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Morimoto S, Tanaka H, Takehara Y, Yamamoto N, Tanino F, Kamigaichi Y, Yamashita K, Takigawa H, Yuge R, Urabe Y, Oka S. Hybrid endoscopic submucosal dissection as a salvage option for difficult colorectal conventional endoscopic submucosal dissection. Surg Endosc 2024; 38:222-228. [PMID: 37968384 DOI: 10.1007/s00464-023-10544-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/13/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND When total submucosal dissection is difficult to achieve during conventional colorectal endoscopic submucosal dissection (C-ESD), the lesion can be resected by final snaring through salvage hybrid ESD (SH-ESD). This study aimed to examine the outcomes of SH-ESD and identify its indications that could achieve en bloc resection. METHODS We recruited 1039 consecutive patients with colorectal lesions that underwent ESD at Hiroshima University Hospital between January 2015 and December 2020. C-ESD was attempted thoroughly in 924 lesions (C-ESD group, including 9 lesions in which ESD was discontinued), and SH-ESD was performed owing to some difficulties in 115 lesions (SH-ESD group). Risk factors for incomplete resection by SH-ESD and ESD discontinuation were evaluated using multivariate analysis. The outcomes were compared between cases with remaining undissected submucosa of < 20 mm in diameter in the SH-ESD and C-ESD groups, using propensity score matching. RESULTS Multivariate analysis revealed that a procedure time > 80 min and remaining undissected submucosa ≥ 20 mm in diameter were significant risk factors for incomplete resection after SH-ESD and ESD discontinuation. By propensity score matching analysis, procedure time was significantly shorter in the SH-ESD group with remaining undissected submucosa < 20 mm in diameter than in the C-ESD group (71 min vs. 90 min, p = 0.0053), although no significant difference was found in the en bloc resection rate (94% vs. 87%, p = 0.0914). CONCLUSION SH-ESD can be an alternative surgical method when conventional ESD is difficult to continue in cases in which the remaining undissected submucosa is < 20 mm in diameter.
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Affiliation(s)
- Shin Morimoto
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hidenori Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan.
| | - Yudai Takehara
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Noriko Yamamoto
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Fumiaki Tanino
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuki Kamigaichi
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Ken Yamashita
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Hidehiko Takigawa
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Ryo Yuge
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Yuji Urabe
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan
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Moreira P, Cardoso PM, Macedo G, Santos-Antunes J. Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review. J Clin Med 2023; 12:4777. [PMID: 37510892 PMCID: PMC10381236 DOI: 10.3390/jcm12144777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that now play a crucial role in the treatment of colorectal lesions. ESD is a minimally invasive endoscopic procedure that allows for the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it is a complex technique, requiring high endoscopic skills, expertise, and specialized training, with higher rates of adverse events expected compared with EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It is a faster and more accessible procedure, with fewer adverse events, although it only allows for an en-bloc resection of lesions measuring 15-20 mm. TAMIS is a minimally invasive surgical technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing for a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, in search for the most adequate treatment for the removal of lesions in the rectum and anorectal junction, as these locations possess distinct characteristics that demand a more specific approach.
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Affiliation(s)
- Pedro Moreira
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Pedro Marílio Cardoso
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - Guilherme Macedo
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
| | - João Santos-Antunes
- Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
- Gastroenterology Department, Centro Hospitalar São João, 4200-319 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, University of Porto, 4099-030 Porto, Portugal
- IPATIMUP-Institute of Molecular Pathology and Immunology, University of Porto, 4200-450 Porto, Portugal
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Conio M, Manta R, Filiberti RA, Baron TH, Pasquale L, Marini M, De Ceglie A. Cap-assisted EMR versus standard inject and cut EMR for treatment of large colonic laterally spreading tumors: a randomized multicenter study (with videos). Gastrointest Endosc 2022; 96:829-839.e1. [PMID: 35697127 DOI: 10.1016/j.gie.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Piecemeal EMR of colorectal laterally spreading tumors (LSTs) >20 mm is effective. Experience is limited in the use of cap-assisted EMR (EMR-C) for resection of colonic lesions. We compared the efficacy and the safety of EMR-C for the removal of colonic LSTs ≥30 mm with "inject-and-cut" standard EMR (EMR-S). METHODS In this randomized trial from 4 Italian centers, 138 patients were treated with EMR-C and 102 with EMR-S. The rates of residual lesions, percentage of recurrence after 12 months, and adverse events were evaluated. RESULTS One hundred forty-three lesions were resected with EMR-C and 102 with EMR-S. Argon plasma coagulation (APC) was used as adjunctive treatment in 2.9% of EMR-Cs and in 22.5% of EMR-Ss (P < .001). The median time required was 20 minutes for EMR-C and 30 minutes for EMR-S (P < .001). Adverse events (AEs) occurred in 14 EMR-Cs (10.1%; 2 perforations, 11 bleeding events, and 1 stenosis) and in 22 EMR-Ss (21.6%; 1 perforation and 21 bleeding events) (P = .017). Intraprocedural AEs occurred in 3.6% of EMR-Cs and 16.7% of EMR-Ss (P = .001). Overall, residual lesions within 12 months were found to be significantly higher with EMR-S (32 patients, 31.4%) than with EMR-C (8 patients, 5.8%) (P < .001). Recurrence at follow-up colonoscopy in 12 months occurred in 7 EMR-Cs (5.1%) and 17 EMR-Ss (16.7%; P < .001). CONCLUSIONS The study demonstrated the feasibility and safety of EMR-C for removing large colorectal LSTs, with higher eradication rates, shorter resection time, and less use of APC when compared with EMR-S. (Clinical trial registration number: NCT03498664.).
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Affiliation(s)
- Massimo Conio
- Gastroenterology Department, Santa Corona General Hospital, Savonese, Italy; Polyclinique St George, Nice, France
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy Department, General Hospital, Perugia, Italy
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luigi Pasquale
- Gastroenterology and Digestive Endoscopy Department, O. Frangipane Hospital, Avellino, Italy
| | - Mario Marini
- Gastroenterology and Operative Endoscopy Unit, Santa Maria Alle Scotte Hospital, Siena, Italy
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Zhang X, Wang Q, Jia C, Li D, Lv Z, Yang J. Role of atrial natriuretic peptide receptor in inhibition of laterally spreading tumors via Wnt/β-catenin signaling. Arch Med Sci Atheroscler Dis 2022; 7:e104-e108. [PMID: 36158061 PMCID: PMC9487803 DOI: 10.5114/amsad/151928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Colorectal cancer (CRC) is the third most prevalent malignancy worldwide. Laterally spreading tumors (LSTs), as special manifestations of digestive tract tumors, are often misdiagnosed or undiagnosed due to their unique morphological and pathological features. LST has no protruding lesions and progresses rapidly, and prognoses are consequently poor. LST progression to CRC is complicated. Clinical data indicate that the heart is rarely the site of primary tumorigenesis, and a class of atrial natriuretic peptides (ANPs) secreted by heart tissue play an important role in this phenomenon, which is closely related to the Wnt/β-catenin signaling pathway. However, previous studies focused solely on correlations between the Wnt/β-catenin signaling pathway, downstream gene expression and LST. Thus, correlational studies of ANP/ANP receptor, LST and CRC may be of great help in understanding the occurrence, development and treatment of LST, as well as in establishing specific and sensitive methods for detecting LST.
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Affiliation(s)
- Xiaoying Zhang
- The Affiliated Shanghai Tenth People’s Hospital of Nanjing Medical University, Shanghai, China
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiang Wang
- Basic Medical School, Gansu Medical College, Pingliang, China
| | - Chengyou Jia
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Dan Li
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhongwei Lv
- The Affiliated Shanghai Tenth People’s Hospital of Nanjing Medical University, Shanghai, China
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianshe Yang
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Basic Medical School, Gansu Medical College, Pingliang, China
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Oh CK, Cho YW, Choi IH, Lee HH, Lim CH, Kim JS, Lee BI, Cho YS. Comparison of precutting endoscopic mucosal resection and endoscopic submucosal dissection for large (20-30 mm) flat colorectal lesions. J Gastroenterol Hepatol 2022; 37:568-575. [PMID: 34845766 DOI: 10.1111/jgh.15744] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM The complete and safe removal of large (≥ 20 mm) colorectal lesions is an area of concern. Endoscopic submucosal dissection (ESD) effectively removes these lesions compared with endoscopic mucosal resection (EMR). However, ESD requires advanced techniques, longer procedure time, and high cost. Precutting EMR (EMR-P) is a modified EMR method that overcomes the limitations of EMR. This study aimed to compare the efficacy and safety of EMR-P and ESD in large (20-30 mm) flat colorectal lesions. METHODS This was a retrospective analysis of cases in which 20- to 30-mm flat colorectal lesions were resected at Seoul St. Mary's Hospital from January 2014 to December 2019. Propensity score matching was performed to control for possible confounders. RESULTS Two hundred and ninety-nine patients were included in this study. After matching, 90 patients were assigned to each group. There were no significant difference in complete resection rates (92.2% vs 92.2%, P = 1.000), en bloc resection rates (95.6% vs 97.8%, P = 0.682), and mean size of lesions (22.9 ± 3.1 mm vs 23.0 ± 3.1 mm, P = 0.867) between EMR-P and ESD. Procedure time was significantly shorter with EMR-P (11.0 ± 6.5 min vs 37.0 ± 19.3 min, P < 0.001). The adverse events rate was not significantly different between both groups. No local recurrence occurred in both groups. CONCLUSIONS Precutting EMR was not significantly different to ESD in terms of complete resection rate and en bloc resection rate for 20- to 30-mm flat colorectal lesions without fibrosis. Furthermore, EMR-P has shorter procedure time than ESD. EMR-P could be considered one of standard treatments for large flat colorectal lesions.
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Affiliation(s)
- Chang Kyo Oh
- Division of Gastroenterology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young Wook Cho
- Division of Gastroenterology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - In Hyoung Choi
- Division of Gastroenterology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin Su Kim
- Division of Gastroenterology, Department of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Shahini E, Libânio D, Lo Secco G, Pisani A, Arezzo A. Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review. World J Gastrointest Endosc 2021; 13:275-295. [PMID: 34512876 PMCID: PMC8394186 DOI: 10.4253/wjge.v13.i8.275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/14/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
In the last years, endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions. At the same time, the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged. The current unsolved dilemma about the endoscopic excision techniques concerns the necessity of a reliable submucosal invasive cancer assessment system that can stratify the risk of the post-procedural need for surgery. Accordingly, this narrative literature review aims to compare the available diagnostic strategies in predicting malignancy and to give a guide about the best techniques to employ. We performed a literature search using electronic databases (MEDLINE/PubMed, EMBASE, and Cochrane Library). We collected all articles about endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) registering the outcomes. Moreover, we analyzed all meta-analyses comparing EMR vs ESD outcomes for colorectal sessile or non-polypoid lesions of any size, preoperatively estimated as non-invasive. Seven meta-analysis studies, mainly Eastern, were included in the analysis comparing 124 studies and overall 22954 patients who underwent EMR and ESD procedures. Of these, eighty-two were retrospective, twenty-four perspective, nine case-control, and six cohorts, while three were randomized clinical trials. A total of 18118 EMR and 10379 ESD were completed for a whole of 28497 colorectal sessile or non-polypoid lesions > 5-10 mm in size. In conclusion, it is crucial to enhance the preoperative diagnostic workup, especially in deciding the most suitable endoscopic method for radical resection of flat colorectal lesions at risk of underlying malignancy. Additionally, the ESD necessitates further improvement because of the excessively time-consuming as well as the intraprocedural technical hindrances and related complications. We found a higher rate of en bloc resections and R0 for ESD than EMR for non-pedunculated colorectal lesions. Nevertheless, despite the lower local recurrence rates, ESD had greater perforation rates and needed lengthier procedural times. The prevailing risk for additional surgery in ESD rather than EMR for complications or oncologic reasons is still uncertain.
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Affiliation(s)
- Endrit Shahini
- Department of Gastroenterology and Digestive Endoscopy Unit, National Institute of Research “Saverio De Bellis,” Castellana Grotte (Bari) 70013, Italy
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute, Porto 4200-072, Portugal
| | - Giacomo Lo Secco
- Department of Surgical Sciences, University of Torino, Turin 10126, Italy
| | - Antonio Pisani
- Department of Gastroenterology and Digestive Endoscopy Unit, National Institute of Research “Saverio De Bellis,” Castellana Grotte (Bari) 70013, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin 10126, Italy
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Kemper G, Turan AS, Schoon EJ, Schrauwen RWM, Epping LSM, Gerges C, Beyna T, Neuhaus H, Gündug U, Siersema PD, van Geenen EJM. Endoscopic techniques to reduce recurrence rates after colorectal EMR: systematic review and meta-analysis. Surg Endosc 2021; 35:5422-5429. [PMID: 34076765 PMCID: PMC8437853 DOI: 10.1007/s00464-021-08574-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/18/2021] [Indexed: 11/21/2022]
Abstract
Background Colorectal endoscopic mucosal resection (EMR) is an effective, safe, and minimally invasive treatment for large lateral spreading and sessile polyps. The reported high recurrence rate of approximately 20% is however one of the major drawbacks. Several endoscopic interventions have been suggested to reduce recurrence rates. We conducted a systematic review and meta-analysis to assess the efficacy of endoscopic interventions targeting the EMR margin to reduce recurrence rates. Methods We searched in PubMed and Ovid for studies comparing recurrence rates after interventions targeting the EMR margin with standard EMR. The primary outcome was the recurrence rate at the first surveillance colonoscopy (SC1) assessed histologically or macroscopically. For the meta-analysis, risk ratios (RRs) were calculated and pooled using a random effects model. The secondary outcome was post-procedural complication rates. Results Six studies with a total of 1335 lesions were included in the meta-analysis. The techniques performed in the intervention group targeting the resection margin were argon plasma coagulation, snare tip soft coagulation, extended EMR, and precutting EMR. The interventions reduced the adenoma recurrence rate with more than 50%, resulting in a pooled RR of 0.37 (95% CI 0.18, 0.76) comparing the intervention group with the control groups. Overall post-procedural complication rates did not increase significantly in the intervention arm (RR 1.30; 95% CI 0.65, 2.58). Conclusion Interventions targeting the EMR margin decrease recurrence rates and may not result in more complications. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08574-z.
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Affiliation(s)
- Gijs Kemper
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands.
| | - Ayla S Turan
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Ruud W M Schrauwen
- Department of Gastroenterology and Hepatology, Bernhoven, Uden, The Netherlands
| | - Ludger S M Epping
- Department of Gastroenterology and Hepatology, Maasziekenhuis Pantein, Boxmeer, The Netherlands
| | - Christian Gerges
- Department of General Internal Medicine and Gastroenterology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
| | - Torsten Beyna
- Department of General Internal Medicine and Gastroenterology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
| | - Horst Neuhaus
- Department of General Internal Medicine and Gastroenterology, Evangelical Hospital Düsseldorf, Düsseldorf, Germany
| | - Ufuk Gündug
- Department of Internal Medicine and Gastroenterology, Katholisches Karl Leisner Klinikum - St.-Antonius-Hospital Kleve, Kleve, Germany
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands
| | - Erwin J M van Geenen
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Radboud Institute for Health Sciences, 6500 HB, Nijmegen, The Netherlands
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Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study. Surg Endosc 2021; 36:1894-1902. [PMID: 33847798 DOI: 10.1007/s00464-021-08471-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Hybrid endoscopic submucosal dissection (ESD) is a colorectal lesion resection procedure that includes both planned and salvage procedures. Previous colorectal hybrid ESD studies have involved single institutions or few operators over a short timeframe, and the size for indication has not been established. In this multicentre study, we investigated the clinical outcomes of hybrid ESD for colorectal tumors that met the 30 mm lesion size criterion. METHODS From January 2008 to December 2018, colorectal hybrid ESD was performed for 172 lesions (diameter range, ≥ 20- < 30 mm) at Hiroshima GI Endoscopy Research Group. We compared clinicopathological characteristics and outcomes between 56 and 116 lesions in planned and salvage groups, respectively. We also compared data between 2008 and 2013 (the first period) and 2014 and 2018 (the second period) to assess operator experience. RESULTS No significant difference was found in the complete en bloc resection rate between the planned and salvage groups (92.9% vs. 83.6%, respectively). Procedure time was shorter in the planned group (44.5 min) than in the salvage group (72.0 min, p < 0.01). The perforation rate was higher in the salvage group (21.6%) than in the planned group (0%, p < 0.01); however, the perforation rate during snaring in the salvage group was 1.8%. During the second period relative to the first period, we recorded a significantly higher complete en bloc resection rate (95.7% vs. 75.6%, respectively, p < 0.01) and experienced operator rate (75.5% vs. 53.9%, respectively, p < 0.01). Furthermore, no significant difference was found in the complete en bloc resection rate between the planned and salvage groups during the second period (100% vs. 94.4%, respectively). CONCLUSION Colorectal hybrid ESD, especially salvage hybrid ESD performed by experienced operators, is adoptable and safe for lesions with diameters ranging from ≥ 20 to < 30 mm.
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Zhao HJ, Yin J, Ji CY, Wang X, Wang N. Endoscopic mucosal resection versus endoscopic submucosal dissection for colorectal laterally spreading tumors: a meta-analysis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:941-947. [PMID: 33207885 DOI: 10.17235/reed.2020.6681/2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE to assess the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) in the treatment of colorectal laterally spreading tumors (LSTs). METHODS a systematic literature search was performed in PubMed, Embase, the Cochrane Library, CNKI and WANFANG databases. The related references were selected according to certain inclusion and exclusion criteria. The Cochrane Collaboration's Revman 5.3 software was used for data analysis. RESULTS a total of 12 studies were included in the analysis. The total number of lesions was 3,062 (EMR: 1,906; ESD: 1,156). The en-bloc resection rate of ESD was 95 % (1,098/1,156), which was significantly higher than that of EMR (42.8 %, 815/1,906) (OR = 0.07, 95 % CI [0.02, 0.07], p < 0.00001). The complete resection rate of ESD was 93.2 % (109/117), which was significantly higher than that of EMR as well (71.9 %, 92/128) (OR = 0.12, 95 % CI [0.05, 0.29], p < 0.00001). The bleeding rate showed no significant difference between EMR and ESD (4.2 % vs 3.5 %) (OR = 1.04, 95 % CI [0.68, 1.60], p = 0.85). The perforation rates of EMR and ESD were 1.8 % and 2.4 %, respectively, which displayed a significant difference (OR = 0.56, 95 % CI [0.32, 0.97], p = 0.04). Nevertheless, the recurrence rate of EMR was significantly higher than that of ESD (15.9 % vs 0.5 %) (OR = 23.06, 95 % CI [11.11, 47.85], p < 0.00001). CONCLUSIONS endoscopic resection of LSTs is safe and effective. As compared with EMR, ESD has higher en-bloc and complete resection rates but a lower recurrence rate. Therefore, ESD is highly recommended for the treatment of LSTs.
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Affiliation(s)
- Hong-Jing Zhao
- Gastroenterology, The Second Hospital of Hebei Medical University, China
| | - Jie Yin
- Gastroenterology, The Second Hospital of Hebei Medical University,
| | - Cui-Ying Ji
- Gastroenterology, The Second Hospital of Hebei Medical University,
| | - Xin Wang
- Gastroenterology, The Second Hospital of Hebei Medical University,
| | - Na Wang
- Gastroenterology, The Second Hospital of Hebei Medical University,
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Anastasiadis S, Georgakis N, Xanthis A, Gatopoulou A, Anastasiadou K, Kountouras J. A retrospective comparative study of argon plasma versus polypectome snare tip coagulation: effect on recurrence rate after resection of large laterally spreading type lesions. Ann Gastroenterol 2019; 32:178-184. [PMID: 30837791 PMCID: PMC6394265 DOI: 10.20524/aog.2019.0359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background Endoscopic mucosal resection (EMR) is an established technique for treating large laterally spreading type (LST) lesions ≥20 mm. The aim of our study was to compare the use of argon plasma (APC) versus snare-tip coagulation on the recurrence rate of large LST lesions. Methods All patients with large LST lesions resected by EMR between January 2006 and December 2014 were enrolled. After piecemeal resection, patients underwent either APC or snare-tip coagulation of the rim of the resection area and any residual adenomatous tissue. Follow up included colonoscopy and biopsies. Medical records, including characteristics of patients and polyps, complications and recurrence were retrieved and collected. Results One hundred one patients were included in the final analysis. They were divided into the APC group (n=50) and the snare-tip coagulation group (n=51). The 2 groups were similar concerning patients’ characteristics, size of polyps and histology. Post-polypectomy coagulation syndrome was observed in 8 patients (7.9%) (APC group: n=5 and snare tip group: n=3). EMR-related bleeding occurred in 9 patients (8.9%) (APC group: n=4 and snare tip group: n=5). Total recurrence rate was 14.85% (16% and 13.7% in APC and snare-tip groups, respectively, P=0.34). Conclusion The effectiveness of snare-tip coagulation is comparable with that of APC with respect to recurrence rate after resection of large LST lesions. It thus represents a cost-effective alternative to APC.
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Affiliation(s)
| | - Georgia Lazaraki
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Grigoris Chatzimavroudis
- 2 Surgical Department, G. Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Sotiris Anastasiadis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Nikolaos Georgakis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Andreas Xanthis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Anthi Gatopoulou
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Kiriaki Anastasiadou
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Jannis Kountouras
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
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11
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Seo M, Song EM, Kim GU, Hwang SW, Park SH, Yang DH, Kim KJ, Ye BD, Myung SJ, Yang SK, Byeon JS. Local recurrence and subsequent endoscopic treatment after endoscopic piecemeal mucosal resection with or without precutting in the colorectum. Intest Res 2017; 15:502-510. [PMID: 29142518 PMCID: PMC5683981 DOI: 10.5217/ir.2017.15.4.502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Precutting before endoscopic piecemeal mucosal resection (EPMR) may increase colorectal polyp resection effectiveness. We aimed to identify risk factors for recurrence after conventional EPMR (CEPMR) and precut EPMR (PEPMR) and investigated endoscopic treatment outcomes for recurrent cases. Methods The medical records of patients with colorectal polyps treated by EPMR were analyzed. Patients without follow-up surveillance colonoscopies were excluded. Results Among 359 lesions, the local recurrence rate on the first surveillance colonoscopy was 5.8% (18/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively. Among lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence on subsequent surveillance colonoscopy were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. Larger tumor size was the only independent risk factor for recurrence (odds ratio, 7.93; 95% confidence interval, 1.95–32.30; P<0.001). Endoscopic treatment was performed for all 27 recurrences. A combination of ≥2 endoscopic treatment modalities was used in 19 of 27 recurrences (70.4%). Surveillance colonoscopies were performed in 20 of 27 recurrences after endoscopic treatment. One (5.0%) had a re-recurrence and was treated by surgical resection because recurrence occurred at the appendiceal orifice. Nineteen of 20 lesions (95.0%) could be cured endoscopically, although 3 of the 19 showed second or third recurrences and were treated by repeat endoscopic resection. Conclusions The local recurrence rates after CEPMR and PEPMR were similar. Larger tumor size was an independent risk factor for local recurrence after EPMR. Endoscopic treatment of recurrences resulted in high cure rates, although combination methods were necessary in many cases.
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Affiliation(s)
- Myeongsook Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwang Un Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Emmanuel A, Gulati S, Burt M, Hayee B, Haji A. Colorectal endoscopic submucosal dissection: patient selection and special considerations. Clin Exp Gastroenterol 2017; 10:121-131. [PMID: 28761366 PMCID: PMC5516776 DOI: 10.2147/ceg.s120395] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) enables en bloc resection of large complex colorectal superficial neoplastic lesions, resulting in very low rates of local recurrence, high-quality pathologic specimens for accurate histopathologic diagnosis and potentially curative treatment of early adenocarcinoma without resorting to major surgical resection. The safety and efficacy of the technique, which was pioneered in the upper gastrointestinal tract, has been established by the consistently impressive outcomes from expert centers in Japan and some other eastern countries. However, ESD is challenging to perform in the colorectum and there is a significant risk of complications, particularly in the early stages of the learning curve. Early studies from western centers raised concerns about the high complication rates, and the impressive results from Japanese centers were not replicated. As a result, many western endoscopists are skeptical about the role of ESD and few centers have incorporated the technique into their practice. Nevertheless, although the distribution of expertise, referral centers and modes of practice may differ in Japan and western countries, ESD has an important role and can be safely and effectively incorporated into western practice. Key to achieving this is meticulous lesion assessment and selection, appropriate referral to centers with the necessary expertise and experience and application of the appropriate technique individualized to the patient. This review discusses the advantages, risks and benefits of ESD to treat colorectal lesions and the importance of preprocedure lesion assessment and in vivo diagnosis and outlines a pragmatic rationale for appropriate lesion selection as well as the patient, technical and institutional factors that should be considered.
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Affiliation(s)
- Andrew Emmanuel
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Shraddha Gulati
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Margaret Burt
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Bu'Hussain Hayee
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
| | - Amyn Haji
- King's Institute of Therapeutic Endoscopy, King's College Hospital, London, UK
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13
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Okamoto K, Muguruma N, Kagemoto K, Mitsui Y, Fujimoto D, Kitamura S, Kimura T, Sogabe M, Miyamoto H, Takayama T. Efficacy of hybrid endoscopic submucosal dissection (ESD) as a rescue treatment in difficult colorectal ESD cases. Dig Endosc 2017; 29 Suppl 2:45-52. [PMID: 28425649 DOI: 10.1111/den.12863] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 03/07/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD), which provides a higher en bloc resection rate than conventional endoscopic mucosal resection (EMR), is considered to be a useful treatment option for large colorectal tumors. However, colorectal ESD is not widely used because of its technical difficulty, risk of complications and time required. To overcome these drawbacks, a simpler modified technique, ESD with snaring (hybrid ESD), has been developed. The aim of the present study was to retrospectively compare the safety and efficacy of hybrid ESD and conventional ESD for colorectal tumors. METHODS Between September 2008 and June 2016, ESD was carried out on 137 lesions and hybrid ESD on 27 lesions. All hybrid ESD cases were carried out as a rescue treatment in difficult ESD cases. We retrospectively investigated procedure time, and the rates of en bloc resection, perforation, bleeding, and local recurrence. RESULTS In the hybrid ESD group, procedure time was shorter compared with the ESD group (108 ± 59.5 min vs 122 ± 72.2 min), but the en bloc resection rate was lower (66.7% vs 94.2%). However, there were no significant differences in procedure time, or in rates of en bloc resection, perforation and bleeding between the two groups. Local recurrence did not develop in any of our cases. CONCLUSIONS Hybrid ESD as a rescue treatment in difficult ESD cases may be less effective for en bloc resection of large colorectal tumors. Indication for hybrid ESD may be limited to scheduled treatment from the outset and emergency cases with patients who present unstable vital signs during ESD.
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Affiliation(s)
- Koichi Okamoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Naoki Muguruma
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kaizo Kagemoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yasuhiro Mitsui
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisaku Fujimoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tetsuo Kimura
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masahiro Sogabe
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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14
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Yang DH, Kwak MS, Park SH, Ye BD, Byeon JS, Myung SJ, Yang SK, Kim HG, Friedland S. Endoscopic Mucosal Resection with Circumferential Mucosal Incision for Colorectal Neoplasms: Comparison with Endoscopic Submucosal Dissection and between Two Endoscopists with Different Experiences. Clin Endosc 2017; 50:379-387. [PMID: 28264251 PMCID: PMC5565045 DOI: 10.5946/ce.2016.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 12/14/2022] Open
Abstract
Background/Aims Endoscopic mucosal resection with circumferential mucosal incision (CMI-EMR) may offer benefits comparable to those of endoscopic submucosal dissection (ESD), while requiring less technical proficiency than ESD. Methods We retrospectively compared the outcomes of CMI-EMR (n=34) and size-matched ESD (n=102), which were performed by a Korean endoscopist for colorectal epithelial lesions of 20–35 mm. Procedural parameters of CMI-EMRs performed by an American ESD novice (n=30) were compared with those performed by the Korean endoscopist. Results The lesion size was 22.3±3.9 mm and 22.9±2.4 mm in the CMI-EMR and size-matched ESD groups, respectively (p=0.730). The resection time was 12.7±7.0 minutes in the CMI-EMR group and 45.6±30.1 minutes in the ESD group (p<0.001). The en bloc resection rate was 94.1% in the CMI-EMR group and 100% in the ESD group (p=0.061). There were no differences in the en bloc resection and complication rates of CMI-EMRs between a Korean and an American endoscopist. Conclusions For the treatment of moderate-size colorectal lesions, CMI-EMR showed a trend toward lower en bloc resection rate, but required shorter procedure time than ESD. CMI-EMR outcomes were similar when performed by a Korean ESD expert and an American ESD novice.
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Affiliation(s)
- Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Seob Kwak
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Gun Kim
- Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Shai Friedland
- Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, Department of Gastroenterology, VA Palo Alto Health Care System, Palo Alto, CA, USA
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15
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Shi Z, Qiu H, Liu H, Yu H. Should antibiotics be administered after endoscopic mucosalresection in patients with colon polyps? Turk J Med Sci 2016; 46:1486-1490. [PMID: 27966318 DOI: 10.3906/sag-1507-147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/28/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Endoscopic mucosal resection (EMR) is widely used for treating gastrointestinal polypoid lesions. However, it is currently unclear whether antibiotic administration is necessary after EMR of colon polyps to prevent infection. We aimed to assess whether antibiotic administration is essential in such conditions. MATERIALS AND METHODS In total, 115 patients with colon polyps were randomly assigned to 3 groups based on the treatment given after EMR: Group A, no antibiotics treatment after EMR (n = 38); Group B, administration of levofloxacin after EMR (n = 38); and Group C, administration of ceftazidime after EMR (n = 39). RESULTS The colon polyps were completely removed by EMR in all cases without any serious complications. Although infection developed in 2 cases in Group A, it was resolved via levofloxacin injection over 3 days; infection did not develop in any cases in Group B and C. The postoperative infection rate was not significantly different among Groups A, B, and C. After 6 months, we noted that the wound surface had properly healed and there was no relapse of colon polyps in any patients. CONCLUSION The use of antibiotics after EMR of colon polyps to prevent infection did not affect the prognosis of patients.
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Affiliation(s)
- Zhimeng Shi
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
| | - Hui Qiu
- Department of Oncology, Xintai Municipal People's Hospital, Taian, Shandong Province, P.R. China
| | - Huangang Liu
- Department of Gastroenterology, Xintai Municipal People's Hospital, Taian, Shandong Province, P.R. China
| | - Honggang Yu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
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16
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Xu JF, Yang L, Jin P, Sheng JQ. Endoscopic Approach for Superficial Colorectal Neoplasms. Gastrointest Tumors 2016; 3:69-80. [PMID: 27904859 DOI: 10.1159/000447128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/26/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females, with an estimated 1.4 million cases and 693,900 deaths in 2012. Colonoscopy is the cornerstone for the detection and prevention of CRC. In addition, endoscopic treatment for CRC at an early stage can effectively improve patients' quality of life and cure rate. SUMMARY This review focuses on endoscopic approaches, including white light endoscopy, chromoendoscopy, magnifying endoscopy and therapeutic endoscopy, for the evaluation and treatment of superficial colorectal neoplasms. KEY MESSAGE Understanding the preoperative evaluation, indications and techniques of endoscopic mucosal resection/endoscopic submucosal dissection as well as postoperative surveillance for superficial colorectal neoplasms is critical for providing appropriate management to the patients. PRACTICAL IMPLICATIONS Endoscopic therapy, a method preserving organ function and improving quality of life, is a widely applied microinvasive treatment for superficial colorectal neoplasms. This review describes the basics and developments of endoscopic approaches and may facilitate daily practice for superficial colorectal neoplasms.
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Affiliation(s)
- Jun-Feng Xu
- People's Liberation Army General Hospital, Beijing, China
| | - Lang Yang
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Peng Jin
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
| | - Jian-Qiu Sheng
- Department of Gastroenterology, PLA Army General Hospital, Beijing, China
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17
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De Ceglie A, Hassan C, Mangiavillano B, Matsuda T, Saito Y, Ridola L, Bhandari P, Boeri F, Conio M. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review. Crit Rev Oncol Hematol 2016; 104:138-55. [PMID: 27370173 DOI: 10.1016/j.critrevonc.2016.06.008] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/23/2016] [Accepted: 06/14/2016] [Indexed: 12/12/2022] Open
Abstract
AIM To assess the efficacy and safety of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) for the treatment of colorectal lesions. METHODS A literature search was conducted from January 2000 to May 2015. The main outcomes were: recurrence after "en bloc" and "piecemeal" resection; procedure related adverse events; the EMR endoscopic success rate and the completely eradicated resection rate (R0) after ESD. RESULTS A total of 66 studies were included in the analysis. The total number of lesions was 17950 (EMR: 11.873; ESD: 6077). Recurrence rate was higher in the EMR than ESD group (765/7303l vs. 50/3910 OR 8.19, 95% CI 6.2-10.9 p<0.0001). EMR-en bloc resection was achieved in 6793/10803 lesions (62.8%) while ESD-en bloc resection was obtained in 5500/6077 lesions (90.5%) (OR 0.18, p<0.0001, 95% CI 0.16-0.2). Perforation occurred more frequently in ESD than in EMR group (p<0.0001, OR 0.19, 95% CI 0.15-0.24). CONCLUSIONS Endoscopic resection of large colorectal lesions is safe and effective. Compared with EMR, ESD results in higher "en bloc" resection rate and lower local recurrence rate, however ESD has high procedure-related complication rates.
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Affiliation(s)
| | - Cesare Hassan
- Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | - Takahisa Matsuda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Lorenzo Ridola
- Gastroenterology Unit, "Sapienza" University, Rome, Italy
| | - Pradeep Bhandari
- Gastroenterology Department, Portsmouth Hospital NHS Trust, Portsmouth, Hampshire, UK
| | - Federica Boeri
- Gastroenterology Department, General Hospital, Sanremo, Italy
| | - Massimo Conio
- Gastroenterology Department, General Hospital, Sanremo, Italy.
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18
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How to deal with large colorectal polyps: snare, endoscopic mucosal resection, and endoscopic submucosal dissection; resect or refer? Curr Opin Gastroenterol 2016; 32:26-31. [PMID: 26627920 DOI: 10.1097/mog.0000000000000228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The importance of accurate polyp detection and removal is paramount to preventing colon cancer. Resection of large polyps can be challenging to the endoscopist based on their size, shape, or location. Large polyps have the potential of harboring malignancy and a higher risk of complications with resection. Careful assessment of each lesion and meticulous resection using the appropriate tools and techniques is essential. RECENT FINDINGS Over the last 15 years, the development of endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) techniques has presented the endoscopist with the opportunity to manage patients with large and flat lesions thereby avoiding the need for surgery. However, these techniques are complex and require extensive knowledge and skill in the use of various devices to resect a lesion completely and manage bleeding and perforation associated with these procedures. SUMMARY Large colon polyps manifest as either polypoid or nonpolypoid (flat) lesions. Polypoid lesions, especially those with pedicles, are removed with snare resection, whereas flat lesions may require the use of EMR or ESD. Resection of large polyps (>1 cm) requires additional tools and techniques to ensure safe and complete resection. We will discuss our approach to dealing with large colorectal polyps: snare, EMR, and ESD; resect or refer?
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19
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Chang DK. Many options to manage laterally spreading tumors. Clin Endosc 2015; 48:4-5. [PMID: 25674518 PMCID: PMC4323431 DOI: 10.5946/ce.2015.48.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/24/2014] [Indexed: 11/14/2022] Open
Affiliation(s)
- Dong Kyung Chang
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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