1
|
Ishikawa T, Okimoto K, Matsumura T, Ogasawara S, Fukuda Y, Kitsukawa Y, Yokoyama Y, Kanayama K, Akizue N, Iino Y, Ohta Y, Ishigami H, Taida T, Tsuchiya S, Saito K, Kamezaki H, Kobayashi A, Kikuchi Y, Tada M, Shiko Y, Ozawa Y, Kato J, Yamaguchi T, Kato N. Risk factors of unintentional piecemeal resection in endoscopic mucosal resection for colorectal polyps ≥ 10 mm. Sci Rep 2024; 14:493. [PMID: 38177176 PMCID: PMC10766986 DOI: 10.1038/s41598-023-50815-9] [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: 02/27/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024] Open
Abstract
This study aimed to investigate the lesion and endoscopist factors associated with unintentional endoscopic piecemeal mucosal resection (uniEPMR) of colorectal lesions ≥ 10 mm. uniEPMR was defined from the medical record as anything other than a preoperatively planned EPMR. Factors leading to uniEPMR were identified by retrospective univariate and multivariate analyses of lesions ≥ 10 mm (adenoma including sessile serrated lesion and carcinoma) that were treated with endoscopic mucosal resection (EMR) at three hospitals. Additionally, a questionnaire survey was conducted to determine the number of cases treated by each endoscopist. A learning curve (LC) was created for each lesion size based on the number of experienced cases and the percentage of uniEPMR. Of 2557 lesions, 327 lesions underwent uniEPMR. The recurrence rate of uniEPMR was 2.8%. Multivariate analysis showed that lesion diameter ≥ 30 mm (odds ratio 11.83, 95% confidence interval 6.80-20.60, p < 0.0001) was the most associated risk factor leading to uniEPMR. In the LC analysis, the proportion of uniEPMR decreased for lesion sizes of 10-19 mm until 160 cases. The proportion of uniEPMR decreased with the number of experienced cases in the 20-29 mm range, while there was no correlation between the number of experienced cases and the proportion of uniEPMR ≥ 30 mm. These results suggest that 160 cases seem to be the minimum number of cases needed to be proficient in en bloc EMR. Additionally, while lesion sizes of 10-29 mm are considered suitable for EMR, lesion sizes ≥ 30 mm are not applicable for en bloc EMR from the perspective of both lesion and endoscopist factors.
Collapse
Affiliation(s)
- Tsubasa Ishikawa
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Kenichiro Okimoto
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan.
| | - Tomoaki Matsumura
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
- Translational Research and Development Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihiro Fukuda
- Department of Gastroenterology, Seikei-kai Chiba Medical Center, Chiba, Japan
| | - Yoshio Kitsukawa
- Department of Gastroenterology, Chiba Municipal Aoba Hospital, Chiba, Japan
| | - Yuya Yokoyama
- Department of Gastroenterology, Chibaken Saiseikai Narashino Hospital, Chiba, Japan
| | - Kengo Kanayama
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Naoki Akizue
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Yotaro Iino
- Department of Gastroenterology, Kimitsu Chuo Hospital, Chiba, Japan
| | - Yuki Ohta
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Hideaki Ishigami
- Department of Gastroenterology, Chiba Rosai Hospital, Chiba, Japan
| | - Takashi Taida
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Shin Tsuchiya
- Department of Gastroenterology, Funabashi Central Hospital, Chiba, Japan
| | - Keiko Saito
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Hidehiro Kamezaki
- Department of Gastroenterology, Eastern Chiba Medical Center, Chiba, Japan
| | - Akitoshi Kobayashi
- Department of Gastroenterology, Funabashi Municipal Medical Center, Chiba, Japan
| | - Yasuharu Kikuchi
- Department of Gastroenterology, Numazu City Hospital, Shizuoka, Japan
| | - Minoru Tada
- Department of Gastroenterology, National Hospital Organization Chiba Medical Center, Chiba, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Jun Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| | - Taketo Yamaguchi
- Department of Gastroenterology, Funabashi Central Hospital, Chiba, Japan
| | - Naoya Kato
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku, Chiba-City, 260-8670, Japan
| |
Collapse
|
2
|
Mouchli M, Bierle L, Reddy S, Walsh C, Mir A, Yeaton P, Chitnavis V. Does completing advanced endoscopy fellowship improve outcomes after endoscopic mucosal resection? Minerva Gastroenterol (Torino) 2023; 69:344-350. [PMID: 33793165 DOI: 10.23736/s2724-5985.21.02782-3] [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: 11/08/2022]
Abstract
BACKGROUND It was reported that about 60% of the physicians in the USA believed that their Gastroenterology fellowship poorly prepared them for large polyp resection. The aim of this study was to compare endoscopic mucosal resection (EMR) efficacy and complication rates between skilled general gastroenterologists who perform high volume of EMR and advanced endoscopists. METHODS We identified 140 patients with documented large colonic polyps treated by 4 providers using EMR technique at Carilion Clinic, in Roanoke, Virginia, USA between 01/01/2014-12/31/2017, with follow-up through 10-2018. Information on demographics, clinical and pathological features of high-risk polyps (i.e., size, histology, site, and degree of dysplasia), timing of surveillance endoscopies, tools used during resection, and skills of performing endoscopist's were extracted. The cumulative risks of polyp recurrence after first resection using EMR technique were estimated using Kaplan-Meier curves. RESULTS One hundred and forty patients were identified (mean age, 64.1±11.2 years; 47.1% males). Fifty-five polyps (39.3%) were removed by 2 skilled gastroenterologists and 85 (60.7%) were removed by advanced endoscopists. Most of the polyps resected were located in the right colon (63.6%) and roughly half of the polyps were removed in piecemeal fashion. At follow-up endoscopy, the advanced endoscopy group had lower polyp recurrence rates. The median recurrence after polypectomy was significantly different between the groups (0.88 and 1.03 years for skilled gastroenterologists who did not complete and completed EMR hands-on workshops; respectively vs. 3.99 years for the advanced endoscopist who did not complete EMR hands-on workshop, P=0.03). CONCLUSIONS There is a need for additional EMR training since polyp recurrence was significantly different between the groups despite high rates of piecemeal resection in the advanced endoscopy groups.
Collapse
Affiliation(s)
- Mohamad Mouchli
- Department of Hepatology and Gastroenterology, Cleveland Clinic Foundation, Cleveland, OH, USA -
| | - Lindsey Bierle
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Shravani Reddy
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Christopher Walsh
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Adil Mir
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Paul Yeaton
- Department of Hepatology and Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Vikas Chitnavis
- Department of Hepatology and Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| |
Collapse
|
3
|
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: 1.0] [Reference Citation Analysis] [Abstract] [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.
Collapse
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
| |
Collapse
|
4
|
Conio M, Manta R, Filiberti RA, Baron TH, Pasquale L, Marini M, De Ceglie A. Cap-assisted EMR versus standard inject and cut EMR for treatment of large colonic laterally spreading tumors: a randomized multicenter study (with videos). Gastrointest Endosc 2022; 96:829-839.e1. [PMID: 35697127 DOI: 10.1016/j.gie.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Piecemeal EMR of colorectal laterally spreading tumors (LSTs) >20 mm is effective. Experience is limited in the use of cap-assisted EMR (EMR-C) for resection of colonic lesions. We compared the efficacy and the safety of EMR-C for the removal of colonic LSTs ≥30 mm with "inject-and-cut" standard EMR (EMR-S). METHODS In this randomized trial from 4 Italian centers, 138 patients were treated with EMR-C and 102 with EMR-S. The rates of residual lesions, percentage of recurrence after 12 months, and adverse events were evaluated. RESULTS One hundred forty-three lesions were resected with EMR-C and 102 with EMR-S. Argon plasma coagulation (APC) was used as adjunctive treatment in 2.9% of EMR-Cs and in 22.5% of EMR-Ss (P < .001). The median time required was 20 minutes for EMR-C and 30 minutes for EMR-S (P < .001). Adverse events (AEs) occurred in 14 EMR-Cs (10.1%; 2 perforations, 11 bleeding events, and 1 stenosis) and in 22 EMR-Ss (21.6%; 1 perforation and 21 bleeding events) (P = .017). Intraprocedural AEs occurred in 3.6% of EMR-Cs and 16.7% of EMR-Ss (P = .001). Overall, residual lesions within 12 months were found to be significantly higher with EMR-S (32 patients, 31.4%) than with EMR-C (8 patients, 5.8%) (P < .001). Recurrence at follow-up colonoscopy in 12 months occurred in 7 EMR-Cs (5.1%) and 17 EMR-Ss (16.7%; P < .001). CONCLUSIONS The study demonstrated the feasibility and safety of EMR-C for removing large colorectal LSTs, with higher eradication rates, shorter resection time, and less use of APC when compared with EMR-S. (Clinical trial registration number: NCT03498664.).
Collapse
Affiliation(s)
- Massimo Conio
- Gastroenterology Department, Santa Corona General Hospital, Savonese, Italy; Polyclinique St George, Nice, France
| | - Raffaele Manta
- Gastroenterology and Digestive Endoscopy Department, General Hospital, Perugia, Italy
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Luigi Pasquale
- Gastroenterology and Digestive Endoscopy Department, O. Frangipane Hospital, Avellino, Italy
| | - Mario Marini
- Gastroenterology and Operative Endoscopy Unit, Santa Maria Alle Scotte Hospital, Siena, Italy
| | | |
Collapse
|
5
|
Kandel P, Hussain M, Yadav D, Dhungana SK, Brahmbhatt B, Raimondo M, Lukens FJ, Bachuwa G, Wallace MB. Post-EMR for colorectal polyps, thermal ablation of defects reduces adenoma recurrence: A meta-analysis. Endosc Int Open 2022; 10:E1399-E1405. [PMID: 36262518 PMCID: PMC9576327 DOI: 10.1055/a-1922-7646] [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: 01/23/2022] [Accepted: 08/10/2022] [Indexed: 10/25/2022] Open
Abstract
Background and study aims Adenoma recurrence is one of the key limitations of endoscopic mucosal resection (EMR), which occurs in 15 % to 30 % of cases during first surveillance colonoscopy. The main hypothesis behind adenoma recurrence is leftover micro-adenomas at the margins of post-EMR defects. In this systematic review and meta-analysis, we evaluated the efficacy of snare tip soft coagulation (STSC) at the margins of mucosal defects to reduce adenoma recurrence and bleeding complications. Methods Electronic databases such as PubMed and the Cochrane library were used for systematic literature search. Studies with polyps only resected by piecemeal EMR and active treatment: with STSC, comparator: non-STSC were included. A random effects model was used to calculate the summary of risk ratio and 95 % confidence intervals. The main outcome of the study was to compare the effect of STSC versus non-STSC with respect to adenoma recurrence at first surveillance colonoscopy after thermal ablation of post-EMR defects. Results Five studies were included in the systematic review and meta-analysis. The total number patients who completed first surveillance colonoscopy (SC1) in the STSC group was 534 and in the non-STSC group was 514. The pooled adenoma recurrence rate was 6 % (37 of 534 cases) in the STSC arm and 22 % (115 of 514 cases) in the non-STSC arm, (odds ratio [OR] 0.26, 95 % confidence interval [CI], 0.16-0.41, P = 0.001). The pooled delayed post-EMR bleeding rate 19 % (67 of 343) in the STSC arm and 22 % (78 of 341) in the non-STSC arm (OR 0.82, 95 %CI, 0.57-1.18). Conclusions Thermal ablation of post-EMR defects significantly reduces adenoma recurrence at first surveillance colonoscopy.
Collapse
Affiliation(s)
- Pujan Kandel
- Michigan State University/Hurley Medical Center, Flint, Michigan, United States
| | - Murtaza Hussain
- Michigan State University/Hurley Medical Center, Flint, Michigan, United States
| | - Deepesh Yadav
- Michigan State University/Hurley Medical Center, Flint, Michigan, United States
| | - Santosh K. Dhungana
- Michigan State University/Hurley Medical Center, Flint, Michigan, United States
| | | | - Massimo Raimondo
- Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
| | - Frank J. Lukens
- Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States
| | - Ghassan Bachuwa
- Michigan State University/Hurley Medical Center, Flint, Michigan, United States
| | - Michael B. Wallace
- Mayo Clinic's Campus in Florida, Jacksonville, Florida, United States,Division of Gastroenterology and Hepatology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| |
Collapse
|
6
|
Chang CC, Chen WC, Tsay FW, Wang HM, Tsai TJ, Hsu CW. Pocket-creation colonic endoscopic submucosal dissection assisted by bidirectional double clip traction - A video vignette. Colorectal Dis 2022; 24:343. [PMID: 34821444 DOI: 10.1111/codi.16001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/14/2021] [Accepted: 11/20/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Chun-Chia Chang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Chi Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Feng-Woei Tsay
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Huay-Min Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tzung-Jiun Tsai
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chao-Wen Hsu
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
7
|
Nagl S, Ebigbo A, Goelder SK, Roemmele C, Neuhaus L, Weber T, Braun G, Probst A, Schnoy E, Kafel AJ, Muzalyova A, Messmann H. Underwater vs Conventional Endoscopic Mucosal Resection of Large Sessile or Flat Colorectal Polyps: A Prospective Randomized Controlled Trial. Gastroenterology 2021; 161:1460-1474.e1. [PMID: 34371000 DOI: 10.1053/j.gastro.2021.07.044] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Conventional endoscopic mucosal resection (CEMR) with submucosal injection is the current standard for the resection of large, nonmalignant colorectal polyps. We investigated whether underwater endoscopic mucosal resection (UEMR) is superior to CEMR for large (20-40mm) sessile or flat colorectal polyps. METHODS In this prospective randomized controlled study, patients with sessile or flat colorectal polyps between 20 and 40 mm in size were randomly assigned to UEMR or CEMR. The primary outcome was the recurrence rate after 6 months. Secondary outcomes included en bloc and R0 resection rates, number of resected pieces, procedure time, and adverse events. RESULTS En bloc resection rates were 33.3% in the UEMR group and 18.4% in the CEMR group (P = .045); R0 resection rates were 32.1% and 15.8% for UEMR vs CEMR, respectively (P = .025). UEMR was performed with significantly fewer pieces compared to CEMR (2 pieces: 45.5% UEMR vs 17.7% CEMR; P = .001). The overall recurrence rate did not differ between both groups (P = .253); however, subgroup analysis showed a significant difference in favor of UEMR for lesions of >30 mm to ≤40 mm in size (P = .031). The resection time was significantly shorter in the UEMR group (8 vs 14 minutes; P < .001). Adverse events did not differ between both groups (P = .611). CONCLUSIONS UEMR is superior to CEMR regarding en bloc resection, R0 resection, and procedure time for large colorectal lesions and shows significantly lower recurrence rates for lesions >30 mm to ≤40 mm in size. UEMR should be considered for the endoscopic resection of large colorectal polyps.
Collapse
Affiliation(s)
- Sandra Nagl
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany.
| | - Alanna Ebigbo
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Karl Goelder
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Christoph Roemmele
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Lukas Neuhaus
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Tobias Weber
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Georg Braun
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Elisabeth Schnoy
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | | | - Anna Muzalyova
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
8
|
Yamasaki Y, Harada K, Yamamoto S, Yasutomi E, Hirai M, Ohmori M, Oka S, Inokuchi T, Kinugasa H, Sugihara Y, Takahara M, Hiraoka S, Tanaka T, Mitsuhashi T, Okada H. Evaluation of complete cold forceps polypectomy resection rate for 3- to 5-mm colorectal polyps. Dig Endosc 2021; 33:948-954. [PMID: 33211353 DOI: 10.1111/den.13895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS The propriety of cold forceps polypectomy (CFP) using jumbo biopsy forceps for diminutive polyps remains controversial. We conducted a prospective study to evaluate the complete CFP resection rate of 3-5-mm polyps using additional endoscopic mucosal resection (EMR) specimens following CFP. PATIENTS AND METHODS Patients with 3-5-mm protruded or flat elevated colorectal polyps diagnosed endoscopically as adenomas or serrated lesions were prospectively enrolled. CFP using jumbo biopsy forceps was used to remove the eligible polyps and repeated until the absence of residuals were confirmed via image-enhanced endoscopy or chromoendoscopy. After CFP, saline was injected at the defect, and the marginal specimen of the defect was resected using EMR to histologically evaluate the residue. The primary outcome was the complete CFP resection rate, which was defined as no residue at the EMR site. Other outcomes were the number of CFP bites and the complete resection rate by lesion size. RESULTS Eighty patients with 120 polyps were enrolled. The mean polyp size was 4.1 ± 0.7 mm. The overall complete resection rate was 96.7% (95% confidence interval [CI], 91.7-98.7), and the rates for 3-, 4- and 5-mm polyps were 100% (95% CI, 86.7-100), 96.0% (95% CI, 86.5-98.9) and 95.5% (95% CI, 85.1-98.8), respectively. The one-bite CFP rates were 92%, 60% and 31% for the 3-, 4- and 5-mm polyps, respectively. CONCLUSIONS The complete CFP resection rate for 3-5-mm polyps was acceptable, although the one-bite clearance rate decreased as the polyp size increased (UMIN000028841).
Collapse
Affiliation(s)
- Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Keita Harada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Shumpei Yamamoto
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Eriko Yasutomi
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Mami Hirai
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Masayasu Ohmori
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Shohei Oka
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Inokuchi
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hideaki Kinugasa
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yuusaku Sugihara
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Masahiro Takahara
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
9
|
Tip-in Endoscopic Mucosal Resection for 15- to 25-mm Colorectal Adenomas: A Single-Center, Randomized Controlled Trial (STAR Trial). Am J Gastroenterol 2021; 116:1398-1405. [PMID: 34074815 DOI: 10.14309/ajg.0000000000001320] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION One-piece endoscopic mucosal resection (EMR) for lesions >15 mm is still unsatisfactory, and attempted 1-piece EMR for lesions >25 mm can increase perforation risk. Therefore, modifications to ensure 1-piece EMR of 15- to 25-mm lesions would be beneficial. The aim of this study was to investigate whether Tip-in EMR, which anchors the snare tip within the submucosal layer, increases en bloc resection for 15- to 25-mm colorectal lesions compared with EMR. METHODS In this prospective randomized controlled trial, patients with nonpolypoid colorectal neoplasms of 15-25 mm in size were recruited and randomly assigned in a 1:1 ratio to undergo Tip-in EMR or standard EMR, stratified by age, sex, tumor size category, and tumor location. The primary endpoint was the odds ratio of en bloc resection adjusted by location and size category. Adverse events and procedure time were also evaluated. RESULTS We analyzed 41 lesions in the Tip-in EMR group and 41 lesions in the EMR group. En bloc resection was achieved in 37 (90.2%) patients undergoing Tip-in EMR and 30 (73.1%) who had EMR. The adjusted odds ratio of en bloc resection in Tip-in EMR vs EMR was 3.46 (95% confidence interval: 1.06-13.6, P = 0.040). The Tip-in EMR and EMR groups did not differ significantly in adverse event rates (0% vs 4.8%) or median procedure times (7 vs 5 minutes). DISCUSSION In this single-center randomized controlled trial, we found that Tip-in EMR significantly improved the en bloc resection rate for nonpolypoid lesions 15-25 mm in size, with no increase in adverse events or procedure time.
Collapse
|
10
|
Indo N, Anami T, Kitamura Y, Watanabe A. Effectiveness of counter traction using a clip with a looped thread for colorectal endoscopic submucosal dissection. Endosc Int Open 2021; 9:E306-E312. [PMID: 33655026 PMCID: PMC7892277 DOI: 10.1055/a-1336-2460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Naohiko Indo
- Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan,Kohshinkai Gastroenterological Endoscopic Clinic, Osaka, Japan
| | - Takahiro Anami
- Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
| | - Yasuaki Kitamura
- Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
| | - Akihiko Watanabe
- Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
| |
Collapse
|
11
|
Nagami Y, Sakai T, Yamamura M, Nakatani M, Katsuno T, Suekane T, Uno H, Minamino H, Okuyama M, Okamoto J, Kumamoto M, Noguchi A, Yamamori K, Takaishi O, Ochi M, Miyazaki T, Tsuji S, Ikehara H, Kawaguchi K, Hayashi T, Mannami T, Kakimoto K, Naito Y, Hashimoto S, Li Z, Komeda Y, Kishino T, Yamamoto Y, Iguchi M, Akamatsu T, Horii T, Miura K, Yamashina T, Sugihara Y, Watanabe N, Kiyotoki S, Fujii R, Murata M, Ono S, Narasaka T, Kitamura S, Kono M, Kato M, Kawaratani H, Tanaka K, Yaoita T, Yamaguchi S, Abe K, Kawamura T, Kinoshita Y, Imai K, Fujinami H, Yada T, Miyamoto H, Yoshida H, Fujiwara Y. Continuous warfarin administration versus heparin bridging therapy in post colorectal polypectomy haemorrhage: a study protocol for a multicentre randomised controlled trial (WHICH study). Trials 2021; 22:33. [PMID: 33413599 PMCID: PMC7791998 DOI: 10.1186/s13063-020-04975-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background Endoscopic removal of colorectal adenoma is considered an effective treatment for reducing the mortality rates associated with colorectal cancer. Warfarin, a type of anticoagulant, is widely used for the treatment and prevention of thromboembolism; however, bleeding may increase with its administration after polypectomy. In recent times, a high incidence of bleeding after endoscopic polypectomy has been reported in patients receiving heparin bridge therapy. However, previous studies have not compared the bleeding rate after endoscopic colorectal polypectomy between patients who continued with anticoagulant therapy and those who received heparin bridge therapy. We hypothesised that endoscopic colorectal polypectomy under the novel treatment with continuous warfarin is not inferior to endoscopic colorectal polypectomy under standard treatment with heparin bridge therapy with respect to the rate of postoperative bleeding. This study aims to compare the efficacy of endoscopic colorectal polypectomy with continuous warfarin administration and endoscopic colorectal polypectomy with heparin bridge therapy with respect to the rate of postoperative bleeding. Methods We will conduct a prospective multicentre randomised controlled non-inferiority trial of two parallel groups. We will compare patients scheduled to undergo colorectal polypectomy under anticoagulant therapy with warfarin. There will be 2 groups, namely, a standard treatment group (heparin bridge therapy) and the experimental treatment group (continued anticoagulant therapy). The primary outcome measure is the rate of postoperative bleeding. On the contrary, the secondary outcomes include the rate of cumulative bleeding, rate of overt haemorrhage (that does not qualify for the definition of haemorrhage after endoscopic polypectomy), incidence of haemorrhage requiring haemostasis during endoscopic polypectomy, intraoperative bleeding during endoscopic colorectal polypectomy requiring angiography, abdominal surgery and/or blood transfusion, total rate of bleeding, risk factors for postoperative bleeding, length of hospital stay, incidence of thromboembolism, prothrombin time-international ratio (PT-INR) 28 days after the surgery, and incidence of serious adverse events. Discussion The results of this randomised controlled trial will provide valuable information for the standardisation of management of anticoagulants in patients scheduled to undergo colorectal polypectomy. Trial registration UMIN-CTR UMIN000023720. Registered on 22 August 2016
Collapse
Affiliation(s)
- Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
| | - Taishi Sakai
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.,Department of Gastroenterology, Baba Memorial Hospital, Osaka, Japan
| | - Masafumi Yamamura
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Masami Nakatani
- Department of Gastroenterology, Minamiosaka Hospital, Osaka, Japan
| | - Takayuki Katsuno
- Department of Gastroenterology, Izumiotsu Municipal Hospital, Osaka, Japan
| | - Takehisa Suekane
- Department of Gastroenterology, Osaka City General Hospital, Osaka, Japan
| | - Hironori Uno
- Department of Gastroenterology, Osaka Ekisaikai Hospital, Osaka, Japan
| | - Hiroaki Minamino
- Department of Gastroenterology, Baba Memorial Hospital, Osaka, Japan.,Department of Gastroenterology, Ishikiriseiki Hospital, Osaka, Japan
| | - Masatsugu Okuyama
- Department of Gastroenterology, Kashiwara Municipal Hospital, Osaka, Japan
| | - Junichi Okamoto
- Department of Gastroenterology, Ikuwakai Memorial Hospital, Osaka, Japan
| | | | - Atsushi Noguchi
- Department of Gastroenterology, Asakayama General Hospital, Osaka, Japan
| | - Kazuki Yamamori
- Department of Gastroenterology, Nagayoshi General Hospital, Osaka, Japan
| | - Osamu Takaishi
- Department of Gastroenterology, Naniwa Ikuno Hospital, Osaka, Japan
| | - Masahiro Ochi
- Department of Internal Medicine, Meijibashi Hospital, Osaka, Japan
| | - Takako Miyazaki
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Shigetsugu Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan
| | - Hisatomo Ikehara
- Department of Gastroenterology, Nihon University Hospital, Tokyo, Japan
| | - Koichiro Kawaguchi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Tomoyuki Hayashi
- Department of Gastroenterology, Kanazawa University, Ishikawa, Japan
| | - Tomohiko Mannami
- Department of Gastroenterology, Okayama Medical Center, Okayama, Japan
| | - Kazuki Kakimoto
- Second Department of Internal Medicine, Osaka Medical Collage, Osaka, Japan
| | - Yoshihide Naito
- Department of Gastroenterology and Hepatology, Fukui Prefectural Hospital, Fukui, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Zhaoliang Li
- Department of Gastroenterology, Takarazuka City Hospital, Hyogo, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takaaki Kishino
- Department of Gastroenterology and Hepatology, Center for Digestive and Liver Diseases, Nara City Hospital, Nara, Japan
| | - Yoshinobu Yamamoto
- Department of Gastroenterological Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology and Hepatology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Toshiki Horii
- Department of Gastroenterology, Yuri Kumiai General Hospital, Akita, Japan
| | - Ko Miura
- Department of Gastroenterology, Tsuyama Chuo Hospital, Okayama, Japan
| | - Takeshi Yamashina
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Yuusaku Sugihara
- Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan
| | - Noboru Watanabe
- Department of Gastroenterology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yanai, Japan
| | - Ryoji Fujii
- Department of Gastroenterology, Tonan Hospital, Hokkaido, Japan
| | - Masaki Murata
- Department of Gastroenterology, Shiga University of Medical Science, Shiga, Japan
| | - Satoshi Ono
- Department of Gastroenterology, Chiba-Nishi General Hospital, Chiba, Japan
| | - Toshiaki Narasaka
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Mitsuhiro Kono
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.,Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiko Kato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Hideto Kawaratani
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Kyosuke Tanaka
- Department of Endoscopy, Mie University Hospital, Mie, Japan
| | - Takao Yaoita
- Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | | | - Keiichiro Abe
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Takuji Kawamura
- Department of Gastroenterology, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Yosuke Kinoshita
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.,Department of Gastroenterology, Ishikiriseiki Hospital, Osaka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Centre, Shizuoka, Japan
| | - Haruka Fujinami
- Department of Gastroenterology, Toyama University Hospital, Toyama, Japan
| | - Tomoyuki Yada
- Division of Gastroenterology & Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Hayato Miyamoto
- Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
12
|
Raju GS, Lum P, Abu-Sbeih H, Ross WA, Thirumurthi S, Miller E, Lynch P, Lee J, Bhutani MS, Shafi M, Weston B, Rashid A, Wang Y, Chang GJ, Carlson R, Hagan K, Davila M, Stroehlein J. Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate. Endosc Int Open 2020; 8:E115-E121. [PMID: 32010742 PMCID: PMC6976333 DOI: 10.1055/a-1012-1811] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence. Patients and methods This was a retrospective study of patients with laterally spreading tumors (LST) ≥ 20 mm, who underwent EMR from January 2009 to August 2018 and follow-up endoscopic assessment. A cap-fitted endoscope was used to assess completeness of resection by systematically inspecting the EMR defect for any macroscopic disease. This was followed by forced APC of the resection edge followed by clip closure of the defect. Surveillance colonoscopy was performed at 6 months after resection to detect recurrence. Results Two hundred forty-six patients met the inclusion criteria. Most were female (53 %) and white (80 %), with a Median age of 64 years. Median polyp size was 35 mm (interquartile range, 30-45 mm). Most polyps were located in the right colon (77 %) and were removed by piecemeal EMR (70 %). Eleven patients (5 %) had residual tumor at the resection site. Conclusions We observed low adenoma recurrence after argon plasma coagulation of the EMR edge with a cap fitted colonoscope in patients with LST ≥ 20 mm of the colon, which requires further validation in a randomized controlled study.
Collapse
Affiliation(s)
- Gottumukkala S. Raju
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Phillip Lum
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Hamzah Abu-Sbeih
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - William A. Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Selvi Thirumurthi
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ethan Miller
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Patrick Lynch
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jeffrey Lee
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Mehnaz Shafi
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Brian Weston
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Asif Rashid
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Yinghong Wang
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - George J. Chang
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Richard Carlson
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Katherine Hagan
- Department of Colorectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Marta Davila
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - John Stroehlein
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| |
Collapse
|
13
|
Choi YS, Kim WS, Hwang SW, Park SH, Yang DH, Ye BD, Myung SJ, Yang SK, Byeon JS. Clinical outcomes of submucosal colorectal cancer diagnosed after endoscopic resection: a focus on the need for surgery. Intest Res 2020; 18:96-106. [PMID: 32013317 PMCID: PMC7000636 DOI: 10.5217/ir.2019.00092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/16/2019] [Indexed: 12/24/2022] Open
Abstract
Background/Aims We aimed to investigate the proportion of and risk factors for residual cancer and/or lymph node metastasis after surgery was performed because of high-risk pathological features in endoscopic resection specimen of suspected superficial submucosal colorectal cancer (SSMC). Methods We reviewed medical records of 497 patients (58.8 ± 9.8 years, 331 males) undergoing endoscopic resection of suspected SSMC. High-risk pathological features included: deep submucosal cancer invasion ≥ 1,000 μm; positive lymphovascular and/or perineural invasion; poorly differentiated adenocarcinoma; and positive resection margin. We investigated the occurrence of additional surgery and residual cancer and/or lymph node involvement in the surgical specimen. Results En bloc resection was performed in 447 patients (89.9%). High-risk pathological features were detected in 372 patients (74.8%). Additional surgery was performed in 336 of 372 patients with high-risk pathological features. Of these, 47 surgical specimens (14.0%) showed residual cancer and/or lymph node metastasis. Piecemeal resection was more common in those with residual cancer and/or lymph node involvement than those without (9/47 [19.1%] vs. 24/289 [8.3%], P= 0.032). Positive resection margin was also significantly associated with positive residual cancer and/or lymph node involvement. As the number of high-risk pathological features increased, the risk of regional lymph node metastasis increased proportionally (P= 0.002). Conclusions High-risk pathological features were frequently detected after endoscopic resection of suspected SSMC while residual cancer and/or lymph node metastasis were not commonly present in the additional surgical specimen. Further optimized strategy for proper endoscopic management of suspected SSMC is necessary.
Collapse
Affiliation(s)
- Yun Sik Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wan Soo Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Prophylactic Snare Tip Soft Coagulation and Its Impact on Adenoma Recurrence After Colonic Endoscopic Mucosal Resection. Dig Dis Sci 2019; 64:3300-3306. [PMID: 31098871 DOI: 10.1007/s10620-019-05666-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Up to 20% of patients can have recurrence of adenomatous tissue at first surveillance study after colon endoscopic mucosal resection of large polyps. AIMS To determine whether an educational intervention discussing thermal ablation of lateral margins of the mucosectomy site of post-endoscopic mucosal resection defect with snare tip soft coagulation (STSC) would decrease adenoma recurrence. METHODS We performed a single-center quality improvement project from November 1, 2016, to November 30, 2017. Gastroenterologists underwent an educational intervention demonstrating the treatment of peripheral margins of mucosectomy site with STSC after standard mucosectomy technique. These cases (intervention group) were compared with consecutive procedures performed prior to commencement of the quality improvement study (pre-intervention group). Patients with large colorectal lesions (≥ 20 mm) were included. RESULTS Of the 120 patients here included, overall demographics of the groups were similar and the most common histology was sessile serrated adenoma (study group 45% vs 32% control group). Adenoma recurrence on intervention group and pre-intervention group was 12% versus 30%; p = 0.01. On univariate analysis, biopsy prior to mucosectomy, intraprocedural bleeding, and application of STSC on mucosectomy defect were the strongest predictors of adenoma recurrence. Adenoma recurrence in the intervention group was significantly lower than in the pre-intervention group in both univariate (odds ratio, 0.3 [95% CI, 0.11-0.80]) and multivariate analyses (odds ratio, 0.2 [95% CI, 0.12-0.92]). CONCLUSIONS The implementation of STSC of post-endoscopic mucosal resection peripheral defects is clinically feasible and significantly decreased adenoma recurrence.
Collapse
|
15
|
Park EY, Baek DH, Song GA, Kim GH, Lee BE, Park DY. Long-term outcomes of endoscopically resected laterally spreading tumors with a positive histological lateral margin. Surg Endosc 2019; 34:3999-4010. [PMID: 31605216 DOI: 10.1007/s00464-019-07187-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND With advances in diagnostic endoscopy, the incidence of superficial colorectal tumors, including laterally spreading tumors (LSTs), has increased. However, little is known about the long-term results of LSTs with positive lateral margin after endoscopic treatment. This study aimed to evaluate the long-term clinical outcomes and risk factors for local recurrence of LSTs with positive lateral margin after initial endoscopic resection. METHODS We performed a retrospective analysis of the medical records of 324 patients who had 363 LSTs with positive lateral margin after endoscopic resection at a tertiary academic medical center. The medical records from 2011 to 2015 were analyzed. Local recurrence was confirmed through endoscopic finding and subsequent biopsy analysis. We assessed the local recurrence rate and performed multivariate analyses to identify the factors associated with local recurrence. RESULTS Follow-up colonoscopy was performed in 176 of 363 LSTs. The local recurrence rate was 6.3% (11/176), with a median (interquartile range [IQR]) follow-up period of 19.8 (12.4-46.5) months. In multivariate analysis, local recurrence was associated with piecemeal resection (odds ratio [OR] 6.62, 95% confidence interval [CI] 1.28-34.33; p = 0.024) and inversely associated with thermal ablation (OR 0.033, 95% CI 0.00-0.45; p = 0.011). At surveillance colonoscopy, histology of the recurrent tumor was adenoma in 10 (90.9%) of 11; these were treated endoscopically. CONCLUSIONS In this retrospective study, we found that endoscopically resected LSTs with positive lateral margin have a low recurrence rate. Piecemeal resection was associated with higher local recurrence, and thermal ablation was inversely associated with local recurrence. Endoscopic resection with positive lateral margin combined with thermal ablation leads to a low recurrence rate.
Collapse
Affiliation(s)
- Eun Young Park
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49421, South Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49421, South Korea.
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49421, South Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49421, South Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan, 49421, South Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| |
Collapse
|
16
|
Abstract
Although an established standard, conventional endoscopic mucosal resection (EMR) has disseminated despite an absence of studies demonstrating the value of submucosal injection. Several consequences of poorly executed submucosal injection may increase the difficulty and risk of EMR. Underwater EMR (UEMR), an alternative resection method for colonic neoplasms, avoids the need for submucosal injections. In comparison with reported outcomes of EMR, UEMR achieves similar rates of complete resection with comparable safety, with lower rates of recurrence and fewer repeat procedures. UEMR also compares favorably with endoscopic submucosal dissection in terms of procedure time and rates of complete resection, recurrence, and complications.
Collapse
Affiliation(s)
- Andrew Nett
- Interventional Endoscopy Services, California Pacific Medical Center, 1101 Van Ness Ave. Floor 3, San Francisco, CA 94109, USA.
| | - Kenneth Binmoeller
- Interventional Endoscopy Services, California Pacific Medical Center, 1101 Van Ness Ave. Floor 3, San Francisco, CA 94109, USA
| |
Collapse
|
17
|
Abstract
BACKGROUND Incomplete polyp resection (IPR) is recognized as a risk factor for interval colorectal cancer (ICC), and is, therefore, an important issue in polypectomy. Cold snare polypectomy (CSP) is a procedure that does not involve electrocautery and has no burn effect. Therefore, there is the possibility that the risk of ICC associated with IPR is higher in cases undergoing CSP than in those undergoing hot polypectomy. However, little is known about the risk factors for IPR after CSP. PURPOSE Precise identification of the risk factors can lead to prevention of IPR after CSP. Therefore, we performed this observational study for accurate identification of the risk factors for IPR after CSP. METHODS Medical records of a total of 501 patients with 1177 colorectal polyps that were resected at Omori Red Cross Hospital between October 2017 and March 2018 were retrospectively reviewed. The lateral and deep margins of the resected polyps were evaluated to check for the resection completeness. RESULTS Among the 1177 polyp resections, 1163 were included in the final analysis. IPR was detected in 206 (17.7%) cases. Performance of the resection by a trainee (OR (95% CI) 1.87 (1.328-2.632); P < 0.001) was identified as an independent risk factor for IPR in patients undergoing CSP. CONCLUSIONS Performance of the polypectomy by a trainee was identified as a significant risk factor for IPR in patients undergoing CSP. Prospective, randomized studies are necessary in the future to develop effective methods for the prevention/control of IPR after CSP.
Collapse
|
18
|
Meier B, Wannhoff A, Klinger C, Caca K. Novel technique for endoscopic en bloc resection (EMR+) - Evaluation in a porcine model. World J Gastroenterol 2019; 25:3764-3774. [PMID: 31391771 PMCID: PMC6676554 DOI: 10.3748/wjg.v25.i28.3764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/24/2019] [Accepted: 06/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic en bloc resection of larger polyps is relevant because risk of advanced neoplasia or malignancy correlates with tumor size. Recurrence rates after piecemeal endoscopic mucosal resection (EMR) are high and endoscopic submucosal dissection (ESD) is associated with higher complication rates in the western world.
AIM To develop a modified endoscopic en bloc resection technique using an external additional working channel and novel agent for submucosal injection.
METHODS EMR+ was considered as modified grasp and snare technique. For simultaneous use of a grasping and cutting device a novel additional working channel was used (AWC®, Ovesco Endoscopy, Tübingen, Germany). AWC® is installed on the outer surface of the endoscope, covered with a plastic sleeve and designed for single use. For submucosal injection a new agent consisting of poloxamers was used (LiftUp®, Ovesco Endoscopy, Tübingen, Germany). The agent is liquid at room temperature and forms a stable and permanent gel cushion after injection. Safety of LiftUp® has been shown in a pre-clinical study in domestic pigs. LiftUp® is commercially not yet available but approval is expected in early 2019. EMR+ was first developed ex vivo (explanted pig stomach) and subsequently evaluated in vivo (stomach, porcine model, 3 domestic pigs). Main outcome measurements were: Procedure time, macroscopic en bloc resection and adverse events.
RESULTS Concept of EMR+ was first developed ex vivo (explanted pig stomach). Ex vivo, 22 resections were performed after technique was established. Median procedure time (measured from begin of injection to extraction of resection specimen) was 7 min (range 5-11, SD 1.68) and median size of resection specimens was 30 mm × 26 mm × 11 mm ex vivo. Subsequently 13 resections were performed in vivo (stomach, porcine model, 3 domestic pigs). In vivo, median procedure time (measured from begin of injection to extraction of resection specimen) was 5 min (range 3-12, SD 2.72) and median size of resection specimens was 35 mm × 35 mm × 11 mm. In vivo, resection was macroscopic complete in 92.3%, major adverse events were not observed. In one case (7.7%) minor periprocedural bleeding was observed and managed by coagulation.
CONCLUSION EMR+ appeared to be effective and safe and was easy and fast to perform in the porcine model. EMR+ needs to be further evaluated clinically in comparative trials.
Collapse
Affiliation(s)
- Benjamin Meier
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Andreas Wannhoff
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Christoph Klinger
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| | - Karel Caca
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg 71640, Germany
| |
Collapse
|
19
|
Komeda Y, Watanabe T, Sakurai T, Kono M, Okamoto K, Nagai T, Takenaka M, Hagiwara S, Matsui S, Nishida N, Tsuji N, Kashida H, Kudo M. Risk factors for local recurrence and appropriate surveillance interval after endoscopic resection. World J Gastroenterol 2019; 25:1502-1512. [PMID: 30948913 PMCID: PMC6441916 DOI: 10.3748/wjg.v25.i12.1502] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/21/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) have not been identified. Additionally, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been established.
AIM To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate interval.
METHODS Three hundred and sixty patients (1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate analyses.
RESULTS Local recurrence was observed in 31 of 360 (8.6%) patients [31 of 1412 (2.2%) lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection to recurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces (3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05).
CONCLUSION Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.
Collapse
Affiliation(s)
- Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Toshiharu Sakurai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Masashi Kono
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Kazuki Okamoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Tomoyuki Nagai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Satoru Hagiwara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Shigenaga Matsui
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Naoko Tsuji
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka 589-8511, Japan
| |
Collapse
|
20
|
Agarwal A, Garimall S, Colling C, Ahmad NA, Kochman ML, Ginsberg GG, Chandrasekhara V. Incidence and risk factors of advanced neoplasia after endoscopic mucosal resection of colonic laterally spreading lesions. Int J Colorectal Dis 2018; 33:1333-1340. [PMID: 29744577 DOI: 10.1007/s00384-018-3075-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate advanced neoplasia (AN) after endoscopic mucosal resection (EMR) of colonic laterally spreading lesions (LSLs). METHODS A retrospective study of patients who underwent injection-assisted EMR of colonic LSLs ≥ 10 mm was performed. Primary outcome was overall rate of AN at initial surveillance colonoscopy. Secondary outcomes were the rates of residual AN (rAN) at the EMR site and metachronous AN (mAN), and analysis of risk factors for AN, including effect of surveillance guidance. RESULTS Three hundred seventy-four patients underwent successful EMR for 388 LSLs. AN occurred in 66/374 (17.6%) patients on initial surveillance colonoscopy at median follow-up of 364.5 days. Two patients had both rAN and mAN, for a total of 68 instances of AN, including 30/374 (8.0%) cases of rAN and 38/374 (10.2%) cases of mAN. On multivariate analysis, use of piecemeal resection was associated with increased likelihood of residual AN (P = 0.003, OR 9.2, 95% CI 2.1-33.3). Twenty-nine out of thirty cases (96.7%) of rAN were successfully endoscopically managed at surveillance colonoscopy. CONCLUSIONS AN occurred in 17.6% of all patients at initial surveillance colonoscopy at a median of 1 year after EMR. Roughly half of the instances of AN were metachronous lesions. Our data support a 1-year surveillance interval after EMR of LSLs ≥ 10 mm with careful inspection of the entire colon, not just the prior resection site.
Collapse
Affiliation(s)
- Amol Agarwal
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sidyarth Garimall
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Caitlin Colling
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Nuzhat A Ahmad
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael L Kochman
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory G Ginsberg
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology, Mayo School of Medicine, 200 First St. SW, Rochester, MN, 55905, USA.
| |
Collapse
|
21
|
Minamino H, Nagami Y, Shiba M, Hayashi K, Sakai T, Ominami M, Fukunaga S, Hayakawa T, Aomatsu K, Sugimori S, Tanigawa T, Yamagami H, Watanabe T, Fujiwara Y. Colorectal polyps located across a fold are difficult to resect completely using endoscopic mucosal resection: A propensity score analysis. United European Gastroenterol J 2018; 6:1547-1555. [PMID: 30574325 DOI: 10.1177/2050640618797854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023] Open
Abstract
Background Incomplete polyp resection during colorectal endoscopic mucosal resection (EMR) might contribute to the development of interval cancer. Objective This retrospective study aimed to determine the incidence of incomplete polyp resection during EMR of colorectal polyps located across a fold compared with that of colorectal polyps located between folds. Methods In total, 262 patients with 262 lesions that were ≥10 mm in diameter and treated with conventional EMR were enrolled. The main outcome was the incidence of incomplete polyp resections. Propensity score matching and inverse probability of treatment weighting (IPTW) were performed to reduce the effects of selection bias. Results Fifty-seven lesions (21.8%) were incompletely resected. After propensity score matching, the lesions located across a fold were at higher risk of incomplete resection than those between folds (26/68, 38.2% vs 7/68, 10.3%; odds ratio (OR): 3.71; 95% confidence interval (CI): 1.61-8.56; p < 0.01). These findings persisted after adjusting for the differences at baseline using the IPTW method (OR: 3.63; 95% CI: 1.72-7.63; p = 0.001). Conclusions There is an increased risk of an incomplete polyp resection for a colorectal polyp that is located across a fold compared with that for a polyp that is located between folds.
Collapse
Affiliation(s)
- Hiroaki Minamino
- Department of Gastroenterology, Baba Memorial Hospital 4-244, Sakai City, Japan.,Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan.,Department of Gastroenterology, Izumiotsu Municipal Hospital 16-1, Izumiotsu City, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Kappei Hayashi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Taishi Sakai
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Masaki Ominami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Tsuyoshi Hayakawa
- Department of Gastroenterology, Izumiotsu Municipal Hospital 16-1, Izumiotsu City, Japan
| | - Kazuki Aomatsu
- Department of Gastroenterology, Izumiotsu Municipal Hospital 16-1, Izumiotsu City, Japan
| | - Satoshi Sugimori
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Hirokazu Yamagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine 1-4-3, Osaka, Japan
| |
Collapse
|
22
|
Vinsard DG, Kandel P, Mejia Perez LK, Bingham RL, Lennon RJ, Woodward TA, Gomez V, Raimondo M, Bouras EP, Wallace MB. Adenoma recurrence after endoscopic mucosal resection: propensity score analysis of old and new colonoscopes and Sydney recurrence tool implementation. Endosc Int Open 2018; 6:E230-E241. [PMID: 29423433 PMCID: PMC5803001 DOI: 10.1055/s-0043-122070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Risk factors for colorectal adenoma recurrence after endoscopic mucosal resection (EMR) have been well documented. We assessed the efficacy of the newer 190 colonoscope versus the standard 180 colonoscope for complete resection of lateral spreading lesions. PATIENTS AND METHODS A single-center, retrospective study of patients who underwent EMR with Olympus 180 or 190 colonoscopes from January 1, 2010 to September 30, 2016. We included patients with lesions ≥ 20 mm and surveillance colonoscopy (SC1) after index EMR. A propensity score approach with inverse probability weighting was used to control for potential confounders. A secondary aim was to identify risk factors for recurrence and assess the applicability of the Sydney EMR recurrence tool (SERT) by grading each lesion of our cohort and analyzing associations with recurrence. RESULTS Two hundred ninety-one lesions met inclusion criteria for the study. Odds ratio (OR) for recurrence with the 190 colonoscope was 1.06 ( P = .85). Adenoma size ( P = .02) and use of argon plasma coagulation (APC; P < .001) were risk factors for recurrence. Lesions with SERT scores > 0 had a higher recurrence risk during follow-up (32 % vs 21 %; OR 1.71; P = .05). Lesions with SERT scores = 0 reached a plateau for recurrence at 12 and 18 months in Kaplan-Meier curves. CONCLUSIONS The use of 190 colonoscopes did not measurably affect adenoma recurrence at SC1. Recurrence was associated with adenoma size, complementary APC for resection, and SERT scores > 0. Lesions with SERT scores = 0 that remain negative for recurrence at 18 months may return to routine surveillance.
Collapse
Affiliation(s)
- Daniela Guerrero Vinsard
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
- Division of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, United States
| | - Pujan Kandel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Russell L. Bingham
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Ryan J. Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Timothy A. Woodward
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Victoria Gomez
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Massimo Raimondo
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Ernest P. Bouras
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| | - Michael B. Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, United States
| |
Collapse
|
23
|
Seo M, Song EM, Kim GU, Hwang SW, Park SH, Yang DH, Kim KJ, Ye BD, Myung SJ, Yang SK, Byeon JS. Local recurrence and subsequent endoscopic treatment after endoscopic piecemeal mucosal resection with or without precutting in the colorectum. Intest Res 2017; 15:502-510. [PMID: 29142518 PMCID: PMC5683981 DOI: 10.5217/ir.2017.15.4.502] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Precutting before endoscopic piecemeal mucosal resection (EPMR) may increase colorectal polyp resection effectiveness. We aimed to identify risk factors for recurrence after conventional EPMR (CEPMR) and precut EPMR (PEPMR) and investigated endoscopic treatment outcomes for recurrent cases. Methods The medical records of patients with colorectal polyps treated by EPMR were analyzed. Patients without follow-up surveillance colonoscopies were excluded. Results Among 359 lesions, the local recurrence rate on the first surveillance colonoscopy was 5.8% (18/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively. Among lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence on subsequent surveillance colonoscopy were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. Larger tumor size was the only independent risk factor for recurrence (odds ratio, 7.93; 95% confidence interval, 1.95–32.30; P<0.001). Endoscopic treatment was performed for all 27 recurrences. A combination of ≥2 endoscopic treatment modalities was used in 19 of 27 recurrences (70.4%). Surveillance colonoscopies were performed in 20 of 27 recurrences after endoscopic treatment. One (5.0%) had a re-recurrence and was treated by surgical resection because recurrence occurred at the appendiceal orifice. Nineteen of 20 lesions (95.0%) could be cured endoscopically, although 3 of the 19 showed second or third recurrences and were treated by repeat endoscopic resection. Conclusions The local recurrence rates after CEPMR and PEPMR were similar. Larger tumor size was an independent risk factor for local recurrence after EPMR. Endoscopic treatment of recurrences resulted in high cure rates, although combination methods were necessary in many cases.
Collapse
Affiliation(s)
- Myeongsook Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwang Un Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
24
|
Kandel P, Wallace MB. Colorectal endoscopic mucosal resection (EMR). Best Pract Res Clin Gastroenterol 2017; 31:455-471. [PMID: 28842056 DOI: 10.1016/j.bpg.2017.05.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/28/2017] [Indexed: 01/31/2023]
Abstract
Colonoscopy has the benefit of detecting and treating precancerous adenomatous polyps and thus reduces mortality associated with CRC. Screening colonoscopy is the keystone for prevention of colorectal cancer. Over the last 20 years there has been increased in the management of large colorectal polyps from surgery to endoscopic removal techniques which is less invasive. Traditionally surgical resection was the treatment of choice for many years for larger polyps but colectomy poses significant morbidity of 14-46% and mortality of up to 7%. There are several advantages of endoscopic resection technique over surgery; it is less invasive, less expensive, has rapid recovery, and preserves the normal gut functions. In addition patient satisfaction and efficacy of EMR is higher with minor complications. Thus, this has facilitated the development of advanced resection technique for the treatment of large colorectal polyps called as endoscopic mucosal resection (EMR).
Collapse
Affiliation(s)
- Pujan Kandel
- Department of Gastroenterology and Hepatology Mayo Clinic Florida 4500 San Pablo Road Jacksonville, FL 32224, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology Mayo Clinic Florida 4500 San Pablo Road Jacksonville, FL 32224, USA.
| |
Collapse
|
25
|
The role of endoscopic mucosal resection in gastrointestinal precancerous lesions. MARMARA MEDICAL JOURNAL 2017. [DOI: 10.5472/marumj.344819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
26
|
Sansone S, Ragunath K, Bianco MA, Manguso F, Beg S, Bagewadi A, Din S, Rotondano G. Clinical utility of the SMSA grading tool for the management of colonic neoplastic lesions. Dig Liver Dis 2017; 49:518-522. [PMID: 28096059 DOI: 10.1016/j.dld.2016.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/18/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Whilst polyp size has been traditionally used as a predictor of the complexity of endoscopic resection, the influence of other factors is increasingly recognised. The SMSA grading system takes into account polyp Site, Morphology, Size and Access, with higher scores correlating with increased technical difficulty. AIMS To evaluate whether the SMSA grading tool correlates with endoscopic and clinical outcomes. METHODS This retrospective study was conducted at two high volume centres in the United Kingdom and Italy. All polyps identified at colonoscopy were included in this study and classified as per the SMSA grading system. RESULTS A total of 1668 lesions were resected in 1016 patients. There was a positive correlation between increasing SMSA level and the inability to resect lesions "en bloc" (p<0.001). Histologically complete clearance was higher in the lower SMSA groups (p<0.0001). Additional endoscopic therapies, were more commonly required with the higher SMSA groups to achieve histological clearance (p<0.0001). Moreover, advanced histology in resection specimens and procedural complications were significantly less common in SMSA level 1 lesions compared to level 3 or 4 lesions (p<0.0001). CONCLUSIONS The SMSA grading tool is a useful predictor of outcome following the resection of colonic neoplastic lesions.
Collapse
Affiliation(s)
- Stefano Sansone
- Gastroenterology, Hospital Maresca, ASLNA3sud, Torre del Greco, Italy; NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK.
| | - Krish Ragunath
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | | | | | - Sabina Beg
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | - Abhay Bagewadi
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | - Said Din
- Derby Teaching Hospitals, NHS Foundation Trust, UK
| | | |
Collapse
|
27
|
Pathiraja A, Ziprin P, Shiraz A, Mirnezami R, Tizzard A, Brown B, Demosthenous A, Bayford R. Detecting colorectal cancer using electrical impedance spectroscopy: an ex vivo feasibility study. Physiol Meas 2017; 38:1278-1288. [PMID: 28333038 DOI: 10.1088/1361-6579/aa68ce] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Colorectal cancer is the fourth most common cancer worldwide, with a lifetime risk of around 20%. Current techniques do not allow clinicians to objectively assess tissue abnormality during endoscopy and perioperatively. A method capable of objectively assessing samples in real time and which can be included in minimally invasive diagnostic and management strategies would be highly transformative. Electrical impedance spectroscopy (EIS) may provide such a solution. This paper presents a feasibility study on using EIS in assessing colorectal tissue. APPROACH We performed tetrapolar EIS using ZedScan on excised human colorectal tumour tissue and the matched normal colonic mucosa in 22 freshly resected specimens following elective surgery for colorectal cancer. Histopathological examination was used to confirm the final diagnosis. Statistical significance was assessed using the Wilcoxon signed rank test. MAIN RESULTS Tetrapolar EIS could discriminate cancer with statistically significant results when applying frequencies between 305 Hz and 625 kHz (p < 0.05). 300 Ω was set as the transfer impedance threshold to detect cancer. Thus, the area under the corresponding receiver operating characteristic curve for this threshold was 0.7105. SIGNIFICANCE This feasibility study demonstrates that impedance spectra changes in colorectal cancer tissue are detectable and may be statistically significant, suggesting that EIS has the potential to be the core technology in a novel non-invasive point of care test for detecting colorectal cancer. These results warrant further development by increasing the size of the study with a device specifically designed for colorectal cancer.
Collapse
|
28
|
Sakamoto H, Hayashi Y, Miura Y, Shinozaki S, Takahashi H, Fukuda H, Okada M, Ino Y, Takezawa T, Sunada K, Lefor AK, Yamamoto H. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open 2017; 5:E123-E129. [PMID: 28337483 PMCID: PMC5361878 DOI: 10.1055/s-0042-122778] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and study aims The pocket-creation method (PCM) is a novel strategy for endoscopic submucosal dissection (ESD). The aim of this study is to determine the efficacy of the PCM for colorectal laterally spreading tumors, non-granular type (LST-NG). Patients and methods The records of 126 consecutive patients with colorectal LST-NG who underwent ESD between April 2012 and July 2015 were retrospectively reviewed. Patients were divided into PCM (n = 73) and conventional method (CM) (n = 53) groups. Results The en bloc resection rate in the PCM group was significantly higher than in the CM group (100 % [73/73] vs. 92 % [49/53], P = 0.03). The en bloc resection rate with severe fibrosis was higher in the PCM group than in the CM group (100 % [3/3] vs. 60 % [3/5]). The R0 resection rate for the two groups was not statistically significantly different (93 % [68/73] vs. 91 % [48/53], P = 0.74). The perforation rate in the PCM group was lower than in the CM group although not statistically significantly less (0 % 0/73 vs. 4 % 2/53, P = 0.18). For lesions resected en bloc, dissection speed for the PCM group was significantly faster than for the CM group (median [IQR], 19 [13 -24] vs. 14 [10 - 22] mm2/min, P = 0.03). Conclusion ESD using PCM achieves a reliable and safe resection of colorectal LST-NG.
Collapse
Affiliation(s)
- Hirotsugu Sakamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshikazu Hayashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yoshimasa Miura
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Satoshi Shinozaki
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan,Shinozaki Medical Clinic, Utsunomiya, Japan
| | - Haruo Takahashi
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Hisashi Fukuda
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Masahiro Okada
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Japan
| | - Yuji Ino
- 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,Corresponding author Hironori Yamamoto, MD PhD 3311-1 YakushijiShimotsukeTochigi 329-0498Japan+81-285-406598
| |
Collapse
|
29
|
Bronsgeest K, Huisman JF, Langers A, Boonstra JJ, Schenk BE, de Vos tot Nederveen Cappel WH, Vasen HFA, Hardwick JCH. Safety of endoscopic mucosal resection (EMR) of large non-pedunculated colorectal adenomas in the elderly. Int J Colorectal Dis 2017; 32:1711-1717. [PMID: 28884225 PMCID: PMC5691088 DOI: 10.1007/s00384-017-2892-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) has been proven to be safe and effective for the treatment of colorectal adenomas. However, data are limited on the safety of this technique for large polyps and in elderly patients. Aims of our study were to examine the bleeding and perforation rates in patients with large non-pedunculated adenomas (≥20mm) and to evaluate the influence of size (≥40mm) and age (≥75 years) on the complication rates. METHODS In this multicenter retrospective study, patients who underwent EMR of non-pedunculated adenomas ≥20mm between January 2012 and March 2016 were included. The demographics of the patients, the use of antithrombotic drugs, size of the polyps, type of resection, pathology report, occurrence of post-polypectomy bleeding, and perforation- and recurrence rate were collected. RESULTS In 343 patients, 412 adenomas were removed. Eighty patients (23.3%) were ≥75 years of age, 138 polyps (33.5%) were ≥40mm. Bleeding complications were observed in 28 cases (6.8%) and were found significantly more frequent in adenomas ≥40mm, independent of the use of antithrombotic therapy. Five perforations (1.2%) were described, not related to the size of the polyp. There was no significant difference in complication rates between patients <75 years and patients ≥75 years. Bleeding complications rates were significantly higher in patients receiving double antithrombotic therapy. CONCLUSION EMR is safe in elderly patients. EMR of adenomas of ≥40mm was associated with more bleeding complications. Future studies should address how the bleeding rates can be reduced in these patients, especially in those who use double antithrombotic treatment.
Collapse
Affiliation(s)
- K. Bronsgeest
- Department of Gastroenterology and Hepathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J. F. Huisman
- Department of Gastroenterology and Hepathology, Isala, Zwolle, The Netherlands
| | - A. Langers
- Department of Gastroenterology and Hepathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J. J. Boonstra
- Department of Gastroenterology and Hepathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - B. E. Schenk
- Department of Gastroenterology and Hepathology, Isala, Zwolle, The Netherlands
| | | | - H. F. A. Vasen
- Department of Gastroenterology and Hepathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - J. C. H. Hardwick
- Department of Gastroenterology and Hepathology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| |
Collapse
|
30
|
Lim SH, Levenick JM, Mathew A, Moyer MT, Dye CE, McGarrity TJ. Endoscopic Management of Large (≥2 cm) Non-pedunculated Colorectal Polyps: Impact of Polyp Morphology on Outcomes. Dig Dis Sci 2016; 61:3572-3583. [PMID: 27696095 DOI: 10.1007/s10620-016-4314-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Referrals for endoscopic management of large non-pedunculated (NP) colorectal polyps have increased as new techniques have emerged. The outcomes for referred large NP polyps based on the polyp morphology were investigated METHODS: A retrospective review of patients referred for large (≥20 mm) NP polyp management from January 2010 through June 2014 was completed. Polyp morphology was classified as either a NP polyp with depression (M1) or NP polyp with no depression (M0). Differences in treatment, histology, adverse events, outcomes at follow-up including residual disease, and need for surgical treatment were determined by morphology for all NP polyps ≥20 mm in size. RESULTS One-hundred and sixty-nine M1 and 136 M0 polyps ≥20 mm were removed endoscopically during the review period. Mean size was 31.9 ± 11.0 mm in M1, and 26.8 ± 9.5 mm in M0 group (p < 0.0001). En bloc resection was possible in 18.3 % of M1 and 30.9 % of M0 lesions (p = 0.011) with endoscopic submucosal dissection used in 13 and 2.2 % of polyps, respectively (p < 0.0001). Residual polyp was found in 26.5 % (27/102) of M1 and 13.6 % (12/88) of M0 patients at surveillance colonoscopy (p = 0.029). On multivariate analysis, piecemeal resection and M1 morphology showed significant association with residual polyp (OR 4.23, 95 % CI 1.23-14.59, p = 0.022, and OR 2.15, 95 % CI 1.004-4.62, p = 0.049, respectively). CONCLUSION Effective endoscopic management of large NP colorectal polyps, especially polyps without depression (M0), can be accomplished in the great majority of patients. Polyp morphology, particularly the presence or absence of depression, is a useful tool which influenced treatment, histology, and outcomes.
Collapse
Affiliation(s)
- Seon Hee Lim
- Division of Gastroenterology, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 138-984, Korea
| | - John M Levenick
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Abraham Mathew
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Matthew T Moyer
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Charles E Dye
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Thomas J McGarrity
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| |
Collapse
|
31
|
Sekiguchi M, Matsuda T, Saito Y. Surveillance after endoscopic and surgical resection of colorectal cancer. Best Pract Res Clin Gastroenterol 2016; 30:959-970. [PMID: 27938790 DOI: 10.1016/j.bpg.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 08/05/2016] [Accepted: 09/06/2016] [Indexed: 01/31/2023]
Abstract
With the increase in colorectal cancer burden, surveillance following endoscopic and surgical resection is an essential issue. The aim of surveillance programs is improvement of patient survival by early detection of residual tumor tissue or local recurrence, metachronous colorectal tumors, and metastases. Appropriate surveillance should be determined according to this risk of factors. In current guidelines, only surveillance colonoscopy is recommended after endoscopic resection of polyps with high-grade dysplasia, whereas intensive, multimodality surveillance using colonoscopy, radiological imaging and tumor marker measurements is recommended following surgical resection of invasive colorectal cancer. Detailed recommendations, including the timing of surveillance, are described based on high-quality evidence. However, there are still many unresolved issues for which more high-quality evidence is required.
Collapse
Affiliation(s)
- Masau Sekiguchi
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Takahisa Matsuda
- Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan; Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Division of Screening Technology, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
32
|
Bhurwal A, Bartel MJ, Heckman MG, Diehl NN, Raimondo M, Wallace MB, Woodward TA. Endoscopic mucosal resection: learning curve for large nonpolypoid colorectal neoplasia. Gastrointest Endosc 2016; 84:959-968.e7. [PMID: 27109458 DOI: 10.1016/j.gie.2016.04.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colorectal EMR for nonpolypoid neoplasia achieves better outcomes when performed by expert endoscopists. The time point at which the endoscopist achieves expert level remains to be defined. The objective of this study was to establish a learning curve of colorectal EMR for nonpolypoid neoplasia based on residual tissue on surveillance colonoscopy and adverse event rate. METHODS Five hundred seventy-eight consecutive patients underwent EMR of colorectal neoplasia by 1 of 3 primary endoscopists between December 2004 and September 2013 in a tertiary academic center. Primary analyses focused on the largest lesion for patients with more than 1 lesion (median age, 69 years; median polyp size, 30 mm; 51% en bloc resection). Data on surveillance colonoscopy were available for 74%. Learning curves were calculated for each of the 3 main outcome measurements: the presence of residual neoplasia on surveillance colonoscopy, endoscopic assessment of incomplete EMR, and the occurrence of an immediate bleeding adverse event. RESULTS Residual neoplasia on surveillance colonoscopy was present for 23.2% of patients, the rate of endoscopist-assessed incomplete EMR was 27.6%, and immediate bleeding adverse events occurred in 6.9% of patients. Although there was between-endoscopist variability, the overall rates of residual neoplasia and incomplete EMR decreased to below 20% to 25% after 100 EMRs; initial decreases in both rates were observed for earlier EMRs. Immediate bleeding adverse events occurred at a low frequency for each endoscopist across all EMRs. Perforation requiring surgical intervention occurred in 1 patient (0.2%). CONCLUSIONS This study demonstrated that an unexpectedly high number of 100 colorectal EMR procedures for large nonpolypoid colorectal neoplasia are required to achieve a plateau phase for crucial outcomes.
Collapse
Affiliation(s)
- Abhishek Bhurwal
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael J Bartel
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Nancy N Diehl
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Massimo Raimondo
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael B Wallace
- Division of Gastroenterology, Mayo Clinic, Jacksonville, Florida, USA
| | | |
Collapse
|
33
|
Gaglia A, Sarkar S. Evaluation and long-term outcomes of the different modalities used in colonic endoscopic mucosal resection. Ann Gastroenterol 2016; 30:145-151. [PMID: 28243034 PMCID: PMC5320026 DOI: 10.20524/aog.2016.0104] [Citation(s) in RCA: 8] [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: 03/31/2016] [Accepted: 07/04/2016] [Indexed: 02/06/2023] Open
Abstract
Endoscopic mucosal resection (EMR) has been used in western countries to remove colonic polyps for at least the last two decades. Significant experience has been accumulated and the efficacy of the method has recently been evaluated in a large meta-analysis. A number of variations to modify the technique, including knife-assisted, cap-assisted, ligation devices, and underwater EMR, have been developed in an attempt to improve outcomes. However, to date there are only limited data comparing these techniques or demonstrating the superiority of any one of them. This article reviews the current evidence on the efficacy of each of these modified techniques.
Collapse
Affiliation(s)
- Asimina Gaglia
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| | - Sanchoy Sarkar
- Department of Gastroenterology, Royal Liverpool University Hospital, Liverpool, UK
| |
Collapse
|
34
|
Ngamruengphong S, Pohl H, Haito-Chavez Y, Khashab MA. Update on Difficult Polypectomy Techniques. Curr Gastroenterol Rep 2016; 18:3. [PMID: 26714965 DOI: 10.1007/s11894-015-0476-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endoscopists often encounter colon polyps that are technically difficult to resect. These lesions traditionally were managed surgically, with significant potential morbidity and mortality. Recent advances in endoscopic techniques and instruments have allowed endoscopists to safely and effectively remove colorectal lesions with high technical and clinical success and potentially avoid invasive surgery. Endoscopic mucosal resection (EMR) has gained acceptance as the first-line therapy for large colorectal lesions. Endoscopic submucosal dissection (ESD) has been reported to be associated with higher rate of en bloc resection and less risk of short-time recurrence, but with an increased risk of adverse events. Therefore, the role of colorectal ESD should be restricted to lesions with high-risk morphologic features of submucosal invasion. In this article, we review the recent literature on the endoscopic management of difficult colorectal neoplasms.
Collapse
Affiliation(s)
- Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA
| | - Heiko Pohl
- Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Department of Gastroenterology, VA Medical Center White River Junction, White River Junction, VT, USA
| | - Yamile Haito-Chavez
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans Street, Zayed Bldg, Suite 7125B, Baltimore, MD, 21287, USA.
| |
Collapse
|
35
|
Raju GS, Lum PJ, Ross WA, Thirumurthi S, Miller E, Lynch PM, Lee JH, Bhutani MS, Shafi MA, Weston BR, Pande M, Bresalier RS, Rashid A, Mishra L, Davila ML, Stroehlein JR. Outcome of EMR as an alternative to surgery in patients with complex colon polyps. Gastrointest Endosc 2016; 84:315-25. [PMID: 26859866 PMCID: PMC4949087 DOI: 10.1016/j.gie.2016.01.067] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/27/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Patients with complex colon polyps were traditionally referred for surgery to avoid adverse events associated with endoscopic resection. Recent advances in endoscopic imaging as well as endoscopic hemostasis and clip closure allow for the use of EMR as an alternative to surgery for such lesions. To determine the outcome of treatment of complex colon polyps with EMR as an alternative to surgery, we conducted a retrospective observational study. METHODS Two hundred three patients with complex colon polyps were referred to an EMR center as an alternative to surgery. Patients underwent a protocol-driven EMR. The primary endpoint was the complete resection rate. Secondary endpoints were safety, residual adenoma rate, and incidence of missed synchronous polyps. RESULTS EMR was performed in 155 patients and was deferred in 48 patients who were referred to surgery. EMR specimens revealed benign polyps in 149 and cancer in 6 patients. EMR adverse events occurred in 7 patients, requiring hospitalization in 5 of them. None of the patients died as a result of their adverse events. Surveillance colonoscopy at 4 to 6 months after resection of a benign lesion in 137 patients revealed residual adenoma at the scar site in 6 patients and additional synchronous precancerous lesions in 117 patients that were not removed by the referring endoscopist. None underwent surgery for failure of EMR. The overall precancerous lesion burden was 2.83 per patient, the adenoma burden was 2.13 per patient, and the serrated polyp burden was .69 per patient. CONCLUSIONS EMR can be used instead of surgery for complex colon polyps in 75% of patients with few adverse events and few residual adenomas at resection sites. In addition, careful repeat examination of the entire colon for synchronous lesions overlooked by the referring endoscopist is required for most patients. ( CLINICAL TRIAL REGISTRATION NUMBER NCT01827241.).
Collapse
Affiliation(s)
- Gottumukkala S Raju
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Phillip J Lum
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - William A Ross
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Selvi Thirumurthi
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ethan Miller
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick M Lynch
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mehnaz A Shafi
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brian R Weston
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mala Pande
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Robert S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Asif Rashid
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Lopa Mishra
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marta L Davila
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - John R Stroehlein
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
36
|
Saunders BP, Tsiamoulos ZP. Endoscopic mucosal resection and endoscopic submucosal dissection of large colonic polyps. Nat Rev Gastroenterol Hepatol 2016; 13:486-96. [PMID: 27353401 DOI: 10.1038/nrgastro.2016.96] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Almost all large and complex colorectal polyps can now be resected endoscopically. Piecemeal endoscopic mucosal resection (PEMR) is an established technique with fairly low complication risk and good short-term and medium-term outcomes. Several modifications to the basic injection and snare technique have been developed contributing to safer and more complete resections. Delayed bleeding requiring reintervention is the most troublesome complication in 2-7% of patients, particularly in those with comorbidities and large, right-sided polyps. Endoscopic submucosal dissection (ESD) has become popular in Japan and has theoretical advantages over PEMR in providing a complete, en bloc excision for accurate histological staging and reduced local recurrence. These advantages come at the cost of a more complex, expensive and time-consuming procedure with a higher risk of perforation, particularly early in the procedure learning curve. These factors have contributed to the slow adoption of ESD in the West and the challenge to develop new devices and endoscopic platforms that will make ESD easier and safer. Currently, ESD indications are limited to large rectal lesions, in which procedural complications are easily managed, and for colorectal polyps with a high risk of containing tiny foci of early submucosally invasive cancer, whereby ESD may be curative compared with PEMR.
Collapse
Affiliation(s)
- Brian P Saunders
- Imperial College, London, Wolfson Unit for Endoscopy, St Mark's Academic Institute, Watford Road, Harrow HA1 3UJ, UK
| | - Zacharias P Tsiamoulos
- Imperial College, London, Wolfson Unit for Endoscopy, St Mark's Academic Institute, Watford Road, Harrow HA1 3UJ, UK
| |
Collapse
|
37
|
Bick BL, Vemulapalli KC, Rex DK. Regional center for complex colonoscopy: yield of neoplasia in patients with prior incomplete colonoscopy. Gastrointest Endosc 2016; 83:1239-44. [PMID: 26584785 DOI: 10.1016/j.gie.2015.10.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/29/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Incomplete colonoscopy increases the risk of incident proximal colon cancer postcolonoscopy. Incomplete colonoscopy is often followed by barium enema or CT colonography. We sought to describe the yield of completion colonoscopy in a regional center for complex colonoscopy. METHODS This is a retrospective cohort study of 520 consecutive patients referred to a single colonoscopist over a 14-year period for completion colonoscopy after a previous incomplete examination. RESULTS Colonoscopy was completed to the cecum in 506 of 520 patients (97.3%). A total of 913 conventional adenomas was removed in 277 patients (adenoma detection rate 53.3%). There were 184 adenomas ≥ 1 cm in size or with advanced pathology. There were 525 serrated-class lesions removed in 175 patients, including 54 sessile serrated polyps in 26 patients and 41 hyperplastic polyps greater than 1 cm in 26 patients. Nine colorectal cancers were found. We estimated that approximately 57% of the conventional adenomas, 58% of the sessile serrated polyps, 27% of the hyperplastic polyps, and all 9 cancers detected by the completion colonoscopy were beyond the extent of the previous examination. CONCLUSIONS The yield of completion colonoscopy in a cohort of patients with previous failed cecal intubation was substantial. Regional centers for complex colonoscopy can provide high rates of cecal intubation in cases of incomplete colonoscopy and high yields of lesions in these cases. The regional center for complex colonoscopy is an important medical service.
Collapse
Affiliation(s)
- Benjamin L Bick
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Krishna C Vemulapalli
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Douglas K Rex
- Department of Medicine, Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
38
|
Jung YS, Park DI, Kim WH, Eun CS, Park SK, Ko BM, Seo GS, Cha JM, Park JJ, Kim KO, Moon CM, Jung Y, Kim ES, Jeon SR, Lee CK. Risk of Advanced Colorectal Neoplasia According to the Number of High-Risk Findings at Index Colonoscopy: A Korean Association for the Study of Intestinal Disease (KASID) Study. Dig Dis Sci 2016; 61:1661-8. [PMID: 26809871 DOI: 10.1007/s10620-016-4038-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/10/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Data regarding outcomes for patients with multiple findings for high-risk adenomas are scarce. AIM To compare the risk for colorectal neoplasm (CRN) recurrence according to the number of high-risk findings. METHODS This was a retrospective and multicenter study. Patients who had one or more high-risk adenomas at the index colonoscopy and underwent follow-up colonoscopy 2.5 or more years after the index colonoscopy were included. The number of high-risk findings was defined as follows: number of adenomas larger than 1 cm + number of adenomas with HGD + number of adenomas with a villous component + existence (counted as 1) or nonexistence (counted as 0) of three or more adenomas. RESULTS A total of 1646 patients were included, and the mean duration between index and follow-up colonoscopy was approximately 4 years. The cumulative incidence rate of recurrent advanced CRN in patients with three or more high-risk findings was higher than that in patients with one or two high-risk findings (p < 0.001). However, the difference in 3-year cumulative incidence rates of recurrent advanced CRN between the two groups was not great, although it was statistically significant (4.8 vs. 2.3 %, p = 0.039). CONCLUSIONS A 3-year surveillance interval for patients with multiple high-risk findings, regardless of the number of high-risk findings, appears reasonable.
Collapse
Affiliation(s)
- Yoon Suk Jung
- Department of Internal Medicine, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, Korea.
| | - Won Hee Kim
- Digestive Disease Center, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-712, Korea.
| | - Chang Soo Eun
- Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Soo-Kyung Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, School of Medicine, Sungkyunkwan University, 108, Pyung-Dong, Jongro-Ku, Seoul, 110-746, Korea
| | - Bong Min Ko
- Department of Internal Medicine, Digestive Disease Center and Research Institute, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Geom Seog Seo
- Department of Internal Medicine, Digestive Disease Research Institute, Wonkwang University College of Medicine, Iksan, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Jun Park
- Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong Ok Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Chang Mo Moon
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Yunho Jung
- Division of Gastroenterology, Department of Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Eun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, Korea
| | - Seong Ran Jeon
- Institute for Digestive Research, Digestive Disease Center, College of Medicine, Soonchunhyang University, Seoul, Korea
| | - Chang Kyun Lee
- Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
39
|
Imai K, Hotta K, Yamaguchi Y, Kakushima N, Tanaka M, Takizawa K, Kawata N, Matsubayashi H, Shimoda T, Mori K, Ono H. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 2016; 83:954-62. [PMID: 26297870 DOI: 10.1016/j.gie.2015.08.024] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 08/07/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The technical difficulties inherent in endoscopic submucosal dissection (ESD) for colorectal neoplasms may result in the failure of en bloc resection or perforation. The aim of this retrospective study was to assess the predictors of en bloc resection failure or perforation by using preoperatively available factors. METHODS Between September 2002 and March 2013, 716 colorectal ESDs in 673 consecutive patients were performed at a tertiary cancer center. Patient characteristics, tumor location, tumor type, colonoscopy-related factors, and endoscopist experience were assessed based on a prospectively recorded institutional ESD database. Logistic regression analysis was performed to identify predictors of failure of en bloc resection or perforations, with subgroup analyses of ESDs performed by endoscopists less experienced in colorectal ESD (<40 cases) and for colonic lesions only. RESULTS On multivariate analysis, independent predictors of failure of en bloc resection or perforations were the presence of fold convergence (odds ratio [OR] 4.4; 95% confidence interval [95% CI], 1.9-9.9), protruding type (OR 3.6; 95% CI, 1.8-7.1), poor endoscope operability (OR 3.5; 95% CI, 1.8-6.9), right-sided colonic lesions (OR 3.0; 95% CI, 1.5-6.3 vs rectal lesions), left-sided colonic lesions (OR 3.2; 95% CI, 1.7-6.3, vs rectal lesions), the presence of an underlying semilunar fold (OR 2.1; 95% CI, 1.3-3.6), and a less-experienced endoscopist (OR 2.1; 95% CI, 1.3-3.6). Among less-experienced endoscopists, colonic lesions were independent predictors (right-sided colonic lesions 8.1; 95% CI, 2.9-25.1; left-sided colonic lesions 8.1; 95% CI, 2.5-28.3 vs rectal lesions). For colonic lesions, the presence of fold convergence (OR 3.7; 95% CI, 1.6-8.6), poor endoscope operability (OR 3.6; 95% CI, 1.8-7.2), a less-experienced endoscopist (OR 3.0; 95% CI, 1.7-1.8), and the presence of an underlying semilunar fold (OR 2.7; 95% CI, 1.5-4.7) were identified predictors. CONCLUSION This study successfully identified predictors of en bloc resection failure or perforation. Understanding these indicators could help to accurately stratify lesions according to technical difficulty and to appropriately select endoscopists.
Collapse
Affiliation(s)
- Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masaki Tanaka
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Keita Mori
- Clinical Trial Coordination Office, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| |
Collapse
|
40
|
Outcome and risk of recurrence for endoscopic resection of colonic superficial neoplastic lesions over 2 cm in diameter. Dig Liver Dis 2016; 48:399-403. [PMID: 26826904 DOI: 10.1016/j.dld.2015.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Large colorectal superficial neoplastic lesions are challenging to remove. This study aimed to assess the outcomes of routine endoscopic resection of large (≥2 cm and <3 cm) and giant (≥3 cm) lesions. METHODS From 4587 endoscopic resections, 265 (5.7%) large and giant lesions were removed in 249 patients. We retrospectively analyzed 125 patients (141 endoscopic mucosal resection, 73 large and 68 giant lesions) with a follow-up of 6-12 months. Rate of en bloc and piecemeal resection, recurrence and risk factors were analyzed. RESULTS En bloc was performed in 92 cases (65.2%) and piecemeal resection in 49 (34.8%). A complete endoscopic resection was achieved in 139 cases (98.5%) with radical resection in 84/139 cases (60.4%). Argon plasma coagulation was applied in 18/141 lesions (12.8%). A recurrence occurred in 16/139 lesions (11.5%). The risk of recurrence at one year was significantly higher for giant than large lesions (p=0.03). The recurrence risk was higher in treated than in non-argon plasma coagulation treated lesions (p=0.01). CONCLUSIONS endoscopic mucosal resection is a safe and effective routine treatment for large superficial neoplastic lesions. The risk factors for recurrence include giant size, non-protruding morphology, piecemeal technique and argon plasma coagulation.
Collapse
|
41
|
Briedigkeit A, Sultanie O, Sido B, Dumoulin FL. Endoscopic mucosal resection of colorectal adenomas > 20 mm: Risk factors for recurrence. World J Gastrointest Endosc 2016; 8:276-281. [PMID: 26981180 PMCID: PMC4781909 DOI: 10.4253/wjge.v8.i5.276] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/21/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To evaluate risk factors for local recurrence after endoscopic mucosal resection of colorectal adenomas > 20 mm.
METHODS: Retrospective data analysis of 216 endoscopic mucosal resections for colorectal adenomas > 20 mm in 179 patients (40.3% female; median age 68 years; range 35-91 years). All patients had at least 1 follow-up endoscopy with a minimum control interval of 2 mo (mean follow-up 6 mo/2.0-43.4 mo). Possible factors associated with local recurrence were analyzed by univariate and multivariate analysis.
RESULTS: Median size of the lesions was 30 mm (20-70 mm), 69.0% were localized in the right-sided (cecum, ascending and transverse) colon. Most of the lesions (85.6%) showed a non-pedunculated morphology and the majority of resections was in piecemeal technique (78.7%). Histology showed carcinoma or high-grade intraepithelial neoplasia in 51/216 (23.6%) lesions including 4 low risk carcinomas (pT1a, L0, V0, R0 - G1/G2). Histologically proven recurrence was observed in 33/216 patients (15.3%). Patient age > 65 years, polyp size > 30 mm, non-pedunculated morphology, localization in the right-sided colon, piecemeal resection and tubular-villous histology were found as associated factors in univariate analysis. On multivariate analysis, only localization in the right-sided colon (HR = 6.842/95%CI: 1.540-30.394; P = 0.011), tubular-villous histology (HR = 3.713/95%CI: 1.617-8.528; P = 0.002) and polyp size > 30 mm (HR = 2.563/95%CI: 1.179-5.570; P = 0.017) were significantly associated risk factors for adenoma recurrence.
CONCLUSION: Meticulous endoscopic follow-up is warranted after endoscopic mucosal resection of adenomas localized in the right-sided colon larger than > 30 mm, with tubular-villous histology.
Collapse
|
42
|
Quaresima S, Balla A, D’Ambrosio G, Bruzzone P, Ursi P, Lezoche E, Paganini AM. Endoluminal loco-regional resection by TEM after R1 endoscopic removal or recurrence of rectal tumors. MINIM INVASIV THER 2016; 25:134-40. [DOI: 10.3109/13645706.2016.1145125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
43
|
Rutter MD, Chattree A, Barbour JA, Thomas-Gibson S, Bhandari P, Saunders BP, Veitch AM, Anderson J, Rembacken BJ, Loughrey MB, Pullan R, Garrett WV, Lewis G, Dolwani S. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut 2015; 64:1847-73. [PMID: 26104751 PMCID: PMC4680188 DOI: 10.1136/gutjnl-2015-309576] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 02/07/2023]
Abstract
These guidelines provide an evidence-based framework for the management of patients with large non-pedunculated colorectal polyps (LNPCPs), in addition to identifying key performance indicators (KPIs) that permit the audit of quality outcomes. These are areas not previously covered by British Society of Gastroenterology (BSG) Guidelines.A National Institute of Health and Care Excellence (NICE) compliant BSG guideline development process was used throughout and the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to structure the guideline development process. A systematic review of literature was conducted for English language articles up to May 2014 concerning the assessment and management of LNPCPs. Quality of evaluated studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist System. Proposed recommendation statements were evaluated by each member of the Guideline Development Group (GDG) on a scale from 1 (strongly agree) to 5 (strongly disagree) with >80% agreement required for consensus to be reached. Where consensus was not reached a modified Delphi process was used to re-evaluate and modify proposed statements until consensus was reached or the statement discarded. A round table meeting was subsequently held to finalise recommendations and to evaluate the strength of evidence discussed. The GRADE tool was used to assess the strength of evidence and strength of recommendation for finalised statements.KPIs, a training framework and potential research questions for the management of LNPCPs were also developed. It is hoped that these guidelines will improve the assessment and management of LNPCPs.
Collapse
Affiliation(s)
- Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Amit Chattree
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Jamie A Barbour
- Department of Gastroenterology, Queen Elizabeth Hospital, Gateshead, UK
| | | | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - John Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
| | | | | | - Rupert Pullan
- Department of Colorectal Surgery, Torbay Hospital, Torquay, UK
| | - William V Garrett
- Department of Colorectal Surgery, Medway Maritime Hospital, Gillingham, UK
| | - Gethin Lewis
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| | - Sunil Dolwani
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| |
Collapse
|
44
|
Bianco F, Arezzo A, Agresta F, Coco C, Faletti R, Krivocapic Z, Rotondano G, Santoro GA, Vettoretto N, De Franciscis S, Belli A, Romano GM. Practice parameters for early colon cancer management: Italian Society of Colorectal Surgery (Società Italiana di Chirurgia Colo-Rettale; SICCR) guidelines. Tech Coloproctol 2015; 19:577-85. [PMID: 26403233 DOI: 10.1007/s10151-015-1361-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 02/08/2023]
Abstract
Early colon cancer (ECC) has been defined as a carcinoma with invasion limited to the submucosa regardless of lymph node status and according to the Royal College of Pathologists as TNM stage T1 NX M0. As the potential risk of lymph node metastasis ranges from 6 to 17% and the preoperative assessment of lymph node metastasis is not reliable, the management of ECC is still controversial, varying from endoscopic to radical resection. A meeting on recent advances on the management of colorectal polyps endorsed by the Italian Society of Colorectal Surgery (SICCR) took place in April 2014, in Genoa (Italy). Based on this material the SICCR decided to issue guidelines updating the evidence and to write a position statement paper in order to define the diagnostic and therapeutic strategy for ECC treatment in context of the Italian healthcare system.
Collapse
Affiliation(s)
- F Bianco
- Department of Surgical Oncology, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - A Arezzo
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - F Agresta
- Department of General Surgery, Ulss1 9 of the Veneto, Civic Hospital, Adria (TV), Italy
| | - C Coco
- Department of Surgical Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - R Faletti
- Department of Surgical Sciences, Radiology Institute University Hospital City of Health and Science, Turin University, Turin, Italy
| | - Z Krivocapic
- Clinical Center of Serbia, Institute for Digestive Disease, University of Belgrade, Belgrade, Serbia and Montenegro
| | - G Rotondano
- Department of Gastroenterology, Maresca Hospital, Torre del Greco (NA), Italy
| | - G A Santoro
- Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - N Vettoretto
- Department of General Surgery, Montichiari Hospital, Civic Hospitals of Brescia, Brescia, Italy
| | - S De Franciscis
- Department of Surgical Oncology, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - A Belli
- Department of Surgical Oncology, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, Naples, Italy
| | - G M Romano
- Department of Surgical Oncology, Istituto Nazionale Tumori, "Fondazione G. Pascale"-IRCCS, Naples, Italy.
| | | |
Collapse
|
45
|
Shergill AK, Conners EE, McQuaid KR, Epstein S, Ryan JC, Shah JN, Inadomi J, Somsouk M. Protective association of colonoscopy against proximal and distal colon cancer and patterns in interval cancer. Gastrointest Endosc 2015; 82:529-37.e1. [PMID: 25936449 PMCID: PMC4540647 DOI: 10.1016/j.gie.2015.01.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 01/27/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND The protective effect of colonoscopy against proximal colorectal cancer is variable and depends on the detection and complete removal of precancerous polyps. OBJECTIVE To estimate the efficacy of colonoscopy in a medical center with open-access screening colonoscopy since 1998. DESIGN Nested case-control study with incidence density sampling. SETTING University-affiliated Veterans Affairs Medical Center. PATIENTS Colorectal cancer (CRC) cases and control subjects selected from screening age patients matched by age, gender, and date of first primary care visit. MAIN OUTCOME MEASUREMENT Colonoscopy preceding the CRC diagnosis date. RESULTS A total of 20.2% of CRC cases had a colonoscopy in the preceding 10 years compared with 49.0% of control subjects (adjusted odds ratio [aOR], 0.20; 95% confidence interval [CI], 0.11-0.34). Colonoscopy was strongly associated with decreased odds of both distal CRC (aOR, 0.16; 95% CI, 0.07-0.34) and proximal CRC (aOR, 0.26; 95% CI, 0.11-0.58). The fraction of cases attributed to interval cancers was 10.5%. Missed lesions predominantly localized to the cecum and rectum, and recurrent lesions clustered in the hepatic flexure. Cecal intubation rate was 93% (98% in adequately prepped patients), and the adenoma detection rate was 45.2% in the control group. LIMITATIONS Single-center, retrospective case-control design. CONCLUSION In an open access colonoscopy program characterized by a high cecal intubation rate and adenoma detection rate, colonoscopy was strongly associated with reduced odds of both distal and proximal CRC. Among interval cancers, missed lesions clustered in the cecum and rectum and recurrent lesions in the hepatic flexure.
Collapse
Affiliation(s)
- Amandeep K. Shergill
- Department: Medicine, Division of Gastroenterology, San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA
| | - Erin E. Conners
- Department: Medicine, Division of Gastroenterology, San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA,Department: Doctoral Program in Public Health, University of California San Diego and San Diego State University, San Diego, CA
| | - Kenneth R. McQuaid
- Department: Medicine, Division of Gastroenterology, San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA
| | - Sara Epstein
- Department: Medicine, University of California San Francisco, San Francisco, CA
| | - James C. Ryan
- Department: Medicine, Division of Gastroenterology, San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA
| | - Janak N. Shah
- Department: Medicine, Division of Gastroenterology, San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA
| | - John Inadomi
- Department: Medicine, Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA
| | - Ma Somsouk
- Department: Medicine, Division of Gastroenterology, San Francisco General Hospital and University of California San Francisco, San Francisco, CA
| |
Collapse
|
46
|
Complete resection of colorectal adenomas: what are the important factors in fellow training? Dig Dis Sci 2015; 60:1579-88. [PMID: 25540087 DOI: 10.1007/s10620-014-3500-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND The complete removal of adenomatous polyps is important for reducing interval cancer after colonoscopy. AIMS To identify factors affecting the completeness of colonoscopic polypectomies and to evaluate the experience level of fellows who achieve competence compared with that of experts. METHODS Medical records of 1,860 patients who underwent at least one polypectomy for an adenomatous polyp at Seoul National University Hospital between March 2011 and February 2013 were retrospectively reviewed. A total of 3,469 adenomatous polyps were included. The lateral and deep margins of the resected polyps were evaluated to check the resection completeness. RESULTS Of the 3,469 adenomatous polyps, 1,389 (40.0 %) were removed by two experts and 2,080 (60.0 %) were removed by seven fellows. In the expert-treated group, larger size [odds ratio (OR) 2.81 for ≥20 mm, 95 % confidence interval (CI) 1.64-4.84, P < 0.001] and right-sided location (OR 1.31, 95 % CI 1.05-1.63, P = 0.019) were associated with incomplete resection. In the fellow-treated group, not only polyp characteristics [right-sided location (OR 1.41, 95 % CI 1.18-1.69, P < 0.001)], but also the cumulative number of procedures was also related to resection completeness. After 300 polypectomies, the complete resection rate of the fellows was comparable to that of the experts. CONCLUSIONS In the fellow-treated group, the level of procedure experience was closely associated with the polypectomy outcomes. Meticulous attention is critical to ensure the completeness of polypectomies performed by trainee endoscopists during the training program.
Collapse
|
47
|
Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Kudo SE, Tsuruta O, Sugihara KI, Watanabe T, Saitoh Y, Igarashi M, Toyonaga T, Ajioka Y, Ichinose M, Matsui T, Sugita A, Sugano K, Fujimoto K, Tajiri H. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27:417-434. [PMID: 25652022 DOI: 10.1111/den.12456] [Citation(s) in RCA: 384] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/02/2015] [Indexed: 12/12/2022]
Abstract
Colorectal endoscopic submucosal dissection (ESD) has become common in recent years. Suitable lesions for endoscopic treatment include not only early colorectal carcinomas but also many types of precarcinomatous adenomas. It is important to establish practical guidelines in which the preoperative diagnosis of colorectal neoplasia and the selection of endoscopic treatment procedures are properly outlined, and to ensure that the actual endoscopic treatment is useful and safe in general hospitals when carried out in accordance with the guidelines. In cooperation with the Japanese Society for Cancer of the Colon and Rectum, the Japanese Society of Coloproctology, and the Japanese Society of Gastroenterology, the Japan Gastroenterological Endoscopy Society has recently compiled a set of colorectal ESD/endoscopic mucosal resection (EMR) guidelines using evidence-based methods. The guidelines focus on the diagnostic and therapeutic strategies and caveat before, during, and after ESD/EMR and, in this regard, exclude the specific procedures, types and proper use of instruments, devices, and drugs. Although eight areas, ranging from indication to pathology, were originally planned for inclusion in these guidelines, evidence was scarce in each area. Therefore, grades of recommendation were determined largely through expert consensus in these areas.
Collapse
Affiliation(s)
- Shinji Tanaka
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
| | | | - Yutaka Saito
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Naohisa Yahagi
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Hiroo Yamano
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Shoichi Saito
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takashi Hisabe
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Takashi Yao
- Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
| | - Masahiko Watanabe
- Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan.,Japanese Society of Coloproctology, Tokyo, Japan
| | | | - Shin-Ei Kudo
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Osamu Tsuruta
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Yusuke Saitoh
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | | | | | - Yoichi Ajioka
- Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan
| | - Masao Ichinose
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| | - Toshiyuki Matsui
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan.,Japanese Society of Coloproctology, Tokyo, Japan
| | - Akira Sugita
- Japanese Society of Coloproctology, Tokyo, Japan
| | | | | | - Hisao Tajiri
- Japan Gastroenterological Endoscopy Society, Tokyo, Japan
| |
Collapse
|
48
|
Oka S, Tanaka S, Saito Y, Iishi H, Kudo SE, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Kobayashi K, Hisabe T, Tsuruta O, Sano Y, Yamano H, Shimizu S, Yahagi N, Watanabe T, Nakamura H, Fujii T, Ishikawa H, Sugihara K. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110:697-707. [PMID: 25848926 DOI: 10.1038/ajg.2015.96] [Citation(s) in RCA: 205] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/17/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Conventional endoscopic resection (CER) is a widely accepted treatment for early colorectal neoplasia; however, large colorectal neoplasias remain problematic, as they necessitate piecemeal resection, increasing the risk of local recurrence. Endoscopic submucosal dissection (ESD) can improve the en bloc resection rate. This study aimed to evaluate local recurrence and its associated risk factors after endoscopic resection (ER) for colorectal neoplasias ≥20 mm. METHODS A multicenter prospective study at 18 medium- and high-volume specialized institutions was conducted in Japan. Follow-up colonoscopy was performed after 12 months in cases of complete resection and after 3-6 months in cases of incomplete resection. Local recurrence was confirmed by endoscopic findings and/or pathological analysis. RESULTS Follow-up colonoscopy was performed in 1,524 of 1,845 enrolled colorectal neoplasias (mean age, 65 years; 885 men; median tumor size, 32.8 mm). The local recurrence rates were 4.3% (65/1,524), 6.8% (55/808), and 1.4% (10/716) for the entire cohort, for CER, and for ESD, respectively. The relative risks of local recurrence were 0.21 (95% confidence interval, 0.11-0.39) with ESD compared with CER, 0.32 (95% confidence interval, 0.11-0.92) with en bloc ESD compared with en bloc CER, and 0.90 (95% confidence interval, 0.39-2.12) with piecemeal ESD compared with piecemeal CER. Significant factors associated with local recurrence were piecemeal resection, laterally spreading tumors of granular type, tumor size ≥40 mm, no pre-treatment magnification, and ≤10 years of experience in CER, and piecemeal resection only in ESD. CONCLUSIONS En bloc ESD reduces the local recurrence rate for large colorectal neoplasias. Piecemeal resection is the most important risk factor for local recurrence regardless of the ER method used.
Collapse
Affiliation(s)
- Shiro Oka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyasu Iishi
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Masahiro Igarashi
- Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan
| | - Yusuke Saitoh
- Digestive Disease Center, Asahikawa City Hospital, Hokkaido, Japan
| | - Yuji Inoue
- Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kiyonori Kobayashi
- Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, Kanagawa, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Osamu Tsuruta
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Hyogo, Japan
| | - Hiroo Yamano
- Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan
| | - Seiji Shimizu
- Department of Gastroenterology, JR West Osaka Railway Hospital, Osaka, Japan
| | - Naohisa Yahagi
- Department of Gastroenterology, Toranomon Hospital and Cancer Center, Keio University, Tokyo, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hisashi Nakamura
- Department of Gastroenterology, Chofu Surgical Clinic, Tokyo, Japan
| | | | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenichi Sugihara
- Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | | |
Collapse
|
49
|
Chattree A, Lee TJW, Gupta S, Rutter MD. Management of colonic polyps and the NHS Bowel Cancer Screening Programme. Br J Hosp Med (Lond) 2015; 76:132-7. [DOI: 10.12968/hmed.2015.76.3.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A Chattree
- Endoscopy Research Fellow in the Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton on Tees
| | - TJW Lee
- Consultant Gastroenterologist in the Department of Gastroenterology, North Tyneside General Hospital, North Shields
| | - S Gupta
- Consultant Gastroenterologist in the Department of Gastroenterology, The Princess Alexandra Hospital, Harlow
| | - MD Rutter
- Consultant Gastroenterologist in the Department of Gastroenterology and Clinical Director of the Tees Bowel Cancer Screening Centre, University Hospital of North Tees, Stockton on Tees TS19 8PE
| |
Collapse
|
50
|
Seo JY, Chun J, Lee C, Hong KS, Im JP, Kim SG, Jung HC, Kim JS. Novel risk stratification for recurrence after endoscopic resection of advanced colorectal adenoma. Gastrointest Endosc 2015; 81:655-64. [PMID: 25500328 DOI: 10.1016/j.gie.2014.09.064] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/29/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Advanced colorectal adenoma (ACA) refers to adenomas with the following predictive characteristics: ≥1 cm in diameter, and/or villous component, and/or high-grade dysplasia. ACA has high risk of transforming to colorectal cancer, and the recurrence rate is relatively high. OBJECTIVE To assess the outcomes of patients with ACA undergoing endoscopic resection and to identify risk factors for local recurrence and development of metachronous advanced neoplasm. DESIGN Retrospective cohort study. SETTING Tertiary care medical center. PATIENTS From 2005 to 2011, the records of 3625 patients who underwent colonoscopic polypectomy at Seoul National University Hospital were retrospectively reviewed. Patients with synchronous colorectal cancers, inflammatory bowel disease, previous colorectal resection, loss to follow-up, and incomplete resection were excluded. INTERVENTION Endoscopic resection for ACA. MAIN OUTCOME MEASUREMENTS Local recurrence and metachronous advanced neoplasm. RESULTS The study included 917 patients with 1206 ACAs. The median duration of follow-up was 28.5 months (interquartile range, 12.8-51.7). Independent risk factors for local recurrence included ACA with 2 or more predictive characteristics (adjusted hazard ratio [HR], 2.46; 95% confidence interval [CI], 1.11-5.48; P = .027) and piecemeal resection (adjusted HR, 6.96; 95% CI, 1.58-30.71; P = .010). Independent risk factors for metachronous advanced neoplasm were male gender (adjusted HR, 1.65; 95% CI, 1.02-2.65; P = .041), ≥3 adenomas (adjusted HR, 2.56; 95% CI, 1.72-3.82; P < .001), and ≥3 ACAs (adjusted HR, 1.44; 95% CI, 1.01-2.06; P = .045). LIMITATIONS Retrospective design. CONCLUSION ACAs with 2 or more predictive characteristics recurred locally at a higher rate than ACAs with 1 predictive characteristic. These results suggest that patients who are found to have ACAs with 2 or more predictive factors at index colonoscopy are at higher risk for local recurrence, and follow-up colonoscopy should be performed sooner.
Collapse
Affiliation(s)
- Ji Yeon Seo
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Changhyun Lee
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea
| | - Kyoung Sup Hong
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gyun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Chae Jung
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| |
Collapse
|