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Sekiguchi M, Igarashi A, Mizuguchi Y, Takamaru H, Yamada M, Sakamoto T, Maltzman H, Falkén Y, Esaki M, Matsuda T, Saito Y. Cost-effectiveness analysis of endoscopic resection for colorectal laterally spreading tumors: Endoscopic submucosal dissection versus piecemeal endoscopic mucosal resection. Dig Endosc 2022; 34:553-568. [PMID: 34101915 DOI: 10.1111/den.14058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The cost-effectiveness of endoscopic submucosal dissection (ESD) and piecemeal endoscopic mucosal resection (pEMR) for colorectal laterally spreading tumors (LSTs) remains unclear. We examined the cost-effectiveness of these procedures for cases of colon/rectal LST-non-granular-type ≥2 cm and LST-granular-mixed-type ≥3 cm. METHODS We performed a simulation model analysis using parameters based on clinical data from the National Cancer Center Hospital, Tokyo, and previous literature. The number of recurrences and surgeries and the required costs for 5 years following ESD and pEMR were assessed. Japanese cost data were used in the base-case analysis, and probabilistic sensitivity analysis (PSA) was performed. The Swedish cost data were used in the scenario analysis. RESULTS Endoscopic submucosal dissection yielded a considerably lower number of recurrences and surgeries but required a higher cost than pEMR. The recurrence rates following ESD and pEMR were 0.9-1.3% and 21.1-25.9%, respectively. The incremental cost-effectiveness ratios for an avoided recurrence and surgery for ESD against pEMR were 376,796-476,496 JPY (3575-4521 USD) and 7,335,436-8,187,476 JPY (69,604-77,689 USD), respectively. PSA demonstrated that the probability of ESD being chosen as a more cost-effective option than pEMR was >50% at willingness-to-pay values of ≥400,000-500,000 JPY (3795-4744 USD) for avoiding a recurrence and ≥9,500,000-10,500,000 JPY (90,143-99,631 USD) for avoiding a surgery. In the scenario analysis, the required cost was also lower for ESD. CONCLUSIONS Our findings suggest potentially favorable cost-effectiveness of ESD, depending on cost settings and the willingness-to-pay value for avoiding recurrence/surgery.
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Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.,Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan.,Unit of Public Health and Preventive Medicine, Yokohama City University School of Medicine, Kanagawa, Japan
| | | | | | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Henrik Maltzman
- Division of Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Ylva Falkén
- Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Minoru Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.,Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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Nakajima T, Sakamoto T, Hori S, Yamada S, Ikematsu H, Harada K, Chiu HM, Kiriyama S, Michida T, Hotta K, Sakamoto N, Abe T, Chino A, Fukuzawa M, Kobayashi N, Fukase K, Matsuda T, Murakami Y, Ishikawa H, Saito Y. Optimal surveillance interval after piecemeal endoscopic mucosal resection for large colorectal neoplasia: a multicenter randomized controlled trial. Surg Endosc 2021; 36:515-525. [PMID: 33569725 DOI: 10.1007/s00464-021-08311-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Colorectal neoplastic lesions (≥ 20 mm) are commonly treated via piecemeal endoscopic mucosal resection (p-EMR) but have a high rate of local recurrence. We aimed to clarify the optimal surveillance interval after p-EMR for these neoplasias. METHODS In this multicenter (15 participating institutions) prospective, randomized trial, 180 patients recruited over a 4-year period and were classified based on tumor location, tumor diameter, histological diagnosis, institution, and number of resected specimens. The patients underwent curative p-EMR followed by scheduled surveillance colonoscopy at 3, 6, 12, and 24 months after p-EMR (group A; n = 90) or at 6, 12, and 24 months after p-EMR (group B; n = 90). The primary endpoint was cumulative local recurrence at 6 months after p-EMR. Secondary endpoints included local recurrence and the cumulative surgical resection rate of recurrent tumors during the 24-month follow-up period. RESULTS The median tumor diameter was 25 mm (IQR 20-30). Six months after p-EMR, 12 and 6 local recurrences were noted in groups A and B, which corresponded to 13 and 8 recurrences, respectively, during the 24-month surveillance period. The primary and secondary endpoints of recurrence were not significantly different between the groups on either intention-to-treat or per-protocol analysis; no surgery case was observed in group B when a strict surveillance protocol of 6-, 12-, and 24-month follow-up post-EMR was followed. CONCLUSIONS For patients who underwent p-EMR for neoplastic lesions, additional postprocedural 3-month surveillance did not show superior results in detecting recurrence compared with a 6-month surveillance interval. CLINICAL TRIAL REGISTRATION UMIN000015740.
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Affiliation(s)
- Takeshi Nakajima
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Shinichiro Hori
- Department of Endoscopy, NHO Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Shinya Yamada
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
| | - Keita Harada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Tomoki Michida
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kinichi Hotta
- Department of Gastroenterology, Saku Central Hospital, Nagano, Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University Hospital, Tokyo, Japan
| | - Takashi Abe
- Gastroenterology Center, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Akiko Chino
- Gastroenterological Medicine, Cancer Institute Hospital, Ariake, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Nozomu Kobayashi
- Department of Gastroenterology, Tochigi Cancer Center, Utsunomiya, Tochigi, Japan
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | | | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Huang ES, Chumfong IT, Alkoraishi AS, Munroe CA. Combined Endoscopic Mucosal Resection and Extended Laparoscopic Appendectomy for the Treatment of Periappendiceal, Cecal, and Appendiceal Adenomas. J Surg Res 2020; 252:89-95. [PMID: 32278221 DOI: 10.1016/j.jss.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/23/2020] [Accepted: 02/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Surgical resection is the gold standard in the treatment of neoplasia involving the appendiceal orifice (Ao). Endoscopic mucosal resection (EMR) of adenomas involving the Ao can be challenging because of the risk of appendicitis, perforation, or incomplete resection. Surgical resection of Ao lesions is limited by the difficulty of ensuring a negative lateral margin without compromising the ileocecal valve and usually necessitates ileocecal resection. Although combined endoscopic and laparoscopic surgery has become more widely accepted for a variety of conditions, a structured approach to lesions involving the Ao has yet to be described. We describe a novel approach to the treatment of periappendiceal, cecal, and appendiceal adenomas-and present an algorithm to guide decision-making regarding the application of these techniques. METHODS All patients referred to our therapeutic endoscopy practice with tumors involving the Ao between August 2013 and July 2017 were included. Based on tumor size and involvement of the os, patients were either referred for extended laparoscopic appendectomy (ELA), EMR, or a combined approach. RESULTS In total, 47 patients were included; 25 patients underwent EMR only, 13 patients underwent ELA only, and nine patients underwent combined resection. Two patients undergoing EMR had postpolypectomy syndrome. One EMR-only patient with a positive lateral margin was referred for appendectomy, but declined. No patient required ileocecectomy. Pathologic examination revealed a high rate of sessile serrated adenoma (SSA; 36%). CONCLUSIONS Our results introduce a decision algorithm and suggest that EMR combined with ELA is a safe and curative technique for the treatment of large cecal adenomas involving the Ao.
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Affiliation(s)
- Emily S Huang
- Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Isabelle T Chumfong
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Ahmed S Alkoraishi
- Department of Surgery, Kaiser Permanente San Francisco, San Francisco, California
| | - Craig A Munroe
- Department of Gastroenterology, Kaiser Permanente San Francisco, San Francisco, California.
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Zhu XS, Dai YC, Chen ZX. Giant Solitary Fibrous Tumor of Esophagus Resected by Endoscopic Submucosal Dissection. Ann Thorac Surg 2016; 100:2340-3. [PMID: 26652528 DOI: 10.1016/j.athoracsur.2015.02.128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/03/2015] [Accepted: 02/06/2015] [Indexed: 12/12/2022]
Abstract
Solitary fibrous tumor is one of the most common soft tissue benign tumors that occur in adults, but it rarely occurs in the gastrointestinal tract and even more infrequently occurs in the esophagus. Only 4 cases of esophageal solitary fibrous tumors have been reported in PubMed using the search terms "solitary fibrous tumor" and "esophagus". These cases were all treated using surgical methods. Thus, we report a case of primary solitary fibrous tumor of the esophagus treated by endoscopic submucosal dissection. Endoscopic submucosal dissection was well tolerated in this patient, suggesting that it may be a therapeutic option for primary giant esophageal neoplasms.
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Affiliation(s)
- Xiao-San Zhu
- Department of Gastroenterology, Chenggong Hospital, Xiamen University, Xiamen, Fujian, China; Department of Gastroenterology, 174th Hospital of the PLA, Xiamen, Fujian, China
| | - Yi-Chen Dai
- Department of Gastroenterology, Chenggong Hospital, Xiamen University, Xiamen, Fujian, China; Department of Gastroenterology, 174th Hospital of the PLA, Xiamen, Fujian, China.
| | - Zhang-Xing Chen
- Department of Gastroenterology, 174th Hospital of the PLA, Xiamen, Fujian, China
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Intramucosal carcinoma of the appendix arising from traditional serrated adenoma. Case Rep Surg 2015; 2015:297450. [PMID: 25977829 PMCID: PMC4421026 DOI: 10.1155/2015/297450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/25/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Serrated adenomas of the appendix are rare and usually found during appendectomy or autopsies. The preoperative diagnosis of these tumors is uncommon. This report describes a case of a sessile serrated adenoma located in the appendix diagnosed by a screening colonoscopy and successfully treated by laparoscopic removal. Presentation of Case. An 86-year-old woman underwent colonoscopy to investigate the cause of her diarrhea, weight loss, and anemia. During the colonoscopy, an expansive and vegetating mass of 1.5 cm in diameter was identified, protruding through the appendicular ostium with slightly lateral growth to the cecum. The patient was referred for laparoscopic surgical resection due to the location of the lesion, which did not allow its removal by colonoscopy. She underwent wedge removal of the cecum without complications and was discharged on the 4th postoperative day. Histopathological examination showed the presence of a sessile serrated adenoma with an intramucosal adenocarcinoma. The patient is currently well one year after surgery, without endoscopic signs of relapse. Conclusion. Despite serrated adenomas being a possibility rarely described in appendix it should be recognized and properly treated because it is presenting a higher risk of cancer.
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