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Costa LCDS, Santos JOM, Miyajima NT, Montes CG, Andreollo NA, Lopes LR. EFFICACY ANALYSIS OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR THE EARLY GASTRIC CANCER AND PRECANCEROUS LESIONS. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:421-427. [PMID: 36102442 DOI: 10.1590/s0004-2803.20220300075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Endoscopic treatment of precancerous lesions and early gastric cancer has been widely accepted in recent years. Endoscopic submucosal dissection (ESD), following established indication criteria, can lead to cure of the disease in more than 90% of cases. OBJECTIVE This study aimed to analyze the use of ESD in patients with early gastric cancer and precancerous lesions, as well as the results of the procedure, its complications and effectiveness in controlling the disease. METHODS This is a retrospective cohort study composed of 41 patients aged from 53 to 87 years (mean age: 65 years; 58.53% male) who were analyzed from 2008 to 2019. The variables collected from the medical records were: comorbidities, classification of the lesion regarding resection criteria, type of resection, histology, degree of invasion, resection margin, complications, disease recurrence. Statistical analysis was performed using the Kruskal-Wallis test, the McNemar's test, and the Mann-Whitney test, with 5% statistical significance (P<0.05). RESULTS The most frequent site of the lesion was the gastric antrum and the predominant presentation by the Japanese or Paris classification was the one with depressed components in 56.09%. Adenocarcinoma occurred in 75.6% of the biopsies, and the remainder were adenomas without neoplasia. En-bloc resection occurred in 97.57% of cases, and compromise of the safety margin occurred in one patient. The main pre-existing comorbidity was liver cirrhosis in 29.26% of cases. There was a significant increase in post- ESD adenocarcinoma compared to pre-resection diagnosis. The mean follow-up time was 38.4 months, with one recurrence (2.43%) and two metachronous lesions (4.87%). Complications during and after the procedure occurred in three patients (7.31%), being due to bleeding (two cases) and perforation (one case). There was one death due to a cardiac event not directly related to the procedure. CONCLUSION Endoscopic submucosal dissection proved to be a safe procedure, with a low complication and recurrence rate. Its recommendation must occur within the established criteria; however, it can be indicated for patients outside the criteria, if there is a high risk for surgical treatment.
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Affiliation(s)
- Luigi Carlo da Silva Costa
- Universidade de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação, Gastrocentro, Campinas, SP, Brasil
| | | | - Nelson Tomio Miyajima
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ciro Garcia Montes
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Gastrocentro, Campinas, SP, Brasil
| | - Nelson Adami Andreollo
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Gastrocentro, Campinas, SP, Brasil
| | - Luiz Roberto Lopes
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Cirurgia, Gastrocentro, Campinas, SP, Brasil
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Kimura CMS, Kawaguti FS, Nahas CSR, Marques CFS, Segatelli V, Martins BC, de Paulo GA, Cecconello I, Ribeiro-Junior U, Nahas SC, Maluf-Filho F. Long-term outcomes of endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumors. J Gastroenterol Hepatol 2021; 36:1634-1641. [PMID: 33091219 DOI: 10.1111/jgh.15309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/28/2020] [Accepted: 10/11/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection and transanal endoscopic microsurgery are good options for the treatment of rectal adenomas and early rectal carcinomas, but whether long-term outcomes of these procedures are comparable is not known. The aim of this study was to address this question. METHODS A retrospective single-center study evaluating 98 consecutive procedures between June 2008 and December 2017 was performed in a tertiary cancer center. Consecutive patients who had undergone either endoscopic submucosal resection or transanal endoscopic microsurgery for rectal adenomas and early rectal carcinomas were evaluated, and long-term recurrence and complication rates were compared. RESULTS Both groups were similar regarding sex, age, preoperative surgical risk, and en bloc resection rate (95.7% in the endoscopic and 100% in the surgical group, P = 0.81). Mean follow-up period was 37.6 months. Lesions resected endoscopically were significantly larger (68.5 mm) than those resected by transanal resection (44.5 mm), P = 0.003. Curative resections occurred in 97.2% of endoscopic resections and 85.2% of the surgical ones (P = 0.04). Comparing resections that fulfilled histologic curative criteria, there were no recurrences in the endoscopic group (out of 69 cases) and two recurrences in the transanal group (8.3% of 24 cases), P = 0.06. Late complications occurred in 12.7% of endoscopic procedures and 25.9% of surgical procedures (P = 0.13). CONCLUSIONS In our experience, endoscopic submucosal resection seems to have advantages over transanal endoscopic microsurgery, with similar en bloc resection rate and lower rate of late complications and recurrences. Multicenter randomized controlled trials are needed to support our findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Ivan Cecconello
- Division of Gastrointestinal Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro-Junior
- Division of Gastrointestinal Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | - Sergio Carlos Nahas
- Division of Gastrointestinal Surgery, Institute of Cancer of São Paulo, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Division of Endoscopy, Institute of Cancer of São Paulo, São Paulo, Brazil
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Role of Magnification Chromoendoscopy in the Management of Colorectal Neoplastic Lesions Suspicious for Submucosal Invasion. Dis Colon Rectum 2019; 62:422-428. [PMID: 30730457 DOI: 10.1097/dcr.0000000000001343] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Correctly predicting the depth of tumor invasion in the colorectal wall is crucial for successful endoscopic resection of superficial colorectal neoplasms. OBJECTIVE The aim of this study was to assess the accuracy of magnifying chromoendoscopy in a Western medical center to predict the depth of invasion by the pit pattern classification in patients with colorectal neoplasms with a high risk of submucosal invasion. DESIGN This single-center retrospective study, from a prospectively collected database, was conducted between April 2009 and June 2015. SETTINGS The study was conducted at a single academic center. PATIENTS Consecutive patients with colorectal neoplasms with high risk of submucosal invasion were included. These tumors were defined by large (≥20 mm) sessile polyps (nonpedunculated), laterally spreading tumors, or depressed lesions of any size. INTERVENTIONS Patients underwent magnifying chromoendoscopy and were classified according to the Kudo pit pattern. The therapeutic decision, endoscopic or surgery, was defined by the magnification assessment. MAIN OUTCOME MEASURES Sensitivity, specificity, and positive and negative predictive values of magnifying chromoendoscopy for assessment of these lesions were determined. RESULTS A total of 123 lesions were included, with a mean size of 54.0 ± 37.1 mm. Preoperative magnifying chromoendoscopy with pit pattern classification had 73.3% sensitivity, 100% specificity, 100% positive predictive value, 96.4% negative predictive value, and 96.7% accuracy to predict depth of invasion and consequently to guide the appropriate treatment. Thirty-three rectal lesions were also examined by MRI, and 31 were diagnosed as T2 lesions. Twenty two (70.1%) of these lesions were diagnosed as noninvasive by magnifying colonoscopy, were treated by endoscopic resection, and met the curative criteria. LIMITATIONS This was a single-center retrospective study with a single expert endoscopist experience. CONCLUSIONS Magnifying chromoendoscopy is highly accurate for assessing colorectal neoplasms suspicious for submucosal invasion and can help to select the most appropriate treatment. See Video Abstract at http://links.lww.com/DCR/A920.
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Akintoye E, Kumar N, Aihara H, Nas H, Thompson CC. Colorectal endoscopic submucosal dissection: a systematic review and meta-analysis. Endosc Int Open 2016; 4:E1030-E1044. [PMID: 27747275 PMCID: PMC5063641 DOI: 10.1055/s-0042-114774] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/29/2016] [Indexed: 02/07/2023] Open
Abstract
Background and study aims: Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique that allows en-bloc resection of gastrointestinal tumor. We systematically review the medical literature in order to evaluate the safety and efficacy of colorectal ESD. Patients and methods: We performed a comprehensive literature search of MEDLINE, EMBASE, Ovid, CINAHL, and Cochrane for studies reporting on the clinical efficacy and safety profile of colorectal ESD. Results: Included in this study were 13833 tumors in 13603 patients (42 % female) who underwent colorectal ESD between 1998 and 2014. The R0 resection rate was 83 % (95 % CI, 80 - 86 %) with significant between-study heterogeneity (P < 0.001) which was partly explained by difference in continent (P = 0.004), study design (P = 0.04), duration of the procedure (P = 0.009), and, marginally, by average tumor size (P = 0.09). Endoscopic en bloc and curative resection rates were 92 % (95 % CI, 90 - 94 %) and 86 % (95 % CI, 80 - 90 %), respectively. The rates of immediate and delayed perforation were 4.2 % (95 % CI, 3.5 - 5.0 %) and 0.22 % (95 % CI, 0.11 - 0.46 %), respectively, while rates of immediate and delayed major bleeding were 0.75 % (95 % CI, 0.31 - 1.8 %) and 2.1 % (95 % CI, 1.6 - 2.6 %). After an average postoperative follow up of 19 months, the rate of tumor recurrence was 0.04 % (95 % CI, 0.01 - 0.31) among those with R0 resection and 3.6 % (95 % CI, 1.4 - 8.8 %) among those without R0 resection. Overall, irrespective of the resection status, recurrence rate was 1.0 % (95 % CI, 0.42 - 2.1 %). Conclusions: Our meta-analysis, the largest and most comprehensive assessment of colorectal ESD to date, showed that colorectal ESD is safe and effective for colorectal tumors and warrants consideration as first-line therapy when an expert operator is available.
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Affiliation(s)
- Emmanuel Akintoye
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Nitin Kumar
- Developmental Endoscopy Lab, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Hiroyuki Aihara
- Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
| | - Hala Nas
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Christopher C. Thompson
- Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts, United States
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Tomiki Y, Kawai M, Takehara K, Tashiro Y, Munakata S, Kure K, Ishiyama S, Sugimoto K, Kamiyama H, Takahashi M, Sakamoto K. Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection. Dig Endosc 2015; 27:679-86. [PMID: 25756606 DOI: 10.1111/den.12468] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/03/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Colorectal endoscopic submucosal dissection (ESD) is a useful treatment method; however, no index has been established for time for patient to start food ingestion or be discharged after ESD. We investigated the potential of a clinical pathway in which patients started food ingestion on day 2 after ESD and were discharged on day 3. METHODS A total of 382 patients underwent colorectal ESD between 2006 and 2012. A flow chart of a clinical pathway was prepared based on the data obtained, with the aim of shortening hospital stay after ESD. RESULTS Mean duration of postoperative hospital stay in the 382 patients was 5.3 ± 1.8 days. The most common cause of extended hospital stay was abnormal blood test finding, as detected in 50 patients in group C (n = 131; 38.2%), followed by careful course observations, as noted in 48 patients in group C (n = 131; 36.6%). Regarding procedural accidents as a result of ESD, intraoperative perforation occurred in 15 patients (3.9%) and post-ESD bleeding in seven patients (1.8%), which extended the hospital stay. Food ingestion was started on day 2 when no abnormality was noted during ESD or in physical and imaging findings or blood tests on day 1. In the 86 patients who underwent the prepared clinical pathway as a validation study, 68 (79.0%) were discharged on day 3. Duration of postoperative hospital stay was 3.4 ± 1.2 days. CONCLUSION Discharge may be possible 3 days after ESD when no abnormalities are noted during ESD or on post-ESD day 1.
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Affiliation(s)
- Yuichi Tomiki
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Masaya Kawai
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiro Takehara
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yoshihiko Tashiro
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shinya Munakata
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazumasa Kure
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Shun Ishiyama
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kiichi Sugimoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Hirohiko Kamiyama
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Makoto Takahashi
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Faculty of Medicine, Juntendo University, Tokyo, Japan
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