located in the transverse colon, 3 points for LST-NG-PD/depressed lesions, 1 point for protruded lesions and LST-NG-F lesions (range 0–10). In the validation study, the rank correlation coefficient between the score according to the scoring system and the resection speed was -0.130, representing a weak and negative correlation (P = 0.03). We defined the difficulty level depending on the sum of the scores: 0–2, low difficulty level; 3–5, intermediate difficulty level; ≥ 6, high difficulty level. The average resection speed was 12.6 mm2/min in the group with scores of 0–2, 8.1 mm2/min in the group with scores of 3–5, and 5.5 mm2/min in the group with scores of ≥ 6 (11.2 mm2/min in all lesions). Conclusion Our colorectal ESD scoring system would be useful for selection of operators with the appropriate skill level in the procedure for colorectal ESD cases.
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Affiliation(s)
- Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Arimoto J, Chiba H, Tachikawa J, Goto T, Nakajima A. New inversion method: endoscopic submucosal dissection of a neoplasm extending into a colonic diverticulum. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2019; 4:230-231. [PMID: 31061946 PMCID: PMC6492311 DOI: 10.1016/j.vgie.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Tohru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
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Wedi E, Koehler P, Hochberger J, Maiss J, Milenovic S, Gromski M, Ho N, Gabor C, Baulain U, Ellenrieder V, Jung C. Endoscopic submucosal dissection with a novel high viscosity injection solution (LiftUp) in an ex vivo model: a prospective randomized study. Endosc Int Open 2019; 7:E641-E646. [PMID: 31058206 PMCID: PMC6497499 DOI: 10.1055/a-0874-1844] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/02/2018] [Indexed: 02/08/2023] Open
Abstract
Introduction Endoscopic submucosal dissection (ESD) is increasingly being used in the western world. Submucosal injectates are an essential tool for the ESD procedure. In this study, we evaluated a novel copolymer injectate (LiftUp, Ovesco, Tübingen Germany) in an established ESD model (EASIE-R) in comparison to existing submucosal injectables. Materials and methods We conducted a prospective, randomized ex vivo study performing ESD with three injectates: LiftUp, hydroxyethyl starch (HAES 6 %) and normal saline solution (NaCl 0.9 %). A total of 60 artificial lesions, each 3 × 3 cm in size, were resected in an ex vivo porcine model, utilizing one of the three studied injectates (n = 20 ESDs per injectate). Study parameters were: en bloc resection rate, perforation rate, lifting property, time of injection, injectate volume, general ESD procedure time, and overall procedure time. Results All 60 lesions were successfully resected using the standard ESD technique. LiftUp had no procedure related perforations, one perforation occurred in the HAES group, and two perforations in the NaCl group ( P > 0.05). Furthermore, adequate lifting was achieved in 16/20 (80 %) using LiftUp, 6/20 (30 %) in the HAES group and 6/20 (30 %) in the NaCl group ( P < 0.0002). En bloc resection was achieved in 19 (95 %) with LiftUp, in 20 (100 %) with HAES, and in 16 (80 %) with NaCl. General ESD procedure time and overall procedure time were not different among the three groups. Conclusion LiftUp appears to be a safe alternative to established fluids for ESD. It had a significantly improved lifting effect and required significantly less injected volume compared to well-established lifting solutions.
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Affiliation(s)
- E. Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
| | - P. Koehler
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Mariensee, Germany
| | - J. Hochberger
- Department of Gastroenterology, Vivantes Klinikum in Friedrichshain, Teaching Hospital of Charité Humboldt University, Berlin, Germany
| | - J. Maiss
- Department of Gastroenterology, Associates Dr. Kerzel and Prof. Maiss, Forchheim, Germany
| | - S. Milenovic
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
| | - M. Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - N. Ho
- Ovesco Endoscopy AG, Tübingen, Germany
| | - C. Gabor
- Ovesco Endoscopy AG, Tübingen, Germany
| | - U. Baulain
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Federal Research Institute for Animal Health, Mariensee, Germany
| | - V. Ellenrieder
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
| | - C. Jung
- Department of Gastroenterology and Gastrointestinal Oncology, Center of Interdisciplinary Endoscopy, University Medical Centre Göttingen, Göttingen, Germany
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Knoop RF, Schmidt A, Kayser G, Thimme R, Fischer A. Endoscopic submucosal dissection of an esophageal granular cell tumor. VideoGIE 2019; 4:58-61. [PMID: 30766943 PMCID: PMC6363592 DOI: 10.1016/j.vgie.2018.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Richard F Knoop
- Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center Goettingen, University of Goettingen, Goettingen, Germany
| | - Arthur Schmidt
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Gian Kayser
- Faculty of Medicine, Institute for Surgical Pathology, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
| | - Andreas Fischer
- Faculty of Medicine, Department of Medicine II, University Hospital Freiburg, University of Freiburg, Freiburg, Germany
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Reggiani Bonetti L, Manta R, Manno M, Conigliaro R, Missale G, Bassotti G, Villanacci V. Optimal processing of ESD specimens to avoid pathological artifacts. Tech Coloproctol 2018; 22:857-866. [PMID: 30560321 DOI: 10.1007/s10151-018-1887-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 11/19/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND En bloc endoscopic submucosal dissection (ESD) has been recently introduced as a treatment for precancerous/neoplastic gastrointestinal conditions. The aim of the present study was histological assessment of en bloc ESD specimens. METHODS Fifty-three ESD specimens were positioned over a cellulose acetate support (40 specimens; 12 from the upper gastrointestinal tract and 28 from the lower gastrointestinal tract) or pinned with nails on polystyrene or cork (13 specimens; 7 from the upper gastrointestinal tract and 6 from the lower gastrointestinal tract). We cut consecutive 2 mm-thick sections stained with hematoxylin and eosin. From the first and the last sections, we obtained a second slide, after a 180° rotation and re-embedding. The quality of ESD samples was scored as inadequate, suboptimal and adequate, based on the amount of crushing, shearing and stretching artifacts that were scored from 0 (absent) to 2 (diffuse or maximum). From the sum of these we obtained a global artifact score (GAS). RESULTS Removed lesions were: adenocarcinoma (5 cases), neuroendocrine tumor (NET) G1 (1 case), premalignant conditions, including adenomatous polyps (41 cases) and hyperplastic lesions (6 cases). A positive deep surgical margin was found in 8/53 cases (15%): high- and low-grade dysplastic glands were detected in 5 cases, low-grade adenocarcinoma in 2, and NET cells in 1. Dysplastic glands were detected in the lateral surgical margins of 12 ESD specimens (23%). Among the ESD specimens positioned on the cellulose acetate support, apart from the modifications due to electrocoagulation, 2 (5%) showed shearing modifications. In the group of ESD specimens fixed with nails, 5 (38%) showed shearing, 10 (77%) crushing artifacts, 11 (85%) stretching and 11 (85%) multiple holes caused by the nails. On the basis of these data all histological specimens from ESD on cellulose acetate were adequate (GAS 0-1).However, in the group of ESD fixed with nails, 1 was adequate (GAS 0), 11 suboptimal (GAS 2-5) and 1 inadequate (GAS 6). CONCLUSIONS Specific devices including cellulose support and adequate sampling blocks can be helpful to perform accurate histological assessment of ESD specimens after en bloc ESD for precancerous/neoplastic gastrointestinal lesions, with complete analysis of the status of the margins and the entirely en bloc evaluation of the lesion.
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Affiliation(s)
- L Reggiani Bonetti
- Institute of Pathology of Modena Az., Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy. .,Department of Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia Section of Pathology, Via del Pozzo 71, 41100, Modena, Italy.
| | - R Manta
- Endoscopy Unit Ospedale Baggiovara, (NOCSAE), Baggiovara, Italy
| | - M Manno
- Digestive Endoscopy Unit, Carpi Hospital, Modena, Italy
| | - R Conigliaro
- Endoscopy Unit Ospedale Baggiovara, (NOCSAE), Baggiovara, Italy
| | - G Missale
- Endoscopy Unit Spedali Civili, Brescia, Italy
| | - G Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - V Villanacci
- Institute of Pathology Spedali Civili, Brescia, Italy
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Tamegai Y, Fukunaga Y, Suzuki S, Lim DN, Chino A, Saito S, Konishi T, Akiyoshi T, Ueno M, Hiki N, Muto T. Laparoscopic and endoscopic cooperative surgery (LECS) to overcome the limitations of endoscopic resection for colorectal tumors. Endosc Int Open 2018; 6:E1477-E1485. [PMID: 30574538 PMCID: PMC6291397 DOI: 10.1055/a-0761-9494] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/24/2018] [Indexed: 12/25/2022] Open
Abstract
Background and study aims We developed a laparoscopy endoscopy cooperative surgery (LECS) to overcome the limitations of endoscopic resection for colorectal tumors. The aim of this study was to evaluate the feasibility of LECS, which combines endoscopic submucosal dissection (ESD) and laparoscopic partial colectomy. Patients and methods We performed LECS for 17 colorectal tumors in 17 patients (male:female 10:7; mean age, 66.5 years). The clinicopathological outcomes of these 17 cases and the feasibility of LECS were evaluated retrospectively. Indications for LECS were as follows: 1) intramucosal cancer and adenoma accompanied by wide and severe fibrosis; 2) intramucosal cancer and adenoma involving the diverticulum or appendix; and 3) submucosal tumors. Results We successfully performed LECS procedures in 17 cases (intramucosal cancer [n = 6], adenoma [n = 9], schwannoma [n = 1], and gastro-intestinal stromal tumour [GIST] [n = 1]. Mean tumor diameter was 22.4 mm (range, 8 - 41 mm). LECS was successfully performed in all 17 cases without conversion to open surgery; the R0 rate was 100 %. LECS was applied to the following situations: involving the appendix (n = 6), tumor accompanied by severe fibrosis (n = 5), involving the diverticulum (n = 3), submucosal tumor (n = 2), and poor endoscopic operability (n = 1). We experienced no adverse events (e. g., leakage or anastomotic stricture) and the median hospital stay was 6.4 dayus (range, 4 to 12). All 17 patients who were followed for ≥ 3 months (median, 30.8 months; range, 3 - 72 months) showed no residual/local recurrence. Conclusion LECS was a safe, feasible, minimally invasive procedure that achieved full-thickness resection of colorectal tumors and showed excellent clinical outcomes.
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Affiliation(s)
- Yoshiro Tamegai
- Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan,Corresponding author Yoshiro Tamegai Cancer Institute Hospital – endoscopy3-8-31 AriakeKoto-ku, Tokyo 135-8550Japan+81-3-3570-0343
| | - Yosuke Fukunaga
- Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinsuke Suzuki
- Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Dennis N.F. Lim
- Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Chino
- Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichi Saito
- Endoscopic Division, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Hiki
- Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tetsuichiro Muto
- Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Kim JY, Han SJ, Jung Y, Cho YS, Chung IK, Lee TH, Park SH, Cho HD, Kim SJ, Hwangbo Y. The relationship between local recurrence and positive lateral margin after en bloc resection of colorectal neoplasm. Scand J Gastroenterol 2018; 53:1541-1546. [PMID: 30600737 DOI: 10.1080/00365521.2018.1547419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The factors associated with recurrence of colonic neoplasm after endoscopic resection with a positive lateral margin are not well known. Thus, we evaluate the relationship between recurrence and positive lateral margin after endoscopic en bloc resection of colorectal neoplasm. METHODS A retrospective review of 9302 patients who underwent colonic endoscopic resection from January 2008 to January 2015. Of these, a total of 76 patients with positive lateral margins with clear evidence of the its location on endoscopic picture after endoscopic en bloc resection of colorectal neoplasm (>10 mm) were included. RESULTS Ten of 76 (13.2%) patients experienced recurrence during the follow-up period (mean f/u month, 21.7 ± 15.6). In cases with positive lateral margins, the 3- and 5-year local recurrence rate of colorectal neoplasm was 28.1% and 40.1%, respectively. The histological features of the recurrence group were as follows: one case of adenocarcinoma [from low-grade adenoma (LGA)]; two cases of high-grade adenoma (HGA) (one from HGA and one from LGA); and seven cases of LGA (four from adenocarcinoma, two from LGA, and one from HGA). The mean age of patients, locations of the lesions, and histologic type were not significantly associated with local recurrence. In multivariate Poisson regression analyses, total length of lateral margin involvement ≥8 mm (relative risk 12.51; 95% CI 1.11-140.34, p = .040) was a significant predictor of local recurrence. CONCLUSIONS Positive lateral margins ≥8 mm may be a reliable predictor of local recurrence after endoscopic en bloc resection of colorectal neoplasm.
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Affiliation(s)
- Jae Yun Kim
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Su Jung Han
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Yunho Jung
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Young Sin Cho
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Il-Kwun Chung
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Tae Hoon Lee
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Sang-Heum Park
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Hyun Deuk Cho
- b Department of Pathology , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Sun-Joo Kim
- a Division of Gastroenterology, Department of Internal Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
| | - Young Hwangbo
- c Department of Preventive Medicine , Soonchunhyang University College of Medicine, Cheonan Hospital , Cheonan , Republic of Korea
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Fuccio L, Repici A, Hassan C, Ponchon T, Bhandari P, Jover R, Triantafyllou K, Mandolesi D, Frazzoni L, Bellisario C, Bazzoli F, Sharma P, Rösch T, Rex DK. Why attempt en bloc resection of non-pedunculated colorectal adenomas? A systematic review of the prevalence of superficial submucosal invasive cancer after endoscopic submucosal dissection. Gut 2018; 67:1464-1474. [PMID: 29208675 DOI: 10.1136/gutjnl-2017-315103] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Endoscopic submucosal dissection (ESD) aims to achieve en bloc resection of non-pedunculated colorectal adenomas which might be indicated in cases with superficial submucosal invasive cancers (SMIC), but the procedure is time consuming and complex. The prevalence of such cancers is not known but may determine the clinical necessity for ESD as opposed to the commonly used piecemeal mucosal resection (endoscopic mucosal resection) of colorectal adenomas. The main aim was to assess the prevalence of SMIC SM1 (ie, invasion ≤1000 µm or less than one-third of the submucosa) on colorectal lesions removed by ESD. DESIGN A literature review was conducted using electronic databases (up to March 2017) for colorectal ESD series reporting the histology of the dissected lesions. RESULTS 51 studies with data on 11 260 colorectal dissected lesions were included. Most resected lesions (82.2%; 95% CI 78.8% to 85.3%) were adenomas (low- and high-grade dysplasia, 26.8% and 55.4%, respectively). Overall, 15.7% were submucosal cancers, but only slightly more than half (8.0%; 95% CI 6.1% to 10.3%) had an infiltration depth of ≤1000 µm, providing a number needed to treat (NNT) to avoid one surgery of 12.5. Estimating an oncologically curative (R0; G1/2; L0/V0) resection rate of 75.3% (95% CI 52.2% to 89.4%) for malignant lesions, the prevalence of curative resection lowered to 6% (95% CI 4.2% to 7.2%) with an NNT of 16.7. CONCLUSION The low prevalence of SMIC SM1 in lesions selected for ESD as well as the even lower rate of curative resection limits the clinical applicability of endoscopic en bloc resection. This calls for caution over an indiscriminate use of this technique in the resection of colorectal neoplasia.
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Affiliation(s)
- Lorenzo Fuccio
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano, Italy
| | | | - Thierry Ponchon
- Department of Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | | | - Rodrigo Jover
- Service of Digestive Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Konstantinos Triantafyllou
- Ηepatogastroenterology Unit, Second Department of Internal Medicine, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Daniele Mandolesi
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Cristina Bellisario
- Department of Cancer Screening, Centre for Epidemiology and Prevention in Oncology (CPO), University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Franco Bazzoli
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Prateek Sharma
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, University of Kansas Medical Center, Kansas, Missouri, USA.,Department of Gastroenterology, Veteran Affairs Medical Center, Kansas, Missouri, USA
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Douglas K Rex
- Division of Gastroenterology/Hepatology, Indiana University Hospital, Indianapolis, Indiana, USA
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Daoud DC, Suter N, Durand M, Bouin M, Faulques B, von Renteln D. Comparing outcomes for endoscopic submucosal dissection between Eastern and Western countries: A systematic review and meta-analysis. World J Gastroenterol 2018; 24:2518-2536. [PMID: 29930473 PMCID: PMC6010943 DOI: 10.3748/wjg.v24.i23.2518] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 05/05/2018] [Accepted: 06/02/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare endoscopic submucosal dissection (ESD) outcomes between Eastern and Western countries. METHODS A systematic review and meta-analysis was performed using PubMed, MEDLINE, Web of Science, CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection, en bloc or R0 resection rates. Secondary outcomes were complication rates, local recurrence rates and procedure times. RESULTS Overall, 238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESD on 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative, en bloc, and R0 resection in the Eastern studies; 82% (CI: 81%-84%), 95% (CI: 94%-96%) and 89% (CI: 88%-91%) compared to Western studies; 71% (CI: 61%-81%), 85% (CI: 81%-89%) and 74% (CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries (0.53%; CI: 0.10-1.16) compared to Eastern countries (0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries (110 min vs 77 min). CONCLUSION Eastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.
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Affiliation(s)
- Dane Christina Daoud
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Nicolas Suter
- Department of Medicine, Division of Internal Medicine, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Madeleine Durand
- Department of Medicine, Division of Internal Medicine, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Mickael Bouin
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Bernard Faulques
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
| | - Daniel von Renteln
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l’Université de Montréal (CHUM) and Centre de Recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec H2X 0A9, Canada
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Kim SY, Chung JW, Kim JH, Kim YJ, Kim KO, Kwon KA, Park DK. Carbon dioxide insufflation during endoscopic resection of large colorectal polyps can reduce post-procedure abdominal pain: A prospective, double-blind, randomized controlled trial. United European Gastroenterol J 2018; 6:1089-1098. [PMID: 30228898 DOI: 10.1177/2050640618776740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/16/2018] [Indexed: 12/12/2022] Open
Abstract
Background Studies of the use of CO2 insufflation during endoscopic resection of large colorectal polyps (LCPs) are lacking. Objective We evaluated the effect of CO2 insufflation on pain after endoscopic resection of LCPs. Methods In a prospective randomized controlled trial (RCT), 132 patients were randomly assigned to groups who underwent endoscopic resection with CO2 insufflation (CO2 group, n = 66) or air insufflation (air group, n = 66). The primary outcome was abdominal pain post-procedure (PP). The secondary outcomes were abdominal distension, rates of technical success, amounts of sedatives prescribed, use of analgesics, and adverse events. Results Baseline patient characteristics were similar between the groups. The mean abdominal pain score was 12.3 in the CO2 group vs. 17.5 in the air group at 1 h PP (p = 0.047). Also, the proportion of patients without pain was significantly higher in the CO2 group at 1 h PP (p = 0.008). The pain score differed more in the endoscopic submucosal dissection group and long-time group. The secondary outcomes were not significantly different between the two groups. Conclusions The results of this RCT demonstrate the superiority of CO2 insufflation for endoscopic resection of LCPs in terms of decreasing PP abdominal pain (KCT0001636).
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Affiliation(s)
- Su Young Kim
- Divison of Gastroenterology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.,Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Jun-Won Chung
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Jung Ho Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Yoon Jae Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Kyoung Oh Kim
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Kwang An Kwon
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
| | - Dong Kyun Park
- Divison of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon, South Korea
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Boda K, Oka S, Tanaka S, Tanaka H, Matsumoto K, Yamashita K, Sumimoto K, Hirano D, Tamaru Y, Ninomiya Y, Hayashi N, Chayama K. Short-term outcomes of endoscopic submucosal dissection for superficial cecal tumors: a comparison between extension and nonextension into the appendiceal orifice. Therap Adv Gastroenterol 2018; 11:1756284818772794. [PMID: 29899756 PMCID: PMC5991193 DOI: 10.1177/1756284818772794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/28/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Few studies have investigated the use of endoscopic submucosal dissection (ESD) for cecal tumors extending into the appendiceal orifice. Herein, we assessed the feasibility and safety of ESD for cecal tumors extending into the appendiceal orifice. METHODS We retrospectively examined the outcomes of ESD for 78 patients with 78 cecal tumors (male/female ratio, 40/38; mean [standard deviation, SD] age, 67 [9] years; mean [SD] tumor size, 32 [15] mm), who underwent ESD at the Hiroshima University Hospital between October 2008 and March 2016. The indication for ESD in cecal tumors extending into the appendiceal orifice was recognition of the distal edge of the lesion in the appendix. They were classified into two groups: patients with cecal tumors extending (Group A: 29 patients, 29 tumors) and not extending (Group B: 49 patients, 49 tumors) into the appendiceal orifice. We compared the outcomes of ESD between both groups. RESULTS No significant differences in clinicopathological characteristics were observed between both groups. The rate of severe submucosal fibrosis in Group A (48%) was significantly higher than that in Group B (24%) (p < 0.05). The mean (SD) procedure speed in Group A (14 [10] mm2/min) was significantly slower than that in Group B (23 [16] mm2/min) (p < 0.01). The en bloc resection rates in Groups A and B were 90% and 96%, respectively. There were no significant differences in adverse events reported between both groups. CONCLUSIONS ESD for cecal tumors with extension into the appendiceal orifice is effective and safe.
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Affiliation(s)
- Kazuki Boda
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | | | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kenta Matsumoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kyoku Sumimoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Daiki Hirano
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuzuru Tamaru
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Yuki Ninomiya
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Nana Hayashi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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48
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Boda K, Oka S, Tanaka S, Nagata S, Kunihiro M, Kuwai T, Hiraga Y, Furudoi A, Terasaki M, Nakadoi K, Higashiyama M, Okanobu H, Akagi M, Chayama K. Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: a large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group. Gastrointest Endosc 2018. [PMID: 28623057 DOI: 10.1016/j.gie.2017.05.051] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Although advanced high-volume centers have reported good outcomes of colorectal endoscopic submucosal dissection (ESD), a limited number of highly skilled experts in specialized institutions performed these procedures. We undertook a retrospective multicenter survey, which included nonspecialized hospitals, to investigate the clinical outcomes of colorectal ESD. METHODS We recruited 1233 consecutive patients with 1259 colorectal tumors resected by ESD at 12 institutions. We evaluated the en bloc resection rate, histologic complete resection rate, curative (R0) resection rate, adverse events, and the long-term prognoses, including local recurrence, metachronous tumor development, and survival rate. RESULTS The en bloc, histologic complete, and R0 resection rates were 92.6%, 87.4%, and 83.7%, respectively. The delayed bleeding, intraoperative perforation, and delayed perforation rates were 3.7%, 3.4%, and .4%, respectively. The long-term outcomes analysis included 1091 patients (88.4%). Local recurrences occurred in 1.7%, and metachronous tumors (>5 mm) developed in 11.0% of the patients. The 3- and 5-year overall survival rates were 95.1% and 92.3%, respectively. The number of colonic tumors, severe submucosal fibrosis, and en bloc resection rates were significantly higher in the high-volume centers (Group H) than those in the low-volume centers (Group L). The average tumor size in Group H was significantly larger than that in Group L. CONCLUSIONS Colorectal ESDs are feasible, have acceptable adverse event risks, and favorable long-term prognoses. (Clinical trial registration number: UMIN000016197.).
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Affiliation(s)
- Kazuki Boda
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Nagata
- Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan
| | - Masaki Kunihiro
- Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | - Yuko Hiraga
- Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Akira Furudoi
- Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan
| | | | - Koichi Nakadoi
- Department of Gastroenterology, Onomichi General Hospital
| | | | | | - Morihisa Akagi
- Department of Gastroenterology, Prefectural Akitsu Hospital
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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49
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Sugiyama T, Araki H, Ozawa N, Takada J, Kubota M, Ibuka T, Shimizu M. Carbon dioxide insufflation reduces residual gas in the gastrointestinal tract following colorectal endoscopic submucosal dissection. Biomed Rep 2018; 8:257-263. [DOI: 10.3892/br.2018.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/10/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Tomohiko Sugiyama
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501‑1194, Japan
| | - Hiroshi Araki
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501‑1194, Japan
| | - Noritaka Ozawa
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501‑1194, Japan
| | - Jun Takada
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501‑1194, Japan
| | - Masaya Kubota
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501‑1194, Japan
| | - Takashi Ibuka
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501‑1194, Japan
| | - Masahito Shimizu
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu 501‑1194, Japan
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50
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Lian JJ, Ma LL, Zhang YQ, Chen WF, Zhong YS, Xu MD, Zhou PH, Chen SY. Clinical outcomes of endoscopic submucosal dissection for large colorectal laterally spreading tumors in older adults. J Geriatr Oncol 2018; 9:249-253. [PMID: 29331274 DOI: 10.1016/j.jgo.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/24/2017] [Accepted: 12/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS The colorectal endoscopic submucosal dissection (ESD) remains technically challenging, especially for older patients who frequently encounter complex chronic diseases and have a loose colon. However, only limited number of studies are available for the safety of ESD in older patients with especially large laterally spreading tumors. Therefore, in this retrospective study, we compared the outcomes of ESD for laterally spreading tumors (LST) ≥3cm(cm) in older patients to that in younger patients. METHODS Consecutive patients with LSTs 3cm or larger were enrolled for from May 2010-2016. These patients were divided into two groups: the younger group (<65years) and the older group (≥65years). The clinicopathologic findings and the outcomes of ESD procedures were compared between the two groups. RESULTS A total of 70 patients in the younger group and 73 patients in the older group were treated by ESD for colorectal LSTs larger than 3cm. No significant differences were observed in the gender ratio, tumor morphological type, tumor location, and tumor size between the two groups. The en bloc resection rates were 85.7 and 89.0%, respectively, without a significant difference. The procedural time was similar between the younger and older patients (71.8±34.7min vs. 70.6±29.5min). The duration of hospital stay was not significantly different between the two groups (4.1±2.2days vs. 4.4±2.5days). No significant differences were observed between the two groups with respect to ESD-related complications including delayed bleeding, perforation, and stricture. CONCLUSIONS ESD appears to be an effective and safe method for LSTs larger than 3cm in older patients.
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Affiliation(s)
- Jing Jing Lian
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Li Ma
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Qun Zhang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Feng Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yun Shi Zhong
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mei Dong Xu
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ping Hong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shi Yao Chen
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
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