Does precutting prior to endoscopic piecemeal resection of large colorectal neoplasias reduce local recurrence? A KASID multicenter study

The efficacy and safety of precutting-endoscopic mucosal resection for colorectal tumors: a systematic review and meta-analysis

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.

Leak After Sleeve Gastrectomy: Updated Algorithm of Treatment

INTRODUCTION

Laparoscopic sleeve gastrectomy (LSG) is currently the most common procedure performed worldwide, and still the leak is considered the main limitation. After an initial enthusiasm for stents, the endoscopic treatment evolved including in the current management the septotomy with balloon dilatation and pigtails insertions. The aim of this study was to evaluate the updated algorithm of endoscopic treatment of leak following LSG including septotomy and balloon dilatation.

METHODS

All consecutive patients treated by endoscopy between January 2018 and March 2020 for leak following LSG were included in the current study. After recording the demographic and the leak history, we have analyzed the number of endoscopic sessions, the duration of treatment, and the healing rate of endoscopic treatment for 3 groups: A, small orifice (< 10 mm); B, large orifice (> 10 mm) and acute leak; and group C with large orifice and late leak.

RESULTS

A total of 53 patients received endoscopic treatment for leak following LSG. The leaks achieved complete healing after average duration of 3.2 months (range 1-7 months), 2.3 months for group A, 4.2 months for group B, and 3.7 months for group C. The average number of endoscopic procedures was 2.8 (range 2-6) and was required for general population: for group A, 2.3 sessions; in group B, 3.4 sessions; and in group C, 2.7 sessions. Two out of 53 patients (3.8%) required additional treatment outside of the current algorithm, one in group A and another in group B. One patient was transferred for pulmonary abscess, and for another patient, the leak was considered chronic after a total of 14 months, and a laparoscopic fistula-jejunostomy was performed with favorable outcomes.

CONCLUSIONS

Although there is still no consensus for endoscopic management of leaks after LSG, the benefits of pigtails and the septotomy are undeniable, and it should be included in the armamentarium of any bariatric endoscopic service.