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Kiesslich R, Teubner D, Hoffman A, Rey JW. Retrospective comparison of G-EYE balloon-colonoscopy with standard colonoscopy for increased adenoma detection rate and reduced polyp removal time. Endosc Int Open 2023; 11:E920-E927. [PMID: 37810901 PMCID: PMC10558257 DOI: 10.1055/a-2005-6934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/08/2022] [Indexed: 01/04/2023] Open
Abstract
Background and study aims The newly introduced G-EYE colonoscope (G-EYE) employs a balloon, installed at the bending section of a standard colonoscope (SC), for increasing adenoma detection and stabilizing the colonoscope tip during intervention. This retrospective work explores the effect of introducing G-EYE into an SC endoscopy room, in terms of adenoma detection and polyp removal time. Patients and methods This was a single-center, retrospective study. Historical data from patients who underwent colonoscopy prior to, and following, introduction of G-EYE into a particular endoscopy room were collected and analyzed to determine adenoma detection rate (ADR), adenoma per patient (APP), and polyp removal time (PRT), in each of the SC and G-EYE groups. Results Records of 1362 patients who underwent SC and 1433 subsequent patients who underwent G-EYE colonoscopy in the same endoscopy unit by the same endoscopists were analyzed. Following G-EYE introduction, overall ADR increased by 37.5 % ( P < 0.0001) from 39.2 % to 53.9 %, the serrated adenoma rate increased by 47.3 % from 27.9 % to 41.1 % ( P < 0.0001), and the APP increased by 50.6 % from 0.79 to 1.19 ( P < 0.0001). The number of advanced adenomas increased by 32.7 %, from 19.6 % to 26.0 % of all adenomas ( P < 0.0001). With G-EYE, average PRT was reduced overall by 29.5 % ( P < 0.0001), and particularly for endoscopic mucosal resection (EMR) by 37.5 % for polyps measuring ≥ 5 mm to ≤ 20 mm ( P < 0.0001) and by 29.4 % for large polyps > 20 mm ( P < 0.0001). Conclusions Introduction of G-EYE to an SC endoscopy room yielded considerable increase in ADR and notable reduction in PRT, particularly with the EMR technique. G-EYE balloon colonoscopy might increase the effectiveness of colorectal cancer screening and surveillance colonoscopy, and can shorten the time of endoscopic intervention.
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Affiliation(s)
- Ralf Kiesslich
- Helios Dr. Horst Schmidt Kliniken (HSK), Klinik für Innere Medizin II, Wiesbaden, Germany
| | - Daniel Teubner
- Helios Dr. Horst Schmidt Kliniken (HSK), Klinik für Innere Medizin II, Wiesbaden, Germany
| | - Arthur Hoffman
- Klinikum Aschaffenburg-Alzenau, Klinik für Innere Medizin III, Wiesbaden, Germany
| | - Johannes W. Rey
- Klinikum Osnabrück, Medizinische Klinik III, Wiesbaden, Germany
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Tanaka H, Oka S, Tsuboi A, Kamigaichi Y, Tamari H, Sumioka A, Shimohara Y, Nishimura T, Inagaki K, Okamoto Y, Iio S, Yamashita K, Sumimoto K, Tanaka S. Efficacy of single-balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score-matched analysis. DEN OPEN 2022; 2:e58. [PMID: 35310737 PMCID: PMC8828212 DOI: 10.1002/deo2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 04/14/2023]
Abstract
OBJECTIVES A single-balloon overtube (SBO) can improve poor scope operability during colonic endoscopic submucosal dissection (ESD). We aimed to evaluate the clinical usefulness of SBO for ESD in the proximal colon and the predictive factors for cases in which SBO is useful. METHODS A total of 88 tumors located in the proximal colon resected by balloon-assisted ESD (BA-ESD) using SBO and 461 tumors resected by conventional ESD (C-ESD) between June 2015 and November 2020 were considered. Seventy-eight tumors each in the BA-ESD and C-ESD groups were matched by propensity score matching. ESD outcomes were compared between the groups, and a decision tree analysis was performed to explore the predictive factors for cases in which SBO is useful. RESULTS There were no significant differences between the groups in the major outcomes such as en bloc resection rate (95% vs. 99%, p = 0.17), R0 resection rate (92% vs. 96%, p = 0.30), mean dissection speed (16 mm2/min vs. 16 mm2/min, p = 0.53), and intraoperative perforation rate (5% vs. 6%, p = 0.73). Even when considering cases with poor preoperative scope operability, there were no significant differences between the groups. Comparison of tumors ≥40 mm in diameter between the groups confirmed that the intraoperative perforation rate was significantly lower in the BA-ESD group than in the C-ESD group (0% vs. 24%, p = 0.0188). CONCLUSION SBO is useful for ESD of tumors ≥40 mm in diameter in the proximal colon to prevent intraoperative perforation, which usually has a long procedure time.
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Affiliation(s)
- Hidenori Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Shiro Oka
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Akiyoshi Tsuboi
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Yuki Kamigaichi
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Hirosato Tamari
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Akihiko Sumioka
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Yasutsugu Shimohara
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Tomoyuki Nishimura
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Katsuaki Inagaki
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Yuki Okamoto
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Sumio Iio
- Department of Gastroenterology and MetabolismHiroshima University HospitalHiroshimaJapan
| | - Ken Yamashita
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Kyoku Sumimoto
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
| | - Shinji Tanaka
- Department of EndoscopyHiroshima University HospitalHiroshimaJapan
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Nehme F, Goyal H, Perisetti A, Tharian B, Sharma N, Tham TC, Chhabra R. The Evolution of Device-Assisted Enteroscopy: From Sonde Enteroscopy to Motorized Spiral Enteroscopy. Front Med (Lausanne) 2022; 8:792668. [PMID: 35004760 PMCID: PMC8733321 DOI: 10.3389/fmed.2021.792668] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022] Open
Abstract
The introduction of capsule endoscopy in 2001 opened the last "black box" of the gastrointestinal tract enabling complete visualization of the small bowel. Since then, numerous new developments in the field of deep enteroscopy have emerged expanding the diagnostic and therapeutic armamentarium against small bowel diseases. The ability to achieve total enteroscopy and visualize the entire small bowel remains the holy grail in enteroscopy. Our journey in the small bowel started historically with sonde type enteroscopy and ropeway enteroscopy. Currently, double-balloon enteroscopy, single-balloon enteroscopy, and spiral enteroscopy are available in clinical practice. Recently, a novel motorized enteroscope has been described with the potential to shorten procedure time and allow for total enteroscopy in one session. In this review, we will present an overview of the currently available techniques, indications, diagnostic yield, and complications of device-assisted enteroscopy.
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Affiliation(s)
- Fredy Nehme
- Department of Gastroenterology and Hepatology, School of Medicine, Saint Luke's Hospital, University of Missouri Kansas City (UMKC), Kansas City, MO, United States
| | - Hemant Goyal
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, United States
| | - Abhilash Perisetti
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, United States
| | - Benjamin Tharian
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Neil Sharma
- Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, IN, United States.,Department of Endoscopy, Indiana University School of Medicine, Fort Wayne, IN, United States
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Belfast, United Kingdom
| | - Rajiv Chhabra
- Department of Gastroenterology and Hepatology, School of Medicine, Saint Luke's Hospital, University of Missouri Kansas City (UMKC), Kansas City, MO, United States
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Miyaguchi K, Tashima T, Terada R, Jinushi R, Nakano Y, Katsuda H, Ogawa T, Fujita A, Tanisaka Y, Mizuide M, Mashimo Y, Nakamoto H, Kawasaki T, Imaeda H, Ryozawa S. A retrospective cohort study of factors influencing long procedure times in colorectal endoscopic submucosal dissection. Scand J Gastroenterol 2021; 56:1255-1263. [PMID: 34320880 DOI: 10.1080/00365521.2021.1958000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the outcomes and factors influencing colorectal endoscopic submucosal dissection (ESD) with a long procedure time. MATERIALS AND METHODS In this single-center, retrospective study, we included 1,100 patients with 1,199 lesions who underwent colorectal ESD between April 2016 and December 2020. ESD was performed using an advanced system knife for lesions >20 mm. An S-O clip was used as the traction device. The long-time group (LP; procedure time >120 min) and normal-time group (NP; procedure time <120 min) were compared. RESULTS The procedure times were 166.86 and 44.72 min in the LP and NP groups, respectively. The completion rate was higher in the NP group (96.5% vs. 83.5%, p = .001); the completed lesions were resected en bloc. Multivariate analysis revealed 18.8% and 7.8% of submucosal fibrosis in the LP and NP groups, respectively (odds ratio [OR] = 2.410, p = .026). Compared to the NP group, the LP group presented larger maximum lesion sizes and higher rates of R1 resection, and traction device use. Time to introduction of traction device use was longer in the LP than in the NP group (126.05 vs. 21.72 min; p < .001). Fibrosis tends to occur cecal lesions (OR 2.436, p = .011) and laterally spreading tumor-non-granular-pseudo-depressed (LST-NG-PD) (OR 2.6181, p = .001). CONCLUSIONS Lesion size and fibrosis were factors associated with a long procedure time in colonic ESD. For fibrotic lesions (LST-NG-PD and cecal lesions), it is necessary to consider early use of traction devices and advisable to plan a strategy for the use of traction devices.
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Affiliation(s)
- Kazuya Miyaguchi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Tomoaki Tashima
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Rie Terada
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuya Nakano
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiromune Katsuda
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tomoya Ogawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akashi Fujita
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuki Tanisaka
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yumi Mashimo
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hidetomo Nakamoto
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroyuki Imaeda
- Department of General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Saitama, Japan
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5
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Coronel M, Coronel E, Romero L, Ge PS. Combination of a dynamic rigidizing overtube and a novel injectable needle-type knife to facilitate colorectal endoscopic submucosal dissection. VideoGIE 2021; 6:297-300. [PMID: 34278090 PMCID: PMC8267954 DOI: 10.1016/j.vgie.2021.02.013] [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: 11/29/2022] Open
Affiliation(s)
- Martin Coronel
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emmanuel Coronel
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura Romero
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Phillip S Ge
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study. BMC Gastroenterol 2021; 21:74. [PMID: 33593282 PMCID: PMC7885483 DOI: 10.1186/s12876-021-01652-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/02/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND When performing colorectal endoscopic submucosal dissection (ESD) in obese patients, technically difficult cases are sometimes experienced because of difficulty with the insertion of the colonoscope, poor scope maneuverability, or an abundance of fat tissue in the submucosal layer. Since the association between obesity and colorectal ESD has not been investigated, we evaluated the clinical impact of obesity in patients who underwent colorectal ESD. METHODS We retrospectively reviewed 535 patients who underwent colorectal ESD between April 2012 and February 2019. Patients were divided into three groups based on their body mass index (BMI): a control group (BMI < 25 kg/m2), an overweight group (25 kg/m2 ≤ BMI < 30 kg/m2), and an obese group (BMI ≥ 30 kg/m2), and the short-term clinical outcomes were analyzed to assess the safety and difficulty of colorectal ESD. RESULTS No significant difference in the procedure times, en bloc resection rates, pathological diagnoses, or complications were seen among the groups. While the amount of sedative per body weight was significantly lower in the group with a higher BMI (flunitrazepam: 1.75 × 10-2 [1.27 × 10-2-2.34 × 10-2] mg/kg vs. 1.48 × 10-2 [1.08 × 10-2-2.03 × 10-2] mg/kg vs. 1.16 × 10-2 [0.98 × 10-2-1.54 × 10-2] mg/kg, P < 0.001; pethidine: 0.63 [0.55-0.72] mg/kg vs. 0.50 [0.46-0.56] mg/kg vs. 0.39 [0.32-0.45] mg/kg, P < 0.001), a reduction in percutaneous arterial oxygen saturation occurred significantly more frequently in the group with a higher BMI (123 [30.2%] vs. 43 [43.9%] vs. 10 [55.6%], P = 0.005). When the procedures were performed by trainees, the number of cases that required a procedure time of longer than 90 min was significantly larger in the group with a higher BMI (27 [10.8%] vs. 14 [21.9%] vs. 3 [25.0%], P = 0.033). CONCLUSIONS This study showed that colorectal ESD could be performed safely and effectively in obese patients. However, ESD in obese patients requires attention, particularly to changes in respiratory conditions.
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Ijiri M, Sasaki T, Fujiya M, Iwama T, Murakami Y, Takahashi K, Tanaka K, Ando K, Ueno N, Kashima S, Moriichi K, Tanabe H, Saito Y, Okumura T. The efficacy of the submucosal injection of lidocaine during endoscopic submucosal dissection for colorectal neoplasms: a multicenter randomized controlled study. Surg Endosc 2020; 35:5225-5230. [PMID: 32989543 PMCID: PMC8346385 DOI: 10.1007/s00464-020-08017-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/16/2020] [Indexed: 12/28/2022]
Abstract
Background Endoscopic submucosal dissection (ESD) is currently a common procedure although it requires a long procedural time. We conducted a prospective study to determine the efficacy and safety of lidocaine injection for shortening the procedural time and relieving bowel peristalsis during ESD. Methods A multicenter randomized controlled study was conducted in three hospitals. Ninety-one patients who underwent colorectal ESD were enrolled. Patients were randomly divided into two groups using the envelope method: the lidocaine group and saline group. The primary endpoint was the procedural time, and the secondary endpoints were the procedural time in each part of the colon and the grade of bowel peristalsis and the incidence and amounts of antispasmodic drugs use and adverse events. Results The patients’ demographics were not markedly different between the two groups. The mean procedural time in the lidocaine group was not markedly different from that in the saline group. In contrast, at the proximal site, the procedural time in the lidocaine group (57 min) was significantly shorter in the saline group (80 min). The grade of bowel peristalsis in the lidocaine group (0.67) was significantly lower than in the saline group (1.17). Antispasmodic drug use was significantly rarer in the lidocaine group than in the saline group. The incidence of adverse events was not markedly different between the two groups. Conclusions Local lidocaine injection is a feasible option for preventing bowel peristalsis, particularly in the proximal colon, leading to a reduced procedural time for ESD and decreased antispasmodic drug use. University Hospital Medical Information Network Center (UMIN number: 000022843).
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Affiliation(s)
- Masami Ijiri
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Takahiro Sasaki
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Takuya Iwama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yuki Murakami
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Keitaro Takahashi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kazuyuki Tanaka
- Department of Gastroenterology, Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan
| | - Katsuyoshi Ando
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Nobuhiro Ueno
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Shin Kashima
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kentaro Moriichi
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Hiroki Tanabe
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yusuke Saito
- Department of Gastroenterology, Asahikawa City Hospital, Asahikawa, Hokkaido, Japan
| | - Toshikatsu Okumura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 2-1-1-1, Midorigaoka, Asahikawa, Hokkaido, 078-8510, Japan
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Review on colorectal endoscopic submucosal dissection focusing on the technical aspect. Surg Endosc 2020; 34:3766-3787. [PMID: 32342217 DOI: 10.1007/s00464-020-07599-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) enables removal of broad-based colorectal polyps or lateral spreading tumors with a higher rate of en bloc resection and a lower risk of local recurrence. However, it is technically demanding. Over the past 20 years, various equipment and innovative techniques have been developed to reduce the difficulty of ESD. The information in the literature is scattered. Our aim is to provide a comprehensive review on the setup and technical aspects of colorectal ESD. METHODS We searched the PubMed database and systemically reviewed all original and review articles related to colorectal ESD. Further manual search according to reference lists of identified articles were done. The selected articles were categorized and reviewed. Original figures were created to help readers understand some of the ESD techniques. RESULTS A total of 216 articles were identified, in which 25 of them were review articles and 191 of them were original articles. They were categorized and reviewed. An in-depth appraisal of the setting, equipment, and technical aspects of colorectal ESD was performed. CONCLUSIONS Although ESD is a technically demanding procedure that requires expert endoscopic skills, it can be mastered. With good peri-procedural preparation, sufficient knowledge of the equipment, and thorough understanding of the useful endoscopic tricks and maneuvers, colorectal ESD can be performed smoothly and safely.
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9
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Kuroki Y, Asonuma K, Uehara N, Endo T, Suzuki R, Yamamoto Y, Nagahama M. Efficacy and suitable indication of colorectal endoscopic submucosal dissection using a balloon-assisted endoscope. JGH Open 2020; 4:185-190. [PMID: 32280763 PMCID: PMC7144785 DOI: 10.1002/jgh3.12247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/23/2019] [Accepted: 08/04/2019] [Indexed: 12/14/2022]
Abstract
Background and Aim Cases of colorectal endoscopic submucosal dissection (ESD) with poor maneuverability are often encountered. We aimed to evaluate the efficacy of balloon‐assisted endoscopy (BAE) for such cases. Methods We confirmed maneuverability preoperatively in 400 consecutive cases of colorectal ESD performed at a single center from April 2011 to April 2018. A total of 83 deep colon cases judged as having poor maneuverability were retrospectively reviewed; 54 cases underwent BAE with a single balloon endoscope (group B), and 29 cases underwent conventional procedures without BAE (group C). Tumor size, procedure duration, dissection speed, en bloc resection rate, histology, and associated complications were compared between groups. Results The mean tumor size, tumor invasiveness, fibrosis, and complications did not differ between groups. Although the en bloc resection rate did not differ (both 98%), the groups significantly differed with regard to the R0 resection rate (B: 96%; C: 83%; P = 0.048). Overall, the procedure duration (B: 51 min; C: 70 min; P = 0.17) and dissection speed (B: 19.4 mm2/min; C: 17.4 mm2/min; P = 0.13) were not significantly different between groups. However, the dissection speed for lesions in the cecum/ascending colon was significantly faster in group B than in group C (B: 22.3 mm2/min; C: 11.3 mm2/min; P = 0.037). Conclusions In cases of colorectal ESD with poor maneuverability, the use of BAE contributed to an improvement in the R0 resection rate. In addition, BAE contributed to a quicker dissection speed for lesions located in the cecum/ascending colon.
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Affiliation(s)
- Yuichiro Kuroki
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Kunio Asonuma
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Natsumi Uehara
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Toshiyuki Endo
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Reika Suzuki
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Yorimasa Yamamoto
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
| | - Masatsugu Nagahama
- Department of Gastroenterology Showa University Fujigaoka Hospital Kanagawa Japan
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Nomura T, Matsuzaki I, Sugimoto S, Oyamda J, Kamei A, Kobayashi M. Clip-on-clip closure method for a mucosal defect after colorectal endoscopic submucosal dissection: a prospective feasibility study. Surg Endosc 2019; 34:1412-1416. [DOI: 10.1007/s00464-019-07195-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/09/2019] [Indexed: 12/28/2022]
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11
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Tachikawa J, Chiba H, Kuwabara H, Nakaoka M, Goto T. Successful 2-channel cold snare polypectomy of a colorectal lesion involving the appendiceal orifice. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2018; 3:279-280. [PMID: 30182088 PMCID: PMC6119232 DOI: 10.1016/j.vgie.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
| | - Hideyuki Chiba
- 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
| | - Toru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
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Nagata M. Usefulness of underwater endoscopic submucosal dissection in saline solution with a monopolar knife for colorectal tumors (with videos). Gastrointest Endosc 2018; 87:1345-1353. [PMID: 29242059 DOI: 10.1016/j.gie.2017.11.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/24/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Generally, colorectal endoscopic submucosal dissection (ESD) is performed with a monopolar knife with CO2 supply from an endoscope. There are few case reports about underwater ESD (UESD) in saline solution with a bipolar knife. The usefulness and safety of UESD in saline solution with a monopolar knife are unclear. The present study aimed to investigate the usefulness and safety of UESD in saline solution with a monopolar knife for colorectal tumors. METHODS This retrospective, observational study on UESD for colorectal tumors included 26 colorectal tumors from 24 patients treated with UESD at our department between October 2015 and February 2017. The characteristics of patients, factors associated with ESD difficulty, treatment results, and variations in blood test data before and after UESD were analyzed. RESULTS En bloc resection was successful in all lesions without any serious adverse events. The median major diameter of the resected specimens was 30 mm (interquartile range [IQR], 28-35) and of the tumor 22.5 mm (IQR, 17.8-25.3). The median procedure time was 60 minutes (IQR, 45-111) and median speed of dissection 10.4 mm2/min (IQR, 6.4-12.2). No cases of perforation occurred. Post-ESD bleeding occurred in only 1 case, and endoscopic hemostasis was achieved. There was no case of electrolyte imbalance requiring treatment after UESD. CONCLUSIONS UESD in saline solution with a monopolar knife for colorectal tumors is useful and safe. UESD has potential advantages that should be further assessed.
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Affiliation(s)
- Mitsuru Nagata
- Department of Endoscopy, Shonan Fujisawa Tokushukai Hospital, Kanagawa, Japan
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13
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Moreels TG. Update in enteroscopy: New devices and new indications. Dig Endosc 2018; 30:174-181. [PMID: 28710777 DOI: 10.1111/den.12920] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022]
Abstract
The present review provides an update of the currently available (proto-) types of device-assisted enteroscopy (DAE). In recent years, newly designed double- and single-balloon enteroscopes have emerged. They aim to improve insertion depth into the small bowel, and they also allow more efficient endoscopic interventions. Nowadays, almost all conventional endoscopic procedures are feasible using DAE, opening the door to new indications. Recently, more data have become available on pediatric DAE, DAE-assisted colonoscopy, and DAE in patients with altered anatomy, including DAE-assisted endoscopic retrograde cholangiopancreatography and direct cholangioscopy. Although new enteroscopes are being developed, few comparative studies are available in order to define which DAE suits best for each indication. It is the duty of the international endoscopy community to set up clinical research projects to provide answers to these open questions.
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Affiliation(s)
- Tom G Moreels
- Gastroenterology & Hepatology, University Hospital Saint-Luc, Brussels, Belgium
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14
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Song KH, Lee BJ. Balloon-Assisted Endoscopy: A Powerful Tool for Complete Colonoscopy. Clin Endosc 2018; 51:3-4. [PMID: 29397651 PMCID: PMC5806909 DOI: 10.5946/ce.2018.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/21/2022] Open
Affiliation(s)
- Kyung Hwan Song
- Department of Gastroenterology, Korea University Guro Hospital, Seoul, Korea
| | - Beom Jae Lee
- Department of Gastroenterology, Korea University Guro Hospital, Seoul, Korea
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15
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Mizutani H, Ono S, Ohki D, Takeuchi C, Yakabi S, Kataoka Y, Saito I, Sakaguchi Y, Minatsuki C, Tsuji Y, Niimi K, Kodashima S, Yamamichi N, Fujishiro M, Koike K. Recent Development of Techniques and Devices in Colorectal Endoscopic Submucosal Dissection. Clin Endosc 2017; 50:562-568. [PMID: 29207854 PMCID: PMC5719918 DOI: 10.5946/ce.2017.108] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/21/2017] [Accepted: 10/20/2017] [Indexed: 12/12/2022] Open
Abstract
Colorectal endoscopic submucosal dissection (ESD) is now a well-established endoscopic treatment for early-stage colorectal neoplasms, especially in Asian countries, including Japan. Despite the spread of colorectal ESD, there are still situations in which achieving successful submucosal dissection is difficult. Various novel techniques and devices have been developed to overcome these difficulties, and past reports have shown that some of these strategies can be applied to colorectal ESD. We review several recent developments in the field. The techniques reviewed include the pocket creation method and traction methods and the devices reviewed include the overtube with balloon and electrosurgical knives with water-jet function. These improved techniques and devices can facilitate safer, more reliable ESDs and expand its applicability and acceptability all over the world.
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Affiliation(s)
- Hiroya Mizutani
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ono
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Ohki
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Takeuchi
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seiichi Yakabi
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Kataoka
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Itaru Saito
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiki Sakaguchi
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chihiro Minatsuki
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Tsuji
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiko Niimi
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinya Kodashima
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobutake Yamamichi
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterolog, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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16
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Fuccio L, Hassan C, Ponchon T, Mandolesi D, Farioli A, Cucchetti A, Frazzoni L, Bhandari P, Bellisario C, Bazzoli F, Repici A. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86:74-86.e17. [PMID: 28254526 DOI: 10.1016/j.gie.2017.02.024] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is an endoscopic resection technique for lesions suspicious of superficial malignancy. It is performed using an ESD knife on its own (standard technique) or by the sequential use of a knife and a snare (hybrid technique). The experience with these techniques is different in Asian and non-Asian countries. We performed a systematic review and meta-analysis of available evidence on colorectal ESD. METHODS Electronic databases were searched up to August 2016 for studies evaluating R0, en bloc resection, and adverse event rates of both techniques for the treatment of colorectal lesions. Proportions were pooled by a random effects model. RESULTS Ninety-seven studies (71 performed in Asia) evaluated the standard technique and 12 studies (7 in Asia) the hybrid technique. The R0 resection rate of the standard technique was 82.9%, and it was significantly lower in non-Asian versus Asian countries: 71.3% versus 85.6%. The en bloc resection rate was 91% and was significantly lower in non-Asian versus Asian countries (81.2% vs 93%, respectively). Surgery was needed in 1.1% of the ESD-related adverse events, with a significant difference between non-Asian and Asian countries (3.1% vs 0.8%). The R0 and en bloc resection rates with the hybrid technique were significantly lower than those achieved with the standard technique: 60.6% and 68.4%, respectively, with similar adverse event rates. CONCLUSIONS In non-Asian countries the standard ESD technique is still failing to achieve acceptable levels of performance. The hybrid technique showed low R0 resection rates and should not be considered as an adequate alternative to the standard technique.
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Affiliation(s)
- Lorenzo Fuccio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Thierry Ponchon
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Daniele Mandolesi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Farioli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences, 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, University of Bologna, Bologna, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research and University Hospital, Rozzano (MI), Italy
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17
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Tashima T, Ohata K, Nonaka K, Sakai E, Minato Y, Horiuchi H, Matsuhashi N. Endoscopic submucosal dissection for laterally spreading tumors involving the appendiceal orifice. Surg Endosc 2017; 31:5444-5450. [PMID: 28567695 DOI: 10.1007/s00464-017-5598-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 05/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Since the endoscopic resection of laterally spreading tumors (LSTs) involving the appendiceal orifice remains technically difficult, such lesions are usually treated by surgical resection. However, with recent advances in endoscopic devices, endoscopic submucosal dissection (ESD) has become feasible and may be safely performed even for lesions involving the appendiceal orifice. Therefore, in order to assess the validity of endoscopic treatment for such lesions, we retrospectively evaluated the safety and efficacy of ESD. METHODS A total of 30 patients with LSTs extending to within 10 mm of the appendiceal orifice (Group AO) and 122 patients with cecal LSTs located away from the appendiceal orifice (Group C) who were treated between December 2011 and September 2015 were retrospectively enrolled in the present study. The indications for ESD were determined by the preoperative endoscopic diagnosis made on the basis of Kudo's pit pattern classification. Based on these preoperative endoscopic diagnoses, 8 of the 30 enrolled patients underwent surgical resection as the initial treatment, because the tumor showed deep invasion beyond the orifice and/or a VN pit pattern was visible. The treatment outcomes (en bloc R0 resection rates, tumor size, procedure time, and complication rates) were compared between the two groups. RESULTS The sensitivity and specificity for the cancer diagnosis were 81.8 and 94.7%, respectively. There was no significant difference in the en bloc R0 resection rate between Group AO and Group C (90.9 vs. 95.9%, P = 0.23). Furthermore, there were also no differences in the mean tumor size (30.0 ± 20.8 vs. 34.9 ± 14.5 mm, P = 0.17) or mean OR time (55.0 ± 39.2 vs. 58.9 ± 48.2 min P = 0.72) between the two groups. One case from Group AO (4.5%) was complicated by a perforation, which was successfully managed endoscopically. CONCLUSIONS Although proficiency in endoscopic techniques is required, our results indicate that LSTs involving the appendiceal orifice can be successfully treated by ESD.
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Affiliation(s)
- Tomoaki Tashima
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
| | - Kouichi Nonaka
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Eiji Sakai
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Yohei Minato
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Hajime Horiuchi
- Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Nobuyuki Matsuhashi
- Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
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18
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Ohata K, Sakai E, Richard Ohya T. Balloon overtube can improve maneuverability of the endoscope during colorectal endoscopic submucosal dissection. Dig Endosc 2017; 29 Suppl 2:68-69. [PMID: 28425648 DOI: 10.1111/den.12812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Eiji Sakai
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
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19
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Akintoye E, Kumar N, Aihara H, Nas H, Thompson CC. Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis. Endosc Int Open 2016; 4:E1030-E1044. [PMID: 27747275 PMCID: PMC5063641 DOI: 10.1055/s-0042-114774] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/29/2016] [Indexed: 02/07/2023] Open
Abstract
Background and study aims: Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique that allows en-bloc resection of gastrointestinal tumor. We systematically review the medical literature in order to evaluate the safety and efficacy of colorectal ESD. Patients and methods: We performed a comprehensive literature search of MEDLINE, EMBASE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of colorectal ESD. Results: Included in this study were 13833 tumors in 13603 patients (42 % female) who underwent colorectal ESD between 1998 and 2014. The R0 resection rate was 83 % (95 % CI, 80 - 86 %) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in continent (P = 0.004), study design (P = 0.04), duration of the procedure (P = 0.009), and, marginally, by average tumor size (P = 0.09). Endoscopic en bloc and curative resection rates were 92 % (95 % CI, 90 - 94 %) and 86 % (95 % CI, 80 - 90 %), respectively. The rates of immediate and delayed perforation were 4.2 % (95 % CI, 3.5 - 5.0 %) and 0.22 % (95 % CI, 0.11 - 0.46 %), respectively, while rates of immediate and delayed major bleeding were 0.75 % (95 % CI, 0.31 - 1.8 %) and 2.1 % (95 % CI, 1.6 - 2.6 %). After an average postoperative follow up of 19 months, the rate of tumor recurrence was 0.04 % (95 % CI, 0.01 - 0.31) among those with R0 resection and 3.6 % (95 % CI, 1.4 - 8.8 %) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 1.0 % (95 % CI, 0.42 - 2.1 %). Conclusions: Our meta-analysis, the largest and most comprehensive assessment of colorectal ESD to date, showed that colorectal ESD is safe and effective for colorectal tumors and warrants consideration as first-line therapy when an expert operator is available.
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Affiliation(s)
- Emmanuel Akintoye
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Nitin Kumar
- Developmental Endoscopy Lab, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Hiroyuki Aihara
- Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Hala Nas
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Christopher C. Thompson
- Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
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20
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Asayama N, Oka S, Tanaka S, Sumimoto K, Hirano D, Tamaru Y, Ninomiya Y, Shigita K, Hayashi N, Nishiyama S, Chayama K. Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection. Endosc Int Open 2016; 4:E614-7. [PMID: 27556066 PMCID: PMC4993897 DOI: 10.1055/s-0042-105434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Poor endoscope operability remains a significant challenge during colorectal endoscopic submucosal dissection (ESD). We retrospectively evaluated the experience and clinical usefulness of a new single-use splinting tube in deep colonic ESD in the setting of poor scope operability. PATIENTS AND METHODS Among 691 patients with colorectal tumors treated with ESD at Hiroshima University Hospital between November 2009 and July 2015, we analyzed 20 consecutive patients who underwent deep colonic ESD using a single-use splinting tube because of poor scope operability. Poor operability was defined as paradoxical movement of the endoscope, poor control with adhesions, and lesion motion with heartbeat or breathing. Technical and clinical success rates and adverse events were assessed. RESULTS Paradoxical movement and poor control with adhesions were improved in all cases using the single-use splinting tube. The en bloc resection rate was 95 % (19/20) and histological en bloc resection rate was 100 % (20/20). There were no complications related to use of the splinting tube. CONCLUSIONS Use of a single-use splinting tube helped to overcome poor scope operability in deep colonic ESD.
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Affiliation(s)
- Naoki Asayama
- Departments of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shiro Oka
- Departments of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan ,Corresponding author Shiro Oka Department of EndoscopyHiroshima University1-2-3 Kasumi, Minami-kuHiroshima 734-8551Japan+81-82-257-5939
| | - Shinji Tanaka
- Departments of Endoscopy, 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
| | - Kenjiro Shigita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Nana Hayashi
- Departments of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Soki Nishiyama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Ohata K, Nonaka K, Misumi Y, Tsunashima H, Takita M, Minato Y, Tashima T, Sakai E, Muramoto T, Matsuyama Y, Hiejima Y, Matsuhashi N. Usefulness of training using animal models for colorectal endoscopic submucosal dissection: is experience performing gastric ESD really needed? Endosc Int Open 2016; 4:E333-9. [PMID: 27004253 PMCID: PMC4798938 DOI: 10.1055/s-0042-101022] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 01/04/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Despite the clinical advantages of colorectal endoscopic submucosal dissection (ESD), an effective training system, especially for Western endoscopists, has been challenging to establish. Herein, we propose a novel training program using ex vivo animal models and evaluate the learning curve of colorectal ESD trainees without gastric ESD experience. PATIENTS AND METHODS A total of 80 colorectal lesions were prospectively collected and removed by two novice operators. Before human ESD procedures, they received ESD training using an ex vivo porcine "proximal colon" model, which simulates a lumen with many folds and flexions. To assess the validity of our training system, the self-completion and en bloc R0 resection rates, the operation time, and prevalence of complications were compared between the first and latter period. Moreover the factors associated with prolonged operation time were evaluated. RESULTS The overall rates of self-completion and en bloc R0 resection were 98 % (78/80) and 100 % (80/80), respectively. The operation time during the first period was significantly longer than that during the latter period (86 ± 50 minutes vs. 60 ± 36 minutes, P = 0.01). Regarding complications, only two cases of perforations and delayed hemorrhage were observed during the first period; however, all of the complications were successfully managed endoscopically. The presence of fibrosis was identified as a significant independent predictor of a prolonged operation time during the first period (coefficient, 5.90; 95 %CI, 2.36 - 9.44, P = 0.002). CONCLUSIONS Our trainees achieved high rates of self-completion and R0 resection without severe complications even during the first 20 cases, suggesting that our training programs using ex vivo animal models are useful for trainees without gastric ESD experience. STUDY REGISTRATION UMIN000013566.
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Affiliation(s)
- Ken Ohata
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan,Corresponding author Ken Ohata, MD Division of GastroenterologyNTT Medical Center5-9-22 Higashi-gotandaShinagawa-kuTokyo141-8625Japan+81-3-34486541
| | - Kouichi Nonaka
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoshitsugu Misumi
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Maiko Takita
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yohei Minato
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomoaki Tashima
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Eiji Sakai
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takashi Muramoto
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yasushi Matsuyama
- Division of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoshimitsu Hiejima
- Graduate School of Healthcare, Tokyo Healthcare University, Tokyo, Japan
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Yamamoto K, Michida T, Nishida T, Hayashi S, Naito M, Ito T. Colorectal endoscopic submucosal dissection: Recent technical advances for safe and successful procedures. World J Gastrointest Endosc 2015; 7:1114-1128. [PMID: 26468335 PMCID: PMC4600177 DOI: 10.4253/wjge.v7.i14.1114] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/27/2015] [Accepted: 09/10/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is very useful in en bloc resection of large superficial colorectal tumors but is a technically difficult procedure because the colonic wall is thin and endoscopic maneuverability is poor because of colonic flexure and extensibility. A high risk of perforation has been reported in colorectal ESD. To prevent complications such as perforation and unexpected bleeding, it is crucial to ensure good visualization of the submucosal layer by creating a mucosal flap, which is an exfoliated mucosa for inserting the tip of the endoscope under it. The creation of a mucosal flap is often technically difficult; however, various types of equipment, appropriate strategy, and novel procedures including our clip-flap method, appear to facilitate mucosal flap creation, improving the safety and success rate of ESD. Favorable treatment outcomes with colorectal ESD have already been reported in many advanced institutions, and appropriate understanding of techniques and development of training systems are required for world-wide standardization of colorectal ESD. Here, we describe recent technical advances for safe and successful colorectal ESD.
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23
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Pinho R. The Vanishing Frontiers of Therapeutic Enteroscopy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 22:133-134. [PMID: 28868394 PMCID: PMC5580178 DOI: 10.1016/j.jpge.2015.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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24
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Hotta K, Katsuki S, Ohata K, Abe T, Endo M, Shimatani M, Nagaya T, Kusaka T, Matsuda T, Uraoka T, Yamaguchi Y, Murakami Y, Saito Y. Efficacy and safety of endoscopic interventions using the short double-balloon endoscope in patients after incomplete colonoscopy. Dig Endosc 2015; 27:95-8. [PMID: 24889819 DOI: 10.1111/den.12318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/26/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM We have previously reported excellent cecal intubation rates using a short double-balloon endoscope in patients with a history of incomplete colonoscopy. However, data on the endoscopic treatment of colorectal tumors using a double-balloon endoscope are limited. The aim of the present study was to evaluate the efficacy and safety of endoscopic intervention of colorectal tumors using a short double-balloon endoscope. METHODS We analyzed data from a multicenter, prospective study on 110 patients (62 men, median age 66.5 years) who underwent total colonoscopy after incomplete colonoscopy to assess the characteristics of colorectal tumors, endoscopic interventions, and complications. RESULTS In all, 113 colorectal tumors were detected in 55 patients; 109 of the tumors were adenomas (24 advanced adenomas) and two each were intramucosal and advanced cancers. Locations of the lesions were eight in the cecum, 30 in the ascending colon, 18 in the transverse colon, 12 in the descending colon, 34 in the sigmoid colon, five in the rectosigmoid and six in the rectum. Average tumor diameter was 6.8 ± 6.3 mm. Fifty-nine polypectomies, 22 endoscopic mucosal resections, four hot biopsies, and six cold biopsies were done. All endoscopic interventions were successfully completed and no complications were noted. Two advanced cancers were located in the ascending colon and only a double-balloon endoscope could reach them to take a biopsy sample. CONCLUSION Double-balloon endoscopy is effective and safe for endoscopic intervention of colorectal tumors, irrespective of the location, in patients after incomplete colonoscopy.
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Affiliation(s)
- Kinichi Hotta
- Department of Gastroenterology, Saku Central Hospital, Saku, Japan; Division of Endoscopy, Shizuoka Cancer Center, Sunto, Japan
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Sakamoto T, Mori G, Yamada M, Kinjo Y, So E, Abe S, Otake Y, Nakajima T, Matsuda T, Saito Y. Endoscopic submucosal dissection for colorectal neoplasms: A review. World J Gastroenterol 2014; 20:16153-16158. [PMID: 25473168 PMCID: PMC4239502 DOI: 10.3748/wjg.v20.i43.16153] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/01/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
The introduction of colorectal endoscopic submucosal dissection (ESD) has expanded the application of endoscopic treatment, which can be used for lesions with a low metastatic potential regardless of their size. ESD has the advantage of achieving en bloc resection with a lower local recurrence rate compared with that of piecemeal endoscopic mucosal resection. Moreover, in the past, surgery was indicated in patients with large lesions spreading to almost the entire circumference of the rectum, regardless of the depth of invasion, as endoscopic resection of these lesions was technically difficult. Therefore, a prime benefit of ESD is significant improvement in the quality of life for patients who have large rectal lesions. On the other hand, ESD is not as widely applied in the treatment of colorectal neoplasms as it is in gastric cancers owing to the associated technical difficulty, longer procedural duration, and increased risk of perforation. To diversify the available endoscopic treatment strategies for superficial colorectal neoplasms, endoscopists performing ESD need to recognize its indications, the technical issues involved in its application, and the associated complications. This review outlines the methods and type of devices used for colorectal ESD, and the training required by endoscopists to perform this procedure.
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Sakamoto T, Takamaru H, Mori G, Yamada M, Kinjo Y, So E, Abe S, Otake Y, Nakajima T, Matsuda T, Saito Y. Endoscopic submucosal dissection for colorectal neoplasms. ANNALS OF TRANSLATIONAL MEDICINE 2014; 2:26. [PMID: 25333002 DOI: 10.3978/j.issn.2305-5839.2014.03.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 03/10/2014] [Indexed: 12/22/2022]
Abstract
Endoscopic submucosal dissection (ESD) is an established therapeutic technique for the treatment of gastrointestinal neoplasms. Because it is typically completed as en bloc resection, this technique provides a complete specimen for precise pathological evaluation. On the other hand, ESD is not as widely applied in treating colorectal neoplasms as with gastric cancers, due to its technical difficulty, longer procedure time, and increased risk of perforation. However, some devices that facilitate ESD and improve the safety of the procedure have been recently reported, and the use of the technique has gradually spread worldwide. Endoscopists who begin to perform ESD need to recognize the indications of ESD, the technical issue involved in this procedure, and its associated complications. This review outlines the methods and certain types of devices used for colorectal ESD.
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Affiliation(s)
- Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Genki Mori
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuzuru Kinjo
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Eriko So
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yosuke Otake
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Nakajima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Hayashi Y, Sunada K, Yamamoto H. Prototype holder adequately supports the overtube in balloon-assisted endoscopic submucosal dissection. Dig Endosc 2014; 26:682. [PMID: 25041131 DOI: 10.1111/den.12330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yoshikazu Hayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc 2014; 28:2959-65. [DOI: 10.1007/s00464-014-3558-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 04/17/2014] [Indexed: 12/28/2022]
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Sato K, Ito S, Kitagawa T, Kato M, Tominaga K, Suzuki T, Maetani I. Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc 2014. [PMID: 24853849 DOI: 10.1016/j.gie.2014.02.988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) for colorectal tumors is technically difficult due to the anatomy of the large intestine, with its narrow lumen, thin walls, and redundancy. Here, we assessed factors associated with incomplete resection and difficult colorectal ESD. METHODS Between November 2009 and April 2013, we performed ESD on 151 consecutive colorectal tumors in 147 patients. We evaluated the clinical outcomes of all cases and conducted multiple logistic regression analysis of the following factors related to incomplete resection and difficult procedure: age, gender, location (right colon, left colon or rectum), tumor size (diameter ≥40 or <40 mm), operation time, morphology [granular-type laterally spreading tumor (LST-G), non-granular-type laterally spreading tumor (LST-NG), or protruded type], fibrosis, and paradoxical movement during the procedure. A procedure that required more than 120 min was defined as a difficult colorectal ESD. RESULTS Average tumor size was 32.1 ± 10.7 mm, and the average procedure length was 71.8 ± 49.5 min. The rate of en bloc resection was 94.7%, while that of en bloc curative resection was 86.8%. Perforation occurred in 1.3% of the ESD procedures. Multivariate logistic regression analysis revealed that only severe fibrosis [odds ratio (OR) 4.51; 95% confidence interval (CI) 1.36-14.91, p = 0.014] contributed to incomplete resection and that a tumor size exceeding 40 mm (OR 5.73 [95% CI 1.66-19.74], p = 0.006), severe fibrosis (OR 23.31 [95% CI 6.59-82.54], p < 0.001), and paradoxical movement (OR 4.26 [95% CI 1.11-16.44], p = 0.035) were independent factors exacerbating the difficulty of colorectal ESD. CONCLUSIONS Severe fibrosis contributed to both incomplete resection and difficult colorectal ESD. Larger tumor size and paradoxical movement during the procedure were independent factors contributing to the difficulty of colorectal ESD. These factors might enable endoscopists to develop strategies for treating colorectal ESD.
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Affiliation(s)
- Koichiro Sato
- Division of Gastroenterology and Hepatology , Department of Internal Medicine, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan,
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Arezzo A, Passera R, Saito Y, Sakamoto T, Kobayashi N, Sakamoto N, Yoshida N, Naito Y, Fujishiro M, Niimi K, Ohya T, Ohata K, Okamura S, Iizuka S, Takeuchi Y, Uedo N, Fusaroli P, Bonino MA, Verra M, Morino M. Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 2013. [PMID: 24149849 DOI: 10.1007/s0464-013-3238-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and full-thickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. METHODS A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. RESULTS This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). CONCLUSIONS The ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy,
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Arezzo A, Passera R, Saito Y, Sakamoto T, Kobayashi N, Sakamoto N, Yoshida N, Naito Y, Fujishiro M, Niimi K, Ohya T, Ohata K, Okamura S, Iizuka S, Takeuchi Y, Uedo N, Fusaroli P, Bonino MA, Verra M, Morino M. Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 2013; 28:427-38. [PMID: 24149849 DOI: 10.1007/s00464-013-3238-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/23/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and full-thickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. METHODS A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. RESULTS This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). CONCLUSIONS The ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment.
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Affiliation(s)
- Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy,
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Repici A, Hassan C, Pagano N, Rando G, Romeo F, Spaggiari P, Roncalli M, Ferrara E, Malesci A. High efficacy of endoscopic submucosal dissection for rectal laterally spreading tumors larger than 3 cm. Gastrointest Endosc 2013; 77:96-101. [PMID: 23261098 DOI: 10.1016/j.gie.2012.08.036] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/30/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) was recently developed to allow en bloc resection of early neoplasia of the GI tract, including colorectal neoplasia. The endoscopic technique is technically demanding and not yet standardized, and new devices are needed. OBJECTIVE This study aimed to evaluate the efficacy and safety of a new device that combines the functions of injection and cutting. DESIGN Prospective, pilot, single-arm study. METHODS Consecutive patients with rectal laterally spreading tumors (LSTs) 3 cm or larger unsuitable for en bloc resection were enrolled. ESD was performed with a new device that allows cutting and coagulation as well as a needleless, tissue-selective mucosal and submucosal elevation through an axial water-jet channel. MAIN OUTCOME MEASUREMENT The primary endpoint of the study was the en bloc resection rate achieved with ESD in a Western hospital setting. RESULTS Overall, ESD was attempted in 40 consecutive patients (27 male, mean age 65.3 years) with rectal LSTs larger than 3 cm (72.5% LSTs, nongranular type, 5% depressed type, 22.5% protruding type). The mean lesion size was 46.8 ± 10.9 mm (range 33-80 mm). The mean procedure time was 86.1 ± 35.5 minutes (range 40-190 minutes). The en bloc resection rate was 90% (36/40). In the remaining patients, resection was completed with a piecemeal approach. The rate of curative resection (R0) was 32 of 40 LSTs (80%). Two patients with submucosal invasion were referred for surgery. Perforation occurred in 1 patient (2.5%), which was managed conservatively. Postoperative bleeding occurred in 2 patients (5%) and was treated by endoscopic hemostasis. LIMITATIONS Single-center study with a relatively small number of patients. CONCLUSIONS ESD is a safe and effective method to provide en bloc and curative resection of large rectal LSTs. The operating time and adverse event rate were comparable to those of previously published data from Japanese experts.
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Affiliation(s)
- Alessandro Repici
- Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
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Hotta K, Yamaguchi Y, Saito Y, Takao T, Ono H. Current opinions for endoscopic submucosal dissection for colorectal tumors from our experiences: indications, technical aspects and complications. Dig Endosc 2012; 24 Suppl 1:110-6. [PMID: 22533764 DOI: 10.1111/j.1443-1661.2012.01262.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endoscopic submucosal dissection (ESD) was first applied in the resection of large colorectal tumors 10 years ago. Frequent complications and technical difficulties were serious problems at first, but were gradually improved with experience. Here, we describe the indications, technical aspects and management of complications of ESD for colorectal tumors. In 2009, we introduce the use of small tip insulation-tipped diathermic (IT) knife. Features separating it from the IT knife and IT Knife2 are a smaller ceramic tip and small round disk at the root of the tip. During submucosal dissection, the small tip IT knife could dissect large pieces of tissue intact. This allows us to shorten the procedure time, particularly the submucosal dissection component. A total of 146 ESD for 140 patients were performed between January 2009 and July 2011. En bloc, and en bloc and R0 resection rates were 92.5% and 83.6%, respectively. Median procedural time was 48.5 min for 40.5 mm specimens. Perforation and delayed bleeding occurred in 2.1% and 1.4%, respectively. We successfully performed ESD for colorectal tumors with a shortened procedure time while preserving quality and safety.
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Affiliation(s)
- Kinichi Hotta
- Division of Endoscopy and Gastrointestinal Oncology, Shizuoka, Japan.
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Okamoto K, Muguruma N, Kitamura S, Kimura T, Takayama T. Endoscopic submucosal dissection for large colorectal tumors using a cross-counter technique and a novel large-diameter balloon overtube. Dig Endosc 2012; 24 Suppl 1:96-9. [PMID: 22533761 DOI: 10.1111/j.1443-1661.2012.01264.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) in early gastric cancer (EGC), which provides a higher complete resection rate than conventional endoscopic mucosal resection (EMR), has rapidly come into widespread use. However, colorectal ESD is not widely used because of its technical difficulty and complications such as perforation, and the procedure time is longer than that of conventional EMR. Development of safer and more reliable devices as well as technique modifications are therefore required. The aim of our study is to compare safety and efficacy of a new traction method, the cross-counter technique, for large colorectal tumors combined with a balloon overtube. METHODS A total of 30 patients with large colorectal tumors were analyzed retrospectively; 15 patients for the cross-counter technique group (CC group) and 15 patients for the no-traction group (NT group). Procedure time, complete resection rate, perforation rate and bleeding rate were assessed. RESULTS The procedure time was 126 ± 42.2 min and 165 ± 61.3 min in the CC and NT groups, respectively, and there was a significant difference between the two groups (P < 0.05). There were no significant differences in complete resection rate, perforation rate and bleeding rate between the two groups. CONCLUSION The cross-counter technique shortened the treatment time in colorectal ESD without any complication.
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Affiliation(s)
- Koichi Okamoto
- Department of Gastroenterology and Oncology, Institute of Health Biosciences, The University of Tokushima, Tokushima, Japan.
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Ohata K, Ito T, Chiba H, Tsuji Y, Matsuhashi N. Effective training system in colorectal endoscopic submucosal dissection. Dig Endosc 2012; 24 Suppl 1:84-9. [PMID: 22533759 DOI: 10.1111/j.1443-1661.2012.01272.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although colorectal endoscopic submucosal dissection (ESD) is superior to endoscopic mucosal resection (EMR) in en bloc resection rate, it is technically quite difficult because of the anatomical and histological characteristics of the colorectal wall. This difficulty prevents wide spread of the technique. Establishment of the training system for colorectal ESD is necessary to standardize training and to achieve wider acceptance of this technique. Herein, we describe our training system for colorectal ESD, and assess the validity of the training system for colorectal ESD, based on the clinical outcomes and learning curve of trainees. Our training system for colorectal ESD would help the spread of this procedure.
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Affiliation(s)
- Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan.
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