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Johnson GGRJ, Vergis A, Singh H, Park J, Warriach A, Helewa RM. Recommendations for Optimal Endoscopic Localization of Colorectal Neoplasms: A Delphi Consensus of National Experts. Dis Colon Rectum 2023; 66:1118-1131. [PMID: 36538707 DOI: 10.1097/dcr.0000000000002441] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colonoscopy is the standard of care for diagnosis and evaluation of colorectal cancers before surgery. However, varied practices and heterogenous documentation affects communication between endoscopists and operating surgeons, hampering surgical planning. OBJECTIVE This study aimed to develop recommendations for the use of standardized localization and reporting practices for colorectal lesions identified during lower GI endoscopy. DESIGN A systematic review of existing endoscopy guidelines and thorough narrative review of the overall endoscopy literature were performed to identify existing practices recommended globally. SETTING An online Delphi process was used to establish consensus recommendations based on a literature review. PATIENTS Colorectal surgeons and gastroenterologists from across Canada who had previously demonstrated leadership in endoscopy, managed large endoscopy programs, produced high-impact publications in the field of endoscopy, or participated in the development of endoscopy guidelines were selected to participate. PRIMARY OUTCOME MEASURES The primary outcomes measured were colorectal lesion localization and documentation practice recommendations important to planning surgical or advanced endoscopic excisions. RESULTS A total of 129 of 197 statements achieved consensus after 3 rounds of voting by 23 experts from across Canada. There was more than 90% participation in each round. Recommendations varied according to lesion location in the cecum, colon, or rectum and whether the referral was planned for surgical or advanced endoscopic resection. Recommendations were provided for appropriate documentation, indications, location, and method of tattoo placement, in addition to photograph and real-time 3-dimensional scope configuration device use. LIMITATIONS Because of a paucity of evidence, recommendations are based primarily on expert opinion. There may be bias, as all representatives were based in Canada. CONCLUSIONS Best practices to optimize endoscopic lesion localization and communication are not addressed in previous guidelines. This consensus involving national experts in colorectal surgery and gastroenterology provides a framework for efficient and effective colorectal lesion localization. See Video Abstract at http://links.lww.com/DCR/C71 . RECOMENDACIONES PARA LA LOCALIZACIN ENDOSCPICA PTIMA DE LAS NEOPLASIAS COLORRECTALES UN CONSENSO DELPHI DE EXPERTOS NACIONALES ANTECEDENTES:La colonoscopia es el estándar de atención para el diagnóstico y la evaluación de los cánceres colorrectales antes de la cirugía. Sin embargo, las prácticas variadas y la documentación heterogénea afectan la comunicación entre los endoscopistas y los cirujanos operadores, lo que dificulta la planificación quirúrgica.OBJETIVO:Este estudio tuvo como objetivo desarrollar recomendaciones para el uso de prácticas estandarizadas de localización y notificación de lesiones colorrectales identificadas en la endoscopia gastrointestinal inferior.DISEÑO:Se realizó una revisión sistemática de las pautas de endoscopia existentes y una revisión narrativa exhaustiva de la literatura general sobre endoscopia para identificar las prácticas existentes recomendadas a nivel mundial. Se utilizó un proceso Delphi en línea para establecer recomendaciones de consenso basadas en la revisión de la literatura.PARTICIPANTES:Se seleccionaron para participar cirujanos colorrectales y gastroenterólogos de todo Canadá que previamente habían demostrado liderazgo en endoscopia, manejado grandes programas de endoscopia, producido publicaciones de alto impacto en el campo de la endoscopia o que habían participado en el desarrollo de pautas de endoscopia.RESULTADOS:Localización de lesiones colorrectales y recomendaciones prácticas de documentación importantes para planificar escisiones quirúrgicas o endoscópicas avanzadas.RESULTADOS:129 de 197 declaraciones lograron consenso después de tres rondas de votación de 23 expertos de todo Canadá. Hubo >90% de participación en cada ronda. Las recomendaciones variaron según la ubicación de la lesión en el ciego, colon o recto, y si se planificó la derivación para resección quirúrgica o endoscópica avanzada. Se proporcionaron recomendaciones para la documentación adecuada, las indicaciones, la ubicación y el método de colocación del tatuaje, además de la fotografía y el uso del dispositivo de configuración del alcance 3D en tiempo real.LIMITACIONES:Debido a la escasez de evidencia, las recomendaciones se basan principalmente en la opinión de expertos. Puede haber sesgo, ya que los representantes tenían su sede en Canadá.CONCLUSIONES:Las mejores prácticas para optimizar la localización y comunicación de lesiones endoscópicas no se abordan en las guías anteriores. Este consenso que involucra a expertos nacionales en cirugía colorrectal y gastroenterología proporciona un marco para la localización eficiente y efectiva de lesiones colorrectales. Consulte Video Resumen en http://links.lww.com/DCR/C71 . (Traducción-Dr. Mauricio Santamaria ).
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Affiliation(s)
- Garrett G R J Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Clinician Investigator Program, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashley Vergis
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Departments of Internal Medicine and Community Health Sciences, University of Manitoba, CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
| | - Jason Park
- Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Ahmed Warriach
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Hayat M, Schlachterman A, Schiavone G, Mizrahi M, Park JK, Kumbhari V, Cheesman A, Draganov PV, Hasan MK, Yang D. Initial multicenter experience using a novel articulating through-the-scope traction device for endoscopic submucosal dissection. Endosc Int Open 2023; 11:E778-E784. [PMID: 37593157 PMCID: PMC10431969 DOI: 10.1055/a-2117-8444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023] Open
Abstract
Background and study aims A single-operator, articulating, through-the-scope (TTS) traction device was recently developed to facilitate endoscopic submucosal dissection (ESD). Clinical data on the performance of this device are limited. We report an initial multicenter experience with ESD using this articulating TTS traction device. Patients and methods Retrospective analysis on all consecutive patients who underwent ESD using this traction device (T-ESD) at five centers between August 2021 and December 2022. Endpoints included: rates of en-bloc resection, R0 resection, curative resection, and adverse events. Results Thirty-six patients (median age 64.8 years; 47.2% women) underwent ESD (median lesion size 40 mm; interquartile range [IRQ]: 27.5-67.5) for lesions in the esophagus (n=2), stomach (n=8), sigmoid colon (n=6), and rectum (n=20). Submucosal fibrosis was encountered in one-third of the lesions (33.3%). Median ESD time was 104.6 minutes (IQR: 65-122). En-bloc, R0 and curative resection were achieved in 94.4%, 91.6%, and 97.2%, respectively. The single patient with non-curative resection of an invasive rectal adenocarcinoma underwent surgery. There were no cases of delayed bleeding or perforation. There was no recurrence on surveillance endoscopy (n=20) at a median of 6 months (IQR: 3.75-6). Conclusions This initial multicenter experience demonstrates high resection rates and excellent safety profile when performing ESD with this novel articulating TTS device. Dynamic real-time traction may lower the technical difficulty of ESD. Additional studies are needed to assess its cost-effectiveness and compare its usefulness with other traction devices and techniques during ESD.
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Affiliation(s)
- Maham Hayat
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
| | - Alexander Schlachterman
- Division of Gastroenterology, Hepatology & Nutrition, University of Florida, Gainesville, United States
| | - Grace Schiavone
- Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, United States
| | - Meir Mizrahi
- Gastroenterology, Florida Center for Gastroenterology, Key Largo, United States
| | - Jong Kyu Park
- Gastroenterology, Mayo Clinic in Florida, Jacksonville, United States
| | - Vivek Kumbhari
- Gastroenterology, Mayo Clinic in Florida, Jacksonville, United States
| | | | - Peter V Draganov
- Medicine/Gastroenterology, University of Florida, Gainesville, United States
| | - Muhammad Khalid Hasan
- Center for Interventional Endoscopy, Florida Hospital Orlando, Orlando, United States
| | - Dennis Yang
- Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States
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Maselli R, Spadaccini M, Galtieri PA, Badalamenti M, Ferrara EC, Pellegatta G, Capogreco A, Carrara S, Anderloni A, Fugazza A, Hassan C, Repici A. Pilot study on a new endoscopic platform for colorectal endoscopic submucosal dissection. Therap Adv Gastroenterol 2023; 16:17562848221104953. [PMID: 37457137 PMCID: PMC10338719 DOI: 10.1177/17562848221104953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/17/2022] [Indexed: 07/18/2023] Open
Abstract
Background The endoscopic submucosal dissection (ESD) is a technically demanding and time-consuming procedure, with an increased risk of adverse events compared to standard endoscopic resection techniques. The main difficulties are related to the instability of the operating field and to the loss of traction. We aimed to evaluate in a pilot trial a new endoscopic platform [tissue retractor system (TRS); ORISE, Boston scientific Co., Marlborough, MA, USA], designed to stabilize the intraluminal space, and to provide tissue retraction and counter traction. Method We prospectively enrolled all consecutive patients who underwent an ESD for sigmoid/rectal lesions. The primary outcome was the rate of technical feasibility. Further technical aspects such as en-bloc and R0 resection rate, number of graspers used, circumferential incision time, TRS assemblage time, submucosal dissection time, and submucosal dissection speed were provided. Clinical outcomes (recurrence rate and adverse events) were recorded as well. Results In all, 10 patients (M/F 4/6, age: 70.4 ± 11.0 years old) were enrolled. Eight out of 10 lesions were located in the rectum. Average lesion size was 31.2 ± 2.7 mm, and mean lesion area was 1628.88 ± 205.3 mm2. The two sigmoid lesions were removed through standard ESD, because the platform assemblage failed after several attempts. All rectal lesions were removed in an en-bloc fashion. R0 resection was achieved in 7/8 (87.5%) patients in an average procedure time of 60.5 ± 23.3 min. None of the patients developed neither intraprocedural nor postprocedural adverse events. Conclusion TRS-assisted ESD is a feasible option when used in the rectum, with promising result in terms of efficacy and safety outcomes. Nevertheless, our pilot study underlines few technical limitations of the present platform that need to be overcome before the system could be widely and routinely used.
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Affiliation(s)
| | - Marco Spadaccini
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Piera Alessia Galtieri
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Matteo Badalamenti
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Elisa Chiara Ferrara
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Gaia Pellegatta
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Antonio Capogreco
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Silvia Carrara
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Alessandro Fugazza
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Cesare Hassan
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
- Digestive Endoscopy Unit, Division of Gastroenterology, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
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Cutting into the black sea: endoscopic submucosal dissection using a clip with line for a rectal polyp with severe fibrosis after tattooing. Endoscopy 2023; 55:E364-E365. [PMID: 36646128 PMCID: PMC9842447 DOI: 10.1055/a-1996-0502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Yang D, Aihara H, Hasan MK, Simsek C, Khan H, Brar TS, Gorrepati VS, Forde JJ, Kadkhodayan K, Arain MA, Draganov PV. Novel single-operator through-the-scope traction device for endoscopic submucosal dissection: Outcomes of a multicenter randomized pilot ex-vivo study in trainees with limited endoscopic submucosal dissection experience (with video). DEN OPEN 2022; 3:e174. [PMID: 36247316 PMCID: PMC9549878 DOI: 10.1002/deo2.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/14/2022] [Accepted: 09/24/2022] [Indexed: 11/06/2022]
Abstract
Objectives Endoscopic submucosal dissection is a technically demanding procedure. The pilot study aimed to prospectively evaluate the efficacy and safety of a novel single‐operator through‐the‐scope dynamic traction device among trainees with limited endoscopic submucosal dissection (ESD) experience. Methods Randomized, controlled, pilot study comparing traction‐assisted ESD (T‐ESD) versus conventional ESD (C‐ESD) in an ex‐vivo porcine stomach model. Trainees were randomized to group 1 (T‐ESD followed by C‐ESD) and group 2 (C‐ESD followed by T‐ESD). Lesions were created on the gravity‐dependent area of the stomachs. The primary outcome was submucosal dissection speed. Secondary outcomes included differences in en‐bloc resection, adverse events, and workload, assessed by the National Aeronautical and Space Administration Task Load Index (NASA‐TLX). Results Five trainees performed two T‐ESD and two C‐ESD each, for a total of 20 procedures. Submucosal dissection speed was significantly faster in the T‐ESD group compared to the C‐ESD group (43.32 ± 22.61 vs. 24.19 ± 15.86 mm2/min; p = 0.042). En‐bloc resection was achieved in 60% with T‐ESD and 70% with C‐ESD (p = 1.00). The muscle injury rate was higher in the C‐ESD group (50% vs. 10%; p = 0.21) with 1 perforation reported with C‐ESD and none with T‐ESD. NASA‐TLX physical demand was lower with T‐ESD compared to C‐ESD (4.5 ± 2.17 vs. 6.9 ± 2.50; p = 0.03). Conclusion T‐ESD resulted in faster submucosal dissection and less physical demand when compared to C‐ESD, as performed by trainees in an ex‐vivo gravity‐dependent model. Future studies are needed to assess its role in human ESD cases.
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Affiliation(s)
- Dennis Yang
- Center for Interventional EndoscopyAdventHealthOrlandoUSA
| | - Hiroyuki Aihara
- Division of GastroenterologyHepatology, and EndoscopyBrigham and Women's HospitalHarvard Medical SchoolBostonUSA
| | | | - Cem Simsek
- Division of GastroenterologyHepatology, and EndoscopyBrigham and Women's HospitalHarvard Medical SchoolBostonUSA
| | - Hafiz Khan
- Center for Interventional EndoscopyAdventHealthOrlandoUSA
| | - Tony S. Brar
- Center for Interventional EndoscopyAdventHealthOrlandoUSA
| | | | - Justin J. Forde
- Division of Gastroenterology and HepatologyUniversity of FloridaGainesvilleUSA
| | | | | | - Peter V. Draganov
- Division of Gastroenterology and HepatologyUniversity of FloridaGainesvilleUSA
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Hayat M, Azeem N, Bilal M. Colon Polypectomy with Endoscopic Submucosal Dissection and Endoscopic Full-Thickness Resection. Gastrointest Endosc Clin N Am 2022; 32:277-298. [PMID: 35361336 DOI: 10.1016/j.giec.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endoscopic resection has become the gold standard for the management of most of the large colorectal polyps. Various endoscopic resection techniques include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection (EFTR). ESD is a minimally invasive method for the resection of advanced lesions in the gastrointestinal (GI) tract to achieve en-bloc resection. While, EFTR is more commonly used in lesions with suspected deeper submucosal invasion, lesions originating from muscularis propria, or those with advanced fibrosis. This article reviews the indications, technique, and adverse events for use of ESD and EFTR in the colon.
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Affiliation(s)
- Maham Hayat
- Section of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, 800 Stanton L Young Boulevard, Oklahoma City, OK 73104, USA
| | - Nabeel Azeem
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mohammad Bilal
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN 55455, USA; Advanced Endoscopy, Division of Gastroenterology & Hepatology, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Minneapolis, MN 55417, USA.
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Orthodontic Rubber Band-Assisted Endoscopic Submucosal Dissection: An Efficient Method for Treating Superficial Colorectal Tumors. Gastroenterol Res Pract 2022; 2022:2835258. [PMID: 35136406 PMCID: PMC8818396 DOI: 10.1155/2022/2835258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Colorectal endoscopic submucosal dissection (ESD) is a complex operation. Effective traction is crucial. We have successfully used an orthodontic rubber band (ORB) combined with the clip traction method to assist ESD (ORB-ESD). The aim of this retrospective study is to describe the method and to compare the efficacy and safety of ORB-ESD versus conventional ESD in the treatment of superficial colorectal tumors. Methods We retrospectively analyzed the data of patients with superficial colorectal tumor (with diameter ≥ 20 mm) who received either ORB-ESD (n = 34) or conventional ESD (n = 90) between January 2019 and September 2020. Propensity score matching (PSM) was used to match the clinical data of 31 pairs of patients in each group. Results Operation time was significantly shorter for ORB-ESD than for conventional ESD (34.5 minutes vs. 56 minutes, P ≤ 0.001). In the propensity-matched cohorts, the operation time remained significantly shorter in the ORB-ESD patients (35 minutes vs. 50 minutes, P = 0.001). Postoperative adverse events, en bloc resection rate, and R0 resection rate were comparable between the two groups (P > 0.05), both before and after propensity score matching. In the ORB subgroup analysis, the trainee and expert ESD operation times were similar (37 (26–53) vs. 33.5 (26–37) minutes, respectively; P = 0.274). Conclusion ORB-ESD appears to be an effective technique for ESD of colorectal cancer. Our findings need to be confirmed in large prospective multicenter studies.
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Sudo G, Tanuma T, Fujisawa T, Hinoda Y, Nakase H. Traction-assisted endoscopic submucosal dissection for a previously tattooed colonic laterally spreading tumor. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2021; 6:329-332. [PMID: 34278099 PMCID: PMC8270785 DOI: 10.1016/j.vgie.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video 1Traction-assisted colorectal endoscopic submucosal dissection using the multiloop method for a previously tattooed laterally spreading tumor in the sigmoid colon.
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Affiliation(s)
- Gota Sudo
- Department of Gastroenterology and Hepatology, Sapporo Teishinkai Hospital, Sapporo, Japan
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tokuma Tanuma
- Department of Gastroenterology and Hepatology, Sapporo Central Hospital, Sapporo, Japan
| | - Takashi Fujisawa
- Department of Pathology, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Yuji Hinoda
- Department of Gastroenterology and Hepatology, Sapporo Teishinkai Hospital, Sapporo, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Nomura T, Hayashi Y, Morikawa T, Okada M, Fukuda H, Takezawa T, Sunada K, Lefor AK, Yamamoto H. Colorectal endoscopic submucosal dissection using the pocket-creation method with single clip traction: a feasibility study. Endosc Int Open 2021; 9:E653-E658. [PMID: 33937504 PMCID: PMC8062220 DOI: 10.1055/a-1372-3740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background and study aims The pocket-creation method (PCM) facilitates dissection of the central part of a tumor. We previously developed the PCM with clip traction (PCM-CT) to facilitate opening the mucosal pocket, which otherwise could become cumbersome. In the present study, we aimed to examine the feasibility of PCM-CT for colorectal endoscopic submucosal dissection (ESD). Patients and methods PCM-CT was performed on 30 patients with early colorectal tumors from October 2019 to April 2020. PCM-CT allows efficient opening of the mucosal pocket by using the PCM to dissect the center of the lesion and then apply traction with a single clip after making a circumferential mucosal incision. Results The median specimen major axis length, ESD time, ESD speed, and en bloc resection rate were 48 mm, 84 minutes, 20 mm 2 /min, and 100 % (30/30), respectively. The success rates for the traction clip and median single-clip-traction time were 100 % (30/30) and 1.5 minutes, respectively. Conclusions Colorectal ESD using PCM-CT is a simple and promising method.
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Affiliation(s)
- Tatsuma Nomura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshikazu Hayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Takaaki Morikawa
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Masahiro Okada
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Hisashi Fukuda
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Takahito Takezawa
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Keijiro Sunada
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | | | - Hironori Yamamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
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Ebigbo A, Tziatzios G, Gölder SK, Probst A, Messmann H. Double-endoscope assisted endoscopic submucosal dissection for treating tumors in rectum and distal colon by expert endoscopists: a feasibility study. Tech Coloproctol 2020; 24:1293-1299. [PMID: 32815048 PMCID: PMC7661416 DOI: 10.1007/s10151-020-02308-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022]
Abstract
Background Colorectal endoscopic submucosal dissection (ESD) is an effective but challenging procedure. To facilitate ESD, several methods that apply traction are available; however, the optimal one remains to be established. The aim of this study was to evaluate the feasibility and safety of the double-endoscope assisted ESD (DEA-ESD) by improving traction to treat complex colorectal lesions. Methods Naïve or previously treated lesions in the rectum and sigmoid colon were included. A grasping forceps advanced through a small-caliber endoscope (GIF-XP190N, Olympus Medical Systems, Tokyo, Japan, 5.4 mm outer diameter) was used to apply traction to the mucosal flap. Lesions were deemed complex when they exceeded a total of nine points on the SMSA scoring system (size, morphology, site, and access) and recurrent when they were previously treated with endoscopic mucosal resection (EMR). Outcome measures included procedural success, total procedure time, complications, and recurrence rate at 3-month follow-up. Results Nine patients (mean age 62.3 ± 14.5 years) were included; five had rectal and four had tumors in the sigmoid colon. The median SMSA score was 14 (SMSA Level IV—complex polyp), while three patients were pre-treated with EMR. DEA-ESD was technically feasible in all cases. En bloc resection and R0 resection rates were 100%, respectively, with a mean procedure time of 128.4 ± 54.1 min. No immediate or delayed complications occurred. Conclusions DEA-ESD is a feasible and safe method for treating complex or recurrent tumors in the rectum and distal colon. Electronic supplementary material The online version of this article (10.1007/s10151-020-02308-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - G Tziatzios
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - S K Gölder
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - A Probst
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - H Messmann
- Department of Gastroenterology, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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Tziatzios G, Ebigbo A, Gölder SK, Probst A, Messmann H. Methods that Assist Traction during Endoscopic Submucosal Dissection of Superficial Gastrointestinal Cancers: A Systematic Literature Review. Clin Endosc 2020; 53:286-301. [PMID: 31914722 PMCID: PMC7280854 DOI: 10.5946/ce.2019.147] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is a well-established method for the treatment of early-stage gastrointestinal neoplasms. Adequate submucosal exposure is one of the most significant factors related to an effective and safe dissection. The aim of this systematic review was to evaluate the effcacy and safety of various methods that assist traction during ESD of precancerous and earlystage neoplastic lesions of the gastrointestinal tract. We performed an electronic search of the MEDLINE and the Cochrane Controlled Trials Register databases for relevant studies published up to May 2019. Trials exclusively recruiting patients undergoing ESD for superficial gastrointestinal cancer were considered eligible for inclusion. Thirty-three articles including 3,134 patients met the inclusion criteria. The studies evaluated different approaches for widening the endoscopic view, including magnetic anchor-guided ESD (3 studies), use of a second endoscope (5 studies), clip-involving technique (21 studies), and miscellaneous methods (4 studies). Among them, only 6 were randomized controlled trials evaluating different approaches. Overall, the implementation of methods that assist traction during ESD significantly improved the operating time and R0 resection rate and decreased the rate of complications (bleeding and perforation). Interventions that assist traction seem effcacious in improving tissue traction, thus facilitating ESD performance.
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Affiliation(s)
- Georgios Tziatzios
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Karl Gölder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
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Harlow C, Sivananthan A, Ayaru L, Patel K, Darzi A, Patel N. Endoscopic submucosal dissection: an update on tools and accessories. Ther Adv Gastrointest Endosc 2020; 13:2631774520957220. [PMID: 33089213 PMCID: PMC7545765 DOI: 10.1177/2631774520957220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
Endoscopic submucosal dissection (ESD) is a minimally invasive therapeutic procedure to remove larger polyps or early non-metastatic lesions. It has long been used in Asia, but is now fast growing in popularity in the West. There are multiple challenges faced by ESD practitioners. While the practice of ESD in gastric lesions is relatively well established, the oesophagus with its narrow lumen and challenging workspace, and the colon with its tortuous course and folds are more challenging frontiers. The nature of performing a procedure endoscopically means that conventional methods offer no mechanism for providing counter-traction while performing dissection, impeding visibility and increasing the rate of complications. There are a multitude of tools available to those performing ESD for the different stages of the procedure. This article reviews the accessories currently used in regular ESD practice including the knives used to cut and dissect lesions, the cap and hood devices used to improve visibility and safety, injection fluids to lift the submucosal plane, haemostatic devices, generators, and finally, emerging traction apparatus. There is some evidence behind the use of these tools, however, ESD remains the domain of a small number of practitioners and the practice relies heavily on expert experience. Evolution of the ESD toolbox will make the procedure more accessible to more endoscopists, which in turn will drive the development of a more substantial evidence base to evaluate efficacy and safety of the multitude of tools.
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Affiliation(s)
| | - Arun Sivananthan
- Imperial College Healthcare NHS Trust, London, UK; Institute of Global Health Innovation, London, UK
| | | | - Kinesh Patel
- Chelsea and Westminster Healthcare NHS Trust, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust; Institute of Global Health Innovation, London, UK
| | - Nisha Patel
- Imperial College Healthcare NHS Trust, Institute of Global Health Innovation, St Mary’s Hospital Campus, 10th Floor, QEQM Wing, South Wharf Road, Paddington, London W2 1NY, UK
- Imperial College Healthcare NHS Trust, London, UK
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