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Chen Y, Wu Z. The efficacy and safety of precutting-endoscopic mucosal resection for colorectal tumors: a systematic review and meta-analysis. MINIM INVASIV THER 2024:1-10. [PMID: 39668459 DOI: 10.1080/13645706.2024.2440403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 11/10/2024] [Indexed: 12/14/2024]
Abstract
BACKGROUND Several modified endoscopic mucosal resection (EMR) techniques have been reported for colorectal tumors. Precutting-EMR (PEMR) is a modification wherein a circumferential mucosal incision is made around a lesion to facilitate en bloc resection. This review compared the efficacy and safety of PEMR with conventional EMR for colorectal lesions. METHODS PubMed, Embase, Scopus, and Web of Science were searched for comparative studies available before February 15, 2024. This systematic review and meta-analysis were recorded in PROSPERO, identified as CRD42024509143. RESULTS Two hundred and eight studies underwent screening of which seven studies were found eligible. We found no significant difference in en bloc resection rates but complete resection rates were significantly better with PEMR. The duration of the procedure was significantly longer with PEMR as compared to EMR. There was no difference in the risk of delayed bleeding and recurrence between the two groups but the risk of perforation was significantly increased with PEMR. CONCLUSIONS The use of PEMR for colorectal lesions can improve complete resection rates, albeit at the cost of increased duration of the procedure and higher perforation rates compared to conventional EMR. PEMR may also have a tendency of better en bloc resection rates which needs to be confirmed by further studies.
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Affiliation(s)
- Yi Chen
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhengjie Wu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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2
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Jung Y. Approaches and considerations in the endoscopic treatment of T1 colorectal cancer. Korean J Intern Med 2024; 39:563-576. [PMID: 38742279 PMCID: PMC11236804 DOI: 10.3904/kjim.2023.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/12/2023] [Accepted: 12/27/2023] [Indexed: 05/16/2024] Open
Abstract
The detection of early colorectal cancer (CRC) is increasing through the implementation of screening programs. This increased detection enhances the likelihood of minimally invasive surgery and significantly lowers the risk of recurrence, thereby improving patient survival and reducing mortality rates. T1 CRC, the earliest stage, is treated endoscopically in cases with a low risk of lymph node metastasis (LNM). The advantages of endoscopic treatment compared with surgery include minimal invasiveness and limited tissue disruption, which reduce morbidity and mortality, preserve bowel function to avoid colectomy, accelerate recovery, and improve cost-effectiveness. However, T1 CRC has a risk of LNM. Thus, selection of the appropriate treatment between endoscopic treatment and surgery, while avoiding overtreatment, is challenging considering the potential for complete resection, LNM, and recurrence risk.
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Affiliation(s)
- Yunho Jung
- Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
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3
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Jung Y. Endoscopic treatment of colorectal polyps and early colorectal cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2023; 66:642-651. [DOI: 10.5124/jkma.2023.66.11.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 01/06/2025] Open
Abstract
Background: Colonoscopy offers higher diagnostic sensitivity than other colorectal cancer screening methods and provides the advantage of both diagnostic tissue sampling and polyp removal. Since the majority of colorectal cancers evolve from adenomatous polyps, polyp resection through colonoscopy is widely considered an effective method of preventing colorectal cancer and reducing mortality rates.Current Concepts: Determining colorectal polyp size and shape requires comprehensive endoscopy with enhanced imaging techniques to choose treatment directions and the appropriate colorectal polypectomy method. The selection of the polypectomy method is contingent upon the polyp’s attributes and possible malignancy according to US Multi-Society Task Force on Colorectal Cancer and European gastrointestinal endoscopy guidelines. This article examines eight polypectomy procedures: cold forceps polypectomy, hot biopsy polypectomy, cold snare polypectomy, hot snare polypectomy, endoscopic mucosal resection (EMR), and modified EMR techniques. Each method has unique benefits and is suitable for particular polyp types and sizes. Piecemeal EMR and endoscopic submucosal dissection offer alternatives for larger or challenging lesions that require careful planning and follow-up. After endoscopic resection of early colorectal cancer, further surgery may be necessary depending on the risk of lymph node metastasis as determined by specific histologic findings following Korean and Japanese guidelines.Discussion and Conclusion: The choice of endoscopic resection technique, which depends on factors such as polyp shape, size, and location as well as endoscopist skill, is crucial for ensuring complete polyp removal.
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4
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Yang QY, Zhao Q, Hu JW. Is endoscopic mucosal resection-precutting superior to conventional methods for removing sessile colorectal polyps? World J Gastrointest Surg 2023; 15:1838-1840. [PMID: 37701687 PMCID: PMC10494592 DOI: 10.4240/wjgs.v15.i8.1838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/24/2023] [Accepted: 07/03/2023] [Indexed: 08/25/2023] Open
Abstract
We reviewed a study that reported a comparative analysis of the effects of endoscopic mucosal resection (EMR) precutting and conventional EMR for removing non-pedunculated, 10-20 mm sized colorectal polyps. We identified some statistical deficiencies in this study. In addition, we believe that the differences between the treatments failed to achieve significance, and therefore, further analysis is required.
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Affiliation(s)
- Qun-Ying Yang
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Qian Zhao
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
| | - Jian-Wen Hu
- Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China
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5
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Peng QH, Zhou XR, Luo SC, Du ZQ, Liu WH. Preliminary Lesion Moulding Facilitates Effective and Safe Endoscopic Mucosal Resection of a Large Non-pedunculated Colorectal Adenoma. Surg Innov 2023; 30:406-407. [PMID: 36495074 DOI: 10.1177/15533506221145300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Qing-Hai Peng
- Department of Gastroenterology, Jianyang People's Hospital, China
| | - Xiang-Rong Zhou
- Department of Gastroenterology, Jianyang People's Hospital, China
| | - Shan-Cheng Luo
- Department of Gastroenterology, Jianyang People's Hospital, China
| | - Zhi-Qiang Du
- Department of Gastroenterology, Jianyang People's Hospital, China
| | - Wei-Hui Liu
- Department of Gastroenterology, Jianyang People's Hospital, China
- Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, China
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6
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Radadiya D. Deep Cuts: Colonic Polyp Resection Using Standard Endoscopic Mucosal Resection vs. Precutting Endoscopic Mucosal Resection Using a Novel Disk Tip Snare. Dig Dis Sci 2023; 68:1663-1664. [PMID: 36879180 DOI: 10.1007/s10620-023-07851-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 03/08/2023]
Affiliation(s)
- Dhruvil Radadiya
- Division of Gastroenterology, Hepatology & Motility, Department of Internal Medicine, University of Kansas - School of Medicine, Kansas City, KS, USA.
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7
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Yoshida N, Inoue K, Hashimoto H, Kobayashi R, Tomita Y, Sugino S, Hirose R, Dohi O, Morinaga Y, Inada Y, Murakami T, Itoh Y. Standard Endoscopic Mucosal Resection vs Precutting Endoscopic Mucosal Resection Using Novel Disk-Tip Snare for Colorectal Lesions. Dig Dis Sci 2023; 68:2030-2039. [PMID: 36881195 DOI: 10.1007/s10620-023-07833-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/05/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION SOUTEN (KANEKA Co., Tokyo, Japan) is a unique snare with a disk tip. We analyzed the efficacy of precutting endoscopic mucosal resection with SOUTEN (PEMR-S) for colorectal lesions. METHODS We retrospectively reviewed 57 lesions of 10-30 mm treated with PEMR-S at our institution from 2017 to 2022. The indications were lesions that were difficult for standard EMR due to size, morphology, and poor elevation by injection. Various therapeutic results of PEMR-S such as en bloc resection, procedure time, and perioperative hemorrhage were analyzed, and the results of 20 lesions of 20-30 mm with PEMR-S were compared to those of lesions with standard EMR (2012-2014) using propensity score matching. Additionally, the stability of the SOUTEN disk tip was analyzed in a laboratory experiment. RESULTS The polyp size was 16.5 ± 4.2 mm and the non-polypoid morphology rate was 80.7%. Histopathological diagnosis included 10 sessile-serrated lesions, 43 low-grade and high-grade dysplasias, and 4 T1 cancers. After matching, the en bloc resection and histopathological complete resection rates of lesions of 20-30 mm between PEMR-S and standard EMR (90.0% vs. 58.1%, p = 0.03 and 70.0% vs. 45.0%, p = 0.11). The procedure time (min) was 14.8 ± 9.7 and 9.7 ± 8.3 (p < 0.01). The en bloc resection (%) and procedure time of expert/non-expert were 89.7/85.7 (p = 0.96) and 6.1 ± 2.2/18.5 ± 7.2 (p < 0.01). The perioperative bleeding and hemostasis success rates with SOUTEN were 43.9% and 96.0%. In the experiment, the SOUTEN disk tip was fixed stably compared to other EMR snares. CONCLUSIONS PEMR-S achieved high en bloc resection of colorectal lesions of 20-30 mm though it leaded to long procedure time.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoshi Sugino
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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8
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Oh CK, Cho YS, Lee SH, Lee BI. Anchoring endoscopic mucosal resection versus conventional endoscopic mucosal resection for large nonpedunculated colorectal polyps: a randomized controlled trial. Endoscopy 2023; 55:158-164. [PMID: 35750321 DOI: 10.1055/a-1884-7849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND : Colorectal polyps > 10 mm in size are often incompletely resected. Anchoring-endoscopic mucosal resection (A-EMR) is the technique of making a small incision at the oral side of the polyp using a snare tip after submucosal injection to avoid slippage during ensnaring. This study was performed to evaluate whether A-EMR could increase the complete resection rate for large colorectal polyps compared with conventional endoscopic mucosal resection (C-EMR). METHODS : Polyps with sizes of 10-25 mm were randomly allocated to either the A-EMR or the C-EMR groups. RESULTS : 105 and 106 polyps were resected using A-EMR and C-EMR, respectively. In the intention-to-treat population, the complete resection rate was 89.5 % in the A-EMR group and 74.5 % in the C-EMR group (relative risk [RR] 1.20, 95 %CI 1.04 to 1.38; P = 0.01). The en bloc resection rates for the A-EMR and C-EMR groups were 92.4 % vs. 76.4 % (RR 1.21, 95 %CI 1.06 to 1.37; P = 0.005) and R0 resection rates were 77.1 % vs. 64.2 % (RR 1.18, 95 %CI 0.98 to 1.42; P = 0.07), respectively. The median (interquartile range [IQR]) total procedure time was 3.2 (2.6-4.1) minutes in the A-EMR group and 3.0 (2.2-4.6) minutes in the C-EMR group (median difference 0.2 minutes, 95 %CI -0.22 to 0.73; P = 0.25). There was one episode of delayed bleeding and one perforation in the C-EMR group. CONCLUSIONS : A-EMR was superior to C-EMR for the complete resection of large colorectal polyps. A-EMR can be considered one of the standard methods for the removal of colorectal polyps of 10 mm or more in size.
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Affiliation(s)
- Chang Kyo Oh
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
- Division of Gastroenterology, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University of Korea, Seoul, South Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Sung Hak Lee
- Departments of Hospital Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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9
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Zhang XQ, Sang JZ, Xu L, Mao XL, Li B, Zhu WL, Yang XY, Yu CH. Endoscopic mucosal resection-precutting vs conventional endoscopic mucosal resection for sessile colorectal polyps sized 10-20 mm. World J Gastroenterol 2022; 28:6397-6409. [PMID: 36533110 PMCID: PMC9753056 DOI: 10.3748/wjg.v28.i45.6397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/14/2022] [Accepted: 10/19/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The optimal method to remove sessile colorectal lesions sized 10-20 mm remains uncertain. Piecemeal and incomplete resection are major limitations in current practice, such as endoscopic mucosal resection (EMR) and cold or hot snare polypectomy. Recently, EMR with circumferential precutting (EMR-P) has emerged as an effective technique, but the quality of current evidence in comparative studies of conventional EMR (CEMR) and EMR-P is limited. AIM To investigate whether EMR-P is superior to CEMR in removing sessile colorectal polyps. METHODS This multicenter randomized controlled trial involved seven medical institutions in China. Patients with colorectal polyps sized 10-20 mm were enrolled and randomly assigned to undergo EMR-P or CEMR. EMR-P was performed following submucosal injection, and a circumferential mucosa incision (precutting) was conducted using a snare tip. Primary outcomes included a comparison of the rates of en bloc and R0 resection, defined as one-piece resection and one-piece resection with histologically assessed clear margins, respectively. RESULTS A total of 110 patients in the EMR-P group and 110 patients in the CEMR group were finally evaluated. In the per-protocol analysis, the proportion of en bloc resections was 94.3% [95% confidence interval (CI): 88.2%-97.4%] in the EMR-P group and 86% (95%CI: 78.2%-91.3%) in the CEMR group (P = 0.041), while subgroup analysis showed that for lesions > 15 mm, EMR-P also resulted in a higher en bloc resection rate (92.0% vs 58.8% P = 0.029). The proportion of R0 resections was 81.1% (95%CI: 72.6%-87.4%) in the EMR-P group and 76.6% (95%CI: 68.8%-84.4%) in the CEMR group (P = 0.521). The EMR-P group showed a longer median procedure time (6.4 vs 3.0 min; P < 0.001). No significant difference was found in the proportion of patients with adverse events (EMR-P: 9.1%; CEMR: 6.4%; P = 0.449). CONCLUSION In this study, EMR-P served as an alternative to CEMR for removing nonpedunculated colorectal polyps sized 10-20 mm, particularly polyps > 15 mm in diameter, with higher R0 and en bloc resection rates and without increasing adverse events. However, EMR-P required a relatively longer procedure time than CEMR. Considering its potential benefits for en bloc and R0 resection, EMR-P may be a promising technique in colorectal polyp resection.
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Affiliation(s)
- Xue-Qun Zhang
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Zhong Sang
- Department of Gastroenterology, Renmin Hospital of Yuyao City, Yuyao 315499, Zhejiang Province, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo First Hospital, Ningbo 315010, Zhejiang Province, China
| | - Xin-Li Mao
- Department of Gastroenterology, Taizhou Hospital, Taizhou 317099, Zhejiang Province, China
| | - Bo Li
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wan-Lin Zhu
- Department of Gastroenterology, The Central Hospital of Lishui City, Lishui 323020, Zhejiang Province, China
| | - Xiao-Yun Yang
- Department of Gastroenterology, Jinhua Municipal Central Hospital, Jinhua 321099, Zhejiang Province, China
| | - Chao-Hui Yu
- Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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10
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Takada K, Hotta K, Imai K, Ito S, Kishida Y, Minamide T, Yamamoto Y, Yabuuchi Y, Yoshida M, Maeda Y, Kawata N, Takizawa K, Ishiwatari H, Matsubayashi H, Kawabata T, Ono H. Tip-in EMR as an alternative to endoscopic submucosal dissection for 20- to 30-mm nonpedunculated colorectal neoplasms. Gastrointest Endosc 2022; 96:849-856.e3. [PMID: 35798055 DOI: 10.1016/j.gie.2022.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/01/2022] [Accepted: 06/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Tip-in EMR, which includes anchoring the snare tip, has recently shown a favorable en-bloc and R0 resection rate for colorectal neoplasms. Thus, Tip-in EMR may be an alternative to endoscopic submucosal dissection (ESD). We aimed to compare clinical outcomes between Tip-in EMR and ESD for large colorectal neoplasms. METHODS This retrospective study evaluated consecutive patients who underwent Tip-in EMR or ESD for 20- to 30-mm nonpedunculated colorectal neoplasms at a Japanese tertiary cancer center between January 2014 and December 2019. Baseline characteristics, treatment results, and long-term outcomes were analyzed using 1:1 propensity score matching. RESULTS Seven hundred nine lesions were evaluated. The Tip-in EMR group included 1 lesion with a nonlifting sign but no lesions with fold convergence. After propensity score matching, each group included 140 lesions. The ESD group showed significantly higher en-bloc resection rates (99.3% vs 85.0%) and R0 resection rates (90.7% vs 62.9%). Procedure time was significantly shorter in the Tip-in EMR group (8 minutes vs 60 minutes). The Tip-in EMR and ESD groups did not differ significantly with respect to local recurrence rate (2.1% vs 0%). CONCLUSIONS Tip-in EMR is comparable with ESD with respect to the local recurrence rate but has a shorter procedure time, despite the lower en-bloc and R0 resection rates for 20- to 30-mm nonpedunculated colorectal neoplasms without fold convergence or nonlifting sign. Thus, Tip-in EMR could be a feasible alternative to ESD in these lesions.
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Affiliation(s)
- Kazunori Takada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Yoichi Yamamoto
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yohei Yabuuchi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan; Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masao Yoshida
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yuki Maeda
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan; Gastroenterology and Endoscopy, Sapporo Kinentou Hospital, Hokkaido, Japan
| | | | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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11
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Metter K, Aepli P, Dumoulin FL, Hayee B, Grund KE, Farin G, Frei R. Endoscopic submucosal resection: a technique using novel devices for incision and resection of neoplastic lesions. Endoscopy 2022; 54:1001-1006. [PMID: 34918311 DOI: 10.1055/a-1723-3194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established techniques for treatment of superficial gastrointestinal neoplasia. Limitations of EMR are low en bloc resection rates for larger lesions, resulting in frequent recurrences. Major disadvantages of ESD are technical difficulty and long procedure times. We evaluated technical feasibility and safety of newly designed devices for en bloc resection of lesions measuring 20-40 mm in a technique called endoscopic submucosal resection (ESR). METHODS This case series included 93 lesions from different locations (11 stomach, 25 colon, 57 rectum) with a median size of 29 mm (range 10-70). ESR was performed using two novel instruments for circumferential mucosal incision and deep submucosal resection, respectively. RESULTS Resection by ESR was feasible in all cases. En bloc and R0 rates were insufficient when ESR was attempted without prior circumferential mucosal incision, but were 70 % and 63 %, respectively, when mucosal incision was done before application of the submucosal resection device. We observed three complications (two delayed bleedings, one microperforation) but no cases of emergency surgery or 30-day mortality. CONCLUSIONS Results demonstrated feasibility and excellent safety of ESR using two novel devices for en bloc resection of early gastrointestinal neoplasia. The technique offered relative technical ease and high efficacy.
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Affiliation(s)
- Klaus Metter
- Klinik für Gastroenterologie, Hepatologie und Diabetologie, Alb Fils Kliniken, Klinik am Eichert, Göppingen, Germany
| | - Patrick Aepli
- Gastroenterologie/Hepatologie, Luzerner Kantonsspital, Luzern, Switzerland
| | | | - Bu'Hussain Hayee
- Gastroenterology, King's College Hospital, London, United Kingdom
| | - Karl-Ernst Grund
- Experimentelle Chirurgische Endoskopie (CETEX), Universitätsklinikum Tübingen, Klinik für AVT-Chirurgie, Tübingen, Germany
| | | | - Remus Frei
- Klinik für Gastroenterologie/Hepatologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
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12
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Yoshida N, Hashimoto H, Inoue K, Kobayashi R, Tomita Y, Sugino S, Hirose R, Dohi O, Morinaga Y, Inada Y, Murakami T, Itoh Y. Repeat Cold Snare Polypectomy Can Be Performed for Recurrent Benign Lesions After Cold Snare Polypectomy. Dig Dis Sci 2022; 67:3192-3199. [PMID: 34731360 DOI: 10.1007/s10620-021-07292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Recurrence after cold snare polypectomy (CSP) sometimes occurs. We assessed the feasibility of repeat CSP for recurrence after CSP. METHODS We retrospectively reviewed recurrent lesions after CSP which were resected by repeat CSP from 2016 to 2021 in our institution and analyzed clinical outcomes of repeat CSP, comparing those of non-recurrent 454 lesions receiving standard CSP in 2016 and follow-up colonoscopy. We also analyzed the recurrent rate among cases receiving follow-up in both groups. Indication of repeat CSP was lesions diagnosed as benign tumors of ≤ 10 mm. RESULTS We analyzed 80 lesions receiving repeat CSP. The polyp size (mean ± standard deviation: SD) was 4.1 ± 2.3 mm (range 2-10 mm). The right-sided colon and non-polypoid morphology rates were 66.3% and 43.8%, respectively. Histopathological diagnosis was 66 adenomas, 12 sessile serrated lesions (SSLs), 1 SSL with dysplasia, and 1 high-grade dysplasia. The procedure time (min, mean ± SD) of repeat CSP was 0.9 ± 0.8. Regarding the comparison of repeat CSP/ standard CSP group, the en bloc resection and histopathological complete resection rates were 78.8%/ 98.0% (p < 0.001) and 43.8%/59.6% (p = 0.007) and the rates of perioperative hemorrhage requiring endoscopic clipping were 1.3%/ 1.0% (p = 0.646). There were no postoperative hemorrhage and perforation in both groups (p = 1.0). Among lesions receiving follow-up colonoscopy, the mean recurrence rates (number, median follow-up period: interquartile) of repeat CSP and standard CSP group were 2.0% (1/50, 12 months: 12-24) versus 0.7% (3/454, 12 months: 12-24) (p = 0.862). CONCLUSIONS Repeat CSP for benign recurrent lesions after CSP was safe and feasible.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoshi Sugino
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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Ge PS, Aihara H. Advanced Endoscopic Resection Techniques: Endoscopic Submucosal Dissection and Endoscopic Full-Thickness Resection. Dig Dis Sci 2022; 67:1521-1538. [PMID: 35246802 DOI: 10.1007/s10620-022-07392-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 02/08/2023]
Abstract
Endoscopic resection is first-line therapy in the management of superficial neoplasms throughout the gastrointestinal tract, as well as an increasingly viable therapeutic alternative in the resection of selected small deep lesions throughout the upper and lower gastrointestinal tract. The mainstay of therapy has traditionally been endoscopic snare polypectomy and endoscopic mucosal resection. However, recent innovative advancements in therapeutic endoscopy have provided for the ability to resect large superficial lesions and selected subepithelial lesions in en bloc and margin-negative fashion. In this review, we discuss the current state of the art in advanced endoscopic resection techniques including endoscopic submucosal dissection and endoscopic full-thickness resection.
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Affiliation(s)
- Phillip S Ge
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1466, Houston, TX, 77030-4009, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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14
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Castillo-Regalado E, Uchima H. Endoscopic management of difficult laterally spreading tumors in colorectum. World J Gastrointest Endosc 2022; 14:113-128. [PMID: 35432746 PMCID: PMC8984535 DOI: 10.4253/wjge.v14.i3.113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/01/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult, including large (> 20 mm) laterally spreading tumors (LSTs), has increased in the last decade. All LSTs should be assessed carefully, looking for suspicious areas of submucosal invasion (SMI), such as nodules or depressed areas, describing the morphology according to the Paris classification, the pit pattern, and vascular pattern. The simplest, most appropriate and safest endoscopic treatment with curative intent should be selected. For LST-granular homogeneous type, piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI. LST-nongranular pseudodepressed type has an increased risk of SMI, and en bloc resection should be mandatory. Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field, e.g., for the resection of scar lesions, with no lifting, adjacent tattoo, incomplete resection attempts, lesions into a colonic diverticulum, in ileocecal valve and lesions with intra-appendicular involvement. Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm. Among the indications, we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions. Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion. It should therefore be indicated in the treatment of lesions with risk of SMI.
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Affiliation(s)
- Edgar Castillo-Regalado
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona 08916, Spain
- Endoscopic Unit, Creu Groga Medical Center, Calella 08370, Spain
| | - Hugo Uchima
- Endoscopy Unit, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Barcelona 08916, Spain
- Endoscopic Unit, Teknon Medical Center, Barcelona 08022, Spain
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15
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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: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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16
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Oh CK, Lee BI, Lee SH, Kim SJ, Lee HH, Lim CH, Kim JS, Cho YK, Park JM, Cho YS, Lee IS, Choi MG. Circumferential submucosal incision prior to endoscopic mucosal resection versus conventional endoscopic mucosal resection for colorectal lesions with endoscopic features of sessile serrated lesions. Surg Endosc 2022; 36:2087-2095. [PMID: 33913030 DOI: 10.1007/s00464-021-08495-x] [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: 11/11/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Sessile serrated lesions (SSLs) are more prone to incomplete resection than conventional adenomas. This study evaluated whether circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) can increase the rate of complete and en bloc resections of colorectal lesions with endoscopic features of SSL. METHODS Retrospective analyses and propensity score matching were performed for the resection of colorectal lesions ≥ 10 mm with endoscopic features of SSL. RESULTS After 1:1 ratio matching, 127 lesions in the CSI-EMR group and 127 in the EMR group were selected for analysis. The median size of the lesions was 15 mm (IQR 12-16) in both groups. There was no significant difference in either the complete resection rate or en bloc resection rate between CSI-EMR and EMR groups (96.9% vs. 92.9%, P = 0.155; 92.1% vs. 89.0%, P = 0.391). By contrast, the R0 resection rate was significantly higher in the CSI-EMR group than in the EMR group (89.8% vs. 59.8%, P < 0.001). The median procedure time was significantly longer in the CSI-EMR group than in the EMR group (6.28 min vs. 2.55 min, P < 0.001), whereas there was no significant difference between the two groups in the incidence of adverse events or recurrence rate. Multivariate analysis showed that CSI-EMR was the only factor significantly associated with R0 resection (P < 0.001). CONCLUSIONS For colorectal lesions with endoscopic features of SSL, CSI-EMR does not increase the complete or en bloc resection rate, but does increase the R0 resection rate. The procedure time is longer for CSI-EMR than EMR. The association of CSI-EMR with R0 resection and non-recurrence should be further evaluated.
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Affiliation(s)
- Chang Kyo Oh
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea.
| | - Sung Hak Lee
- Departments of Hospital Pathology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Korea.
| | - Seung-Jun Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, 10, 63-ro, Yeongdeungpo-gu, Seoul, Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021,Tongil Ro, Eunpyeong-gu, Seoul, Korea
| | - Jin Su Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, 1021,Tongil Ro, Eunpyeong-gu, Seoul, Korea
| | - Yu Kyung Cho
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Jae Myung Park
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - In Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
| | - Myung-Gyu Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, Korea
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17
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Yoshida N, Fukumoto K, Hasegawa D, Inagaki Y, Inoue K, Hirose R, Dohi O, Ogiso K, Murakami T, Tomie A, Okuda K, Inada Y, Okuda T, Rani RA, Morinaga Y, Kishimoto M, Itoh Y. Recurrence rate and lesions characteristics after cold snare polypectomy of high-grade dysplasia and T1 lesions: A multicenter analysis. J Gastroenterol Hepatol 2021; 36:3337-3344. [PMID: 34260116 DOI: 10.1111/jgh.15625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/28/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM High-grade dysplasia (HGD) and T1 lesions are accidentally resected by cold snare polypectomy (CSP) and the characteristics, and follow-up of them has not been reported. In this study, we analyzed the histopathological findings and recurrence of them. METHODS This was a multicenter retrospective-cohort study. We collected HGD and T1 lesions of ≤ 10 mm resected by CSP among 15 520 patients receiving CSP from 2014 to 2019 at nine related institutions, and we extracted only cases receiving definite follow-up colonoscopy after CSP of HGD and T1 lesions. We analyzed these tumor's characteristics and therapeutic results such as R0 resection and local recurrence and risk factors of recurrence. RESULTS We collected 103 patients (0.63%) and extracted 80 lesions in 74 patients receiving follow-up colonoscopy for CSP scar. Mean age was 68.4 ± 12.0, and male rate was 68.9% (51/80). The mean tumor size (mm) was 6.6 ± 2.5, and the rate of polypoid morphology and rectum location was 77.5% and 25.0%. The rate of magnified observation was 53.8%. The rates of en bloc resection and R0 resection were 92.5% and 37.5%. The local recurrence rate was 6.3% (5/80, median follow-up period: 24.0 months). The recurrence developed within 3 months after CSP for four out of five recurrent cases. Comparing five recurrent lesions to 75 non-recurrent lesions, a positive horizontal margin was a significant risk factor (60.0% vs 10.7%, P < 0.001). CONCLUSIONS High-grade dysplasia and T1 resected by CSP were analyzed, and the local recurrence rate of them was substantially high.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
- Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan
| | - Kohei Fukumoto
- Department of Gastroenterology, Nara City Hospital, Nara, Japan
| | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
| | | | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Japan Community Health Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Akira Tomie
- Department of Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Takashi Okuda
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Rafiz Abdul Rani
- Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuo Kishimoto
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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18
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Tziatzios G, Gkolfakis P, Papadopoulos V, Papanikolaou IS, Fuccio L, Facciorusso A, Ebigbo A, Gölder SK, Probst A, Messmann H, Triantafyllou K. Modified endoscopic mucosal resection techniques for treating precancerous colorectal lesions. Ann Gastroenterol 2021; 34:757-769. [PMID: 34815641 PMCID: PMC8596214 DOI: 10.20524/aog.2021.0647] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/24/2021] [Indexed: 11/13/2022] Open
Abstract
Endoscopic mucosal resection (EMR) is a technique allowing efficacious and minimally invasive resection of precancerous lesions across the entire gastrointestinal tract. However, conventional EMR, involving injection of fluid into the submucosal space, is imperfect, given the high rate of recurrence of post-endoscopic resection adenoma, especially after piecemeal resection. In light of these observations, modifications of the technique have been proposed to overcome the weakness of conventional EMR. Some of them were designed to maximize the chance of en bloc resection-cap-assisted EMR, underwater EMR, tip-in EMR, precutting, assisted by ligation device-while others were designed to minimize the complications (cold EMR). In this review, we present their modes of action and summarize the evidence regarding their efficacy and safety.
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Affiliation(s)
- Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens, Greece (Georgios Tziatzios, Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (Paraskevas Gkolfakis)
| | - Vasilios Papadopoulos
- Department of Gastroenterology, Koutlimbaneio & Triantafylleio General Hospital, Larissa, Greece (Vasilios Papadopoulos)
| | - Ioannis S. Papanikolaou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens, Greece (Georgios Tziatzios, Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
| | - Lorenzo Fuccio
- Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy (Lorenzo Fuccio)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Italy (Antonio Facciorusso)
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Stefan Karl Gölder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann)
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, “Attikon” University General Hospital, Athens, Greece (Georgios Tziatzios, Ioannis S. Papanikolaou, Konstantinos Triantafyllou)
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19
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Yoshida N, Inoue K, Tomita Y, Hashimoto H, Sugino S, Hirose R, Dohi O, Naito Y, Morinaga Y, Kishimoto M, Inada Y, Murakami T, Itoh Y. Cold snare polypectomy for large sessile serrated lesions is safe but follow-up is needed: a single-centre retrospective study. United European Gastroenterol J 2021; 9:370-377. [PMID: 33045938 PMCID: PMC8259250 DOI: 10.1177/2050640620964641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Cold snare polypectomy (CSP) is growing in popularity due to its safety and convenience. Its indication is benign tumours such as adenoma and sessile serrated lesions (SSLs) <10 mm in size. CSP for SSLs ≥10 mm in size has not been well examined. In this study, we aimed the feasibility of this treatment regarding therapeutic results and local recurrence. METHODS This was a single-centre retrospective cohort study. We reviewed SSLs with or without dysplasia of 10-20 mm that were resected by CSP from 2014 to 2020. All tumours were diagnosed endoscopically as SSLs without dysplasia before CSP with the help of magnifying narrow band imaging or blue laser imaging. We analysed the lesion characteristics, en bloc resection, histopathological diagnosis, adverse events and local recurrence. We analysed risk factors for recurrence, comparing recurrent lesions to non-recurrent lesions. We also compared risk factors for lesions 10-14 mm in size to those for lesions 15-20 mm in size. RESULTS We analysed 160 lesions in 100 patients (Mage ± SD = 67.7 ± 10.1 years). The polyp size (M ± SD) was 11.8 ± 2.8 mm, and the en bloc resection rate was 60.0% (96 cases). The rates of massive perioperative haemorrhage, postoperative haemorrhage and perforation were 1.3%, 0% and 0%, respectively. Regarding histopathological diagnosis, two (1.2%) cases showed SSLs with high-grade dysplasia. The recurrence rate in 101 lesions with a median follow-up period of 18 months (interquartile range 12-24 months) was 5.0%. There were no significant risk factors such as tumour size, location, morphology and so on in terms of recurrence. All recurrent cases could be resected by repeat CSP. The recurrence rates of lesions 10-14 mm in size and 15-20 mm in size were 4.7% and 6.3%, respectively (p = 0.713). CONCLUSION CSP of SSLs ≥10 mm in size according to magnifying endoscopic diagnosis was safe and promising, but the rate of recurrence was slightly high, meaning that close follow-up is required.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Ken Inoue
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Satoshi Sugino
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yuji Naito
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yukiko Morinaga
- Department of Surgical PathologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | | | - Yutaka Inada
- Department of GastroenterologyKyoto First Red Cross HospitalKyotoJapan
| | - Takaaki Murakami
- Department of GastroenterologyAiseikai Yamashina HospitalKyotoJapan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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20
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Inada Y, Yoshida N, Fukumoto K, Hirose R, Inoue K, Dohi O, Murakami T, Ogiso K, Tomie A, Kugai M, Yoriki H, Inagaki Y, Hasegawa D, Okuda K, Okuda T, Morinaga Y, Kishimoto M, Itoh Y. Risk of lymph node metastasis after endoscopic treatment for rectal NETs 10 mm or less. Int J Colorectal Dis 2021; 36:559-567. [PMID: 33388960 DOI: 10.1007/s00384-020-03826-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE For rectal neuroendocrine tumors (NETs) ≤ 10 mm, endoscopic resection is a standard treatment. However, there is no consensus whether additional surgery should be performed for patients at risk of lymph node metastasis (LNM) after endoscopic resection. The purpose of this study was to analyze the results of endoscopic resection and additional surgery of rectal NETs, thereby clarify the characteristics of cases with LNM. METHODS This study was a multicenter retrospective cohort study conducted at 12 Japanese institutions. A total of 132 NETs ≤ 10 mm were analyzed regarding various therapeutic results. A comparative analysis was performed by dividing the cases into two groups that underwent additional surgery or not. Furthermore, the relationship between tumor size and LNM was examined. RESULTS The endoscopic treatments were 12 endoscopic mucosal resections (EMR), 58 endoscopic submucosal resections with ligation (ESMR-L), 29 precutting EMRs, and 33 endoscopic submucosal dissections (ESD). The R0 resection rates of EMR were 41.7%, and compared to this rate, other three treatments were 86.2% (p < 0.001), 86.2% (p = 0.005), and 97.0% (p < 0.001), respectively. There were 41 non-curative cases (31.1%), and 13 had undergone additional surgery. Then, LNM was observed in 4 of the 13 patients, with an overall rate of LNM of 3.0% (4/132). The rate of positive lymphatic invasion and the rate of LNM by tumor size ≤ 6 mm and 7-10 mm were 9.7 vs. 15.4% (p = 0.375) and 0 vs. 10.3% (p = 0.007). CONCLUSIONS A multicenter study revealed the priority of each endoscopic resection and the low rate of LNM for rectal NETs ≤ 6 mm.
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Affiliation(s)
- Yutaka Inada
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Kohei Fukumoto
- Department of Gastroenterology, Nara City Hospital, Nara, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Akira Tomie
- Department of Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan
| | - Munehiro Kugai
- Department of Gastroenterology, Akashi City Hospital, Akashi, Hyogo, Japan
| | - Hiroyuki Yoriki
- Department of Gastroenterology, Otsu City Hospital, Otsu, Shiga, Japan
| | | | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Takashi Okuda
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Mitsuo Kishimoto
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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21
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Visrodia K, Sethi A. A knife plus a snare, but how will it fare? Gastrointest Endosc 2021; 93:679-681. [PMID: 33583523 DOI: 10.1016/j.gie.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Kavel Visrodia
- Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amrita Sethi
- Division of Digestive and Liver Disease, Columbia University Medical Center-NYPH, New York, New York, USA
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22
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Yoshida N, Inoue K, Dohi O. Especially thin laser colonoscope enabled precutting endoscopic mucosal resection for proximal T1 cancer in a case of stenotic rectal cancer. Dig Endosc 2021; 33:e16-e18. [PMID: 33258496 DOI: 10.1111/den.13877] [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: 09/02/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 02/08/2023]
Abstract
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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23
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Noh SM, Kim JY, Park JC, Oh EH, Kim J, Ham NS, Hwang SW, Park SH, Ye BD, Byeon JS, Myung SJ, Yang SK, Yang DH. Tip-in versus conventional endoscopic mucosal resection for flat colorectal neoplasia 10 mm or larger in size. Int J Colorectal Dis 2020; 35:1283-1290. [PMID: 32347341 DOI: 10.1007/s00384-020-03604-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE A modified endoscopic mucosal resection (EMR) technique, Tip-in EMR, was recently introduced to enhance the complete resection of colorectal neoplasia (CRN). We aimed to evaluate the feasibility of Tip-in EMR for flat CRNs. METHODS From January to September 2018, conventional or Tip-in EMR was consecutively performed for 112 flat CRNs ≥ 10 mm in diameter. Tip-in EMR was performed when en bloc snaring was impossible with conventional EMR or when a lesion was inadequately lifted owing to a previous forceps biopsy. We retrospectively collected the clinical, procedural, and histologic data of the conventional and Tip-in EMR groups and compared the en bloc resection rate, complete resection rate, and complications between the two groups. RESULTS Among 112 flat CRNs of 80 patients, conventional EMR and Tip-in EMR were performed for 74 and 38 lesions, respectively. The median lesion size was 12 (10-27) mm. Tip-in EMR was superior to conventional EMR in terms of en bloc resection (94.7% vs. 77.0%, p = 0.018) and histologic complete resection (76.3% vs. 54.1%, p = 0.022). There was no difference in postprocedural bleeding between the two groups; however, overall adverse events, including bleeding and postpolypectomy electrocoagulation syndrome, were more frequent in the Tip-in EMR group. CONCLUSIONS Tip-in EMR is a feasible technique for flat colorectal lesions ≥ 10 mm and is superior to conventional EMR with respect to en bloc and complete resection rates. The safety profiles of Tip-in EMR and conventional EMR should be compared via large-scale prospective studies.
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Affiliation(s)
- Soo Min Noh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Yong Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Cheol Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Hye Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeongseok Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Nam Seok Ham
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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