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Ferlitsch M, Hassan C, Bisschops R, Bhandari P, Dinis-Ribeiro M, Risio M, Paspatis GA, Moss A, Libânio D, Lorenzo-Zúñiga V, Voiosu AM, Rutter MD, Pellisé M, Moons LMG, Probst A, Awadie H, Amato A, Takeuchi Y, Repici A, Rahmi G, Koecklin HU, Albéniz E, Rockenbauer LM, Waldmann E, Messmann H, Triantafyllou K, Jover R, Gralnek IM, Dekker E, Bourke MJ. Colorectal polypectomy and endoscopic mucosal resection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2024. Endoscopy 2024. [PMID: 38670139 DOI: 10.1055/a-2304-3219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
1: ESGE recommends cold snare polypectomy (CSP), to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of diminutive polyps (≤ 5 mm).Strong recommendation, high quality of evidence. 2: ESGE recommends against the use of cold biopsy forceps excision because of its high rate of incomplete resection.Strong recommendation, moderate quality of evidence. 3: ESGE recommends CSP, to include a clear margin of normal tissue (1-2 mm) surrounding the polyp, for the removal of small polyps (6-9 mm).Strong recommendation, high quality of evidence. 4: ESGE recommends hot snare polypectomy for the removal of nonpedunculated adenomatous polyps of 10-19 mm in size.Strong recommendation, high quality of evidence. 5: ESGE recommends conventional (diathermy-based) endoscopic mucosal resection (EMR) for large (≥ 20 mm) nonpedunculated adenomatous polyps (LNPCPs).Strong recommendation, high quality of evidence. 6: ESGE suggests that underwater EMR can be considered an alternative to conventional hot EMR for the treatment of adenomatous LNPCPs.Weak recommendation, moderate quality of evidence. 7: Endoscopic submucosal dissection (ESD) may also be suggested as an alternative for removal of LNPCPs of ≥ 20 mm in selected cases and in high-volume centers.Weak recommendation, low quality evidence. 8: ESGE recommends that, after piecemeal EMR of LNPCPs by hot snare, the resection margins should be treated by thermal ablation using snare-tip soft coagulation to prevent adenoma recurrence.Strong recommendation, high quality of evidence. 9: ESGE recommends (piecemeal) cold snare polypectomy or cold EMR for SSLs of all sizes without suspected dysplasia.Strong recommendation, moderate quality of evidence. 10: ESGE recommends prophylactic endoscopic clip closure of the mucosal defect after EMR of LNPCPs in the right colon to reduce to reduce the risk of delayed bleeding.Strong recommendation, high quality of evidence. 11: ESGE recommends that en bloc resection techniques, such as en bloc EMR, ESD, endoscopic intermuscular dissection, endoscopic full-thickness resection, or surgery should be the techniques of choice in cases with suspected superficial invasive carcinoma, which otherwise cannot be removed en bloc by standard polypectomy or EMR.Strong recommendation, moderate quality of evidence.
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Affiliation(s)
- Monika Ferlitsch
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
- Department of Gastroenterology, Evangelical Hospital, Vienna, Austria
| | - Cesare Hassan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Leuven, Belgium
| | - Pradeep Bhandari
- Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Mário Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Mauro Risio
- Department of Pathology, Institute for Cancer Research and Treatment, Candiolo, Turin, Italy
| | - Gregorios A Paspatis
- Gastroenterology Department, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Alan Moss
- Department of Gastroenterology, Western Health, Melbourne, Australia
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute of Porto, Porto, Portugal
- MEDCIDS/Faculty of Medicine, University of Porto, Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) and RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Vincente Lorenzo-Zúñiga
- Endoscopy Unit, La Fe University and Polytechnic Hospital / IISLaFe, Valencia, Spain
- Department of Medicine, Catholic University of Valencia, Valencia, Spain
| | - Andrei M Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Bucharest, Romania
- Internal Medicine and Gastroenterology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthew D Rutter
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Stockton-on-Tees, UK
- Department of Gastroenterology, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Maria Pellisé
- Department of Gastroenterology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), University of Barcelona, Barcelona, Spain
| | - Leon M G Moons
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Andreas Probst
- Department of Gastroenterology, University Hospital of Augsburg, Augsburg, Germany
| | - Halim Awadie
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
| | - Arnaldo Amato
- Digestive Endoscopy and Gastroenterology Department, Ospedale A. Manzoni, Lecco, Italy
| | - Yoji Takeuchi
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Endoscopy Unit, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Gabriel Rahmi
- Hepatogastroenterology and Endoscopy Department, Hôpital européen Georges Pompidou, Paris, France
- Laboratoire de Recherches Biochirurgicales, APHP-Centre Université de Paris, Paris, France
| | - Hugo U Koecklin
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Teknon Medical Center, Barcelona, Spain
| | - Eduardo Albéniz
- Gastroenterology Department, Hospital Universitario de Navarra (HUN); Navarrabiomed, Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Lisa-Maria Rockenbauer
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Waldmann
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Helmut Messmann
- III Medizinische Klinik, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Propaedeutic Internal Medicine, Medical School, National and Kapodastrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario Dr. Balmis, Instituto de Investigación Sanitaria ISABIAL, Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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2
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Schreuder RM, Stoop MWJ, Piek JMJ, Lijnschoten GV, Schoon EJ. Endoscopic full-thickness resection of a solitary ovarian carcinoma colorectal metastasis. BMJ Case Rep 2024; 17:e256466. [PMID: 38355211 PMCID: PMC10868322 DOI: 10.1136/bcr-2023-256466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
A woman in her 70s with a medical history of recurrent ovarian carcinoma was referred to the gastroenterologist because of rectal blood loss. Colonoscopy revealed a spontaneously bleeding lesion, which was not a typical colorectal carcinoma by optical diagnosis. Biopsies confirmed the diagnosis of recurrence of the former ovarian carcinoma. The patient was not eligible for surgical resection due to former abdominal surgery and she declined chemotherapy due to severe side effects earlier. After a multidisciplinary team consultation, she was treated with endoscopic full-thickness resection (eFTR). This is a minimally invasive resection technique for removal of challenging colorectal lesions. The patient has recovered well and 2 years after the metastasis resection with eFTR there still have been no signs of recurrent malignancy.
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Affiliation(s)
- Ramon-Michel Schreuder
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Maud W J Stoop
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jurgen M J Piek
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Gesina van Lijnschoten
- Department of Pathology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, the Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
- GROW, School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
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3
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Nabi Z, Samanta J, Dhar J, Mohan BP, Facciorusso A, Reddy DN. Device-assisted endoscopic full-thickness resection in colorectum: Systematic review and meta-analysis. Dig Endosc 2024; 36:116-128. [PMID: 37422920 DOI: 10.1111/den.14631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES Endoscopic full-thickness resection (EFTR) is emerging as an effective modality for mucosal and submucosal lesions in the colorectum. In this systematic review and meta-analysis, we aimed to analyze the success and safety of device-assisted EFTR in the colon and rectum. METHODS A literature search was performed in the Embase, PubMed, and Medline databases for studies evaluating device-assisted EFTR between inception to October 2022. The primary outcome of the study was clinical success (R0 resection) with EFTR. Secondary outcomes included technical success, procedure duration, and adverse events. RESULTS In all, 29 studies with 3467 patients (59% male patients, 3492 lesions) were included in the analysis. The lesions were located in right colon (47.5%), left colon (28.6%), and rectum (24.3%). EFTR was performed for subepithelial lesions in 7.2% patients. The pooled mean size of the lesions was 16.6 mm (95% confidence interval [CI] 14.9-18.2, I2 98%). Technical success was achieved in 87.1% (95% CI 85.1-88.9%, I2 39%) procedures. The pooled rate of en bloc resection was 88.1% (95% CI 86-90%, I2 47%) and R0 resection was 81.8% (95% CI 79-84.3%, I2 56%). In subepithelial lesions, the pooled rate of R0 resection was 94.3% (95% CI 89.7-96.9%, I2 0%). The pooled rate of adverse events was 11.9% (95% CI 10.2-13.9%, I2 43%) and major adverse events requiring surgery was 2.5% (95% CI 2.0-3.1%, I2 0%). CONCLUSION Device-assisted EFTR is a safe and effective treatment modality in cases with adenomatous and subepithelial colorectal lesions. Comparative studies are required with conventional resection techniques, including endoscopic mucosal resection and submucosal dissection.
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Affiliation(s)
- Zaheer Nabi
- Department of Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, India
| | - Jayanta Samanta
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jahnvi Dhar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu P Mohan
- Department of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - D Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
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Bernklev L, Nilsen JA, Augestad KM, Holme Ø, Pilonis ND. Management of non-curative endoscopic resection of T1 colon cancer. Best Pract Res Clin Gastroenterol 2024; 68:101891. [PMID: 38522886 DOI: 10.1016/j.bpg.2024.101891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024]
Abstract
Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding. In these cases, complete (R0), local endoscopic resection is considered sufficient as negligible risk of lymph nodes metastases does not outweigh morbidity and mortality associated with surgical resection. Challenges arise when endoscopic resection is incomplete (RX/R1) or high-risk histological features are present. The risk of lymph node metastasis in T1 CRC ranges from 1% to 36.4%, depending on histologic risk factors. Presence of any risk factor labels the patient "high risk," warranting oncologic surgery with mesocolic lymphadenectomy. However, even if 70%-80% of T1-CRC patients are classified as high-risk, more than 90% are without lymph node involvement after oncological surgery. Surgical overtreatment in T1 CRC is a challenge, requiring a balance between oncologic safety and minimizing morbidity/mortality. This narrative review explores the landscape of managing non-curative T1 colon cancer, focusing on the choice between advanced endoscopic resection techniques and surgical interventions. We discuss surveillance strategies and shared decision-making, emphasizing the importance of a multidisciplinary approach.
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Affiliation(s)
- Linn Bernklev
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.
| | - Jens Aksel Nilsen
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Vestre Viken Hospital Trust, Bærum Hospital, Norway
| | - Knut Magne Augestad
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway; Division of Surgery Campus Ahus, University of Oslo, Oslo, Norway
| | - Øyvind Holme
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Department of Research, Sorlandet Hospital Trust, Kristiansand, Norway
| | - Nastazja Dagny Pilonis
- Clinical Effectiveness Research Group, University of Oslo, Oslo, Norway; Medical Center of Postgraduate Education, Warsaw, Poland; Department of Gastroenterological Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdansk, Poland
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5
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Barbaro F, Papparella LG, Chiappetta MF, Ciuffini C, Fukuchi T, Hamanaka J, Quero G, Pecere S, Gibiino G, Petruzziello L, Maeda S, Hirasawa K, Costamagna G. Endoscopic full-thickness resection vs. endoscopic submucosal dissection of residual/recurrent colonic lesions on scars: a retrospective Italian and Japanese comparative study. Eur J Gastroenterol Hepatol 2024; 36:162-167. [PMID: 38131424 DOI: 10.1097/meg.0000000000002684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIMS Endoscopic treatment of recurrent/residual colonic lesions on scars is a challenging procedure. In this setting, endoscopic submucosal dissection (ESD) is considered the first choice, despite a significant rate of complications. Endoscopic full-thickness resection (eFTR) has been shown to be well-tolerated and effective for these lesions. The aim of this study is to conduct a comparison of outcomes for resection of such lesions between ESD and eFTR in an Italian and a Japanese referral center. METHODS From January 2018 to July 2020, we retrospectively enrolled patients with residual/recurrent colonic lesions, 20 treated by eFTR in Italy and 43 treated by ESD in Japan. The primary outcome was to compare the two techniques in terms of en-bloc and R0-resection rates, whereas complications, time of procedure, and outcomes at 3-month follow-up were evaluated as secondary outcomes. RESULTS R0 resection rate was not significantly different between the two groups [18/20 (90%) and 41/43 (95%); P= 0.66]. En-bloc resection was 100% in both groups. No significant difference was found in the procedure time (54 min vs. 61 min; P= 0.9). There was a higher perforation rate in the ESD group [11/43 (26%) vs. 0/20 (0%); P= 0.01]. At the 3-month follow-up, two lesions relapsed in the eFTR cohort and none in the ESD cohort (P= 0.1). CONCLUSION eFTR is a safer, as effective and equally time-consuming technique compared with ESD for the treatment of residual/recurrent colonic lesions on scars and could become an alternative therapeutic option for such lesions.
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Affiliation(s)
- Federico Barbaro
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Luigi Giovanni Papparella
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Michele Francesco Chiappetta
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Section of Gastroenterology and Hepatology, Promise, Policlinico Universitario Paolo Giaccone, Palermo, Italy
| | - Cristina Ciuffini
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Takehide Fukuchi
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Hamanaka
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Giuseppe Quero
- Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Università Cattolica del Sacro Cuore, Roma
| | - Silvia Pecere
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Giulia Gibiino
- Gastroenterology and Digestive Endoscopy Unit, Ospedale Morgagni-Pierantoni, AUSL Romagna, Forlì, Italy
| | - Lucio Petruzziello
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Yokohama, Japan
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS
- Center for Endoscopic Research Therapeutics and training (CERTT), Università Cattolica del Sacro Cuore, Roma
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Cavalcoli F, Magarotto A, Kelly ME, Cantù P, Mancini A, Rausa E, Masci E. Outcomes of endoscopic full thickness resection in the colon rectum at an Italian tertiary center. Tech Coloproctol 2023; 27:1289-1296. [PMID: 37204474 DOI: 10.1007/s10151-023-02823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/04/2023] [Indexed: 05/20/2023]
Abstract
PURPOSE Endoscopic full-thickness resection (EFTR) is an innovative technique for the treatment of colonic lesions not feasible by conventional endoscopic resection. Here, we aimed to evaluate the efficacy and safety of a Full-Thickness Resection Device (FTRD) for colonic lesions in a high-volume tertiary referral center. METHODS A review of a prospectively collected database on patients that underwent EFTR with FTRD for colonic lesions from June 2016 to January 2021 at our institution was performed. Data regarding the clinical history, previous endoscopic treatments, pathological examination, technical and histological success, and follow-up were evaluated. RESULTS Thirty-five patients (26 males, median age 69 years) underwent FTRD for colonic lesion. Eighteen lesions were in the left colon, three in the transverse, and 12 in the right colon. The median size of the lesions was 13 (range 10-40) mm. Resection was technically successful in 94% of patients. The mean hospital stay was 3.2 (SD ± 1.2) days. Adverse events were reported in four cases (11.4%). Histological complete resection (R0) was achieved in 93.9% of cases. Endoscopic follow-up was available in 96.8% of patients, at a median duration of 14.6 months (3-46 months). Recurrence was observed in 19.4% of cases at a median time of 3 months (3-7 months). Five patients had multiple FTRD performed, with R0 resection in three cases. In this subset, adverse events were observed in 40% of cases. CONCLUSIONS FTRD is safe and feasible for standard indication. The non-negligible rate of recurrence observed suggests the need for close endoscopic follow-up in these patients. Multiple EFTR could help achieve complete resection in selected cases; however, in this setting, a higher risk of adverse events was observed.
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Affiliation(s)
- F Cavalcoli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy.
| | - A Magarotto
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - M E Kelly
- St James Hospital, Dublin 8, Ireland
| | - P Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - A Mancini
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
| | - E Rausa
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - E Masci
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Istituto Nazionale Tumori, Via Venezian 1, 20133, Milan, Italy
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7
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Hanevelt J, Leicher LW, Moons LMG, Vleggaar FP, Huisman JF, van Westreenen HL, de Vos Tot Nederveen Cappel WH. Colonoscopic-assisted laparoscopic wedge resection versus segmental colon resection for benign colonic polyps: a comparative cost analysis. Colorectal Dis 2023; 25:2147-2154. [PMID: 37814456 DOI: 10.1111/codi.16757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/15/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023]
Abstract
AIM The colonoscopic-assisted laparoscopic wedge resection (CAL-WR) is proven to be an effective and safe alternative to a segmental colon resection (SCR) for large or complex benign colonic polyps that are not eligible for endoscopic removal. This analysis aimed to evaluate the costs of CAL-WR and compare them to the costs of an SCR. METHOD A single-centre 90-day 'in-hospital' comparative cost analysis was performed on patients undergoing CAL-WR or SCR for complex benign polyps between 2016 and 2020. The CAL-WR group consisted of 44 patients who participated in a prospective multicentre study (LIMERIC study). Inclusion criteria were (1) endoscopically unresectable benign polyps; (2) residual or recurrence after previous polypectomy; or (3) irradically resected low risk pT1 colon carcinoma. The comparison group, which was retrospectively identified, included 32 patients who underwent an elective SCR in the same period. RESULTS Colonoscopic-assisted laparoscopic wedge resection was associated with significantly fewer complications (7% in the CAL-WR group vs. 45% in the SCR group, P < 0.001), shorter operation time (50 min in the CAL-WR group vs. 119 min in the SCR group, P < 0.001), shorter length of hospital stay (median length of stay 2 days in the CAL-WR group vs. 4 days in the SCR group, P < 0.001) and less use of surgical resources (reduction in costs of 32% per patient), resulting in a cost savings of €2372 (£2099 GBP) per patient (P < 0.001). CONCLUSION Given the clinical and financial benefits, CAL-WR should be recommended for complex benign polyps that are not eligible for endoscopic resection before major surgery is considered.
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Affiliation(s)
- Julia Hanevelt
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
| | - Laura W Leicher
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Jelle F Huisman
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
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8
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Zwager LW, Mueller J, Schmidt A, Bastiaansen BAJ. Response. Gastrointest Endosc 2023; 98:877-878. [PMID: 37863579 DOI: 10.1016/j.gie.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 07/22/2023] [Accepted: 07/23/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Liselotte W Zwager
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam; Amsterdam Gastroenterology Endocrinology Metabolism; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Julius Mueller
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam; Amsterdam Gastroenterology Endocrinology Metabolism; Cancer Center Amsterdam, Amsterdam, the Netherlands
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Yzet C, Le Baleur Y, Albouys J, Jacques J, Doumbe-Mandengue P, Barret M, Abou Ali E, Schaefer M, Chevaux JB, Leblanc S, Lepillez V, Privat J, Degand T, Wallenhorst T, Rivory J, Chaput U, Berger A, Aziz K, Rahmi G, Coron E, Kull E, Caillo L, Vanbiervliet G, Koch S, Subtil F, Pioche M. Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study. Endoscopy 2023; 55:1002-1009. [PMID: 37500072 DOI: 10.1055/a-2116-9930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION : Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions. METHODS : All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins. RESULTS : 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20-30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30-40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations. CONCLUSION: ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.
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Affiliation(s)
- Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Yann Le Baleur
- Endoscopy and Gastroenterology Unit, Hospital Saint Joseph, Paris, France
| | - Jérémie Albouys
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Paul Doumbe-Mandengue
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Maximilien Barret
- Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
| | - Einas Abou Ali
- Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France
| | | | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Vincent Lepillez
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Jocelyn Privat
- Endoscopy and Gastroenterology Unit, Vichy Hospital, Vichy, France
| | - Thibault Degand
- Endoscopy and Gastroenterology Unit, Dijon University Hospital, Dijon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ulriikka Chaput
- Endoscopy and Gastroenterology Unit, Saint-Antoine University Hospital, Paris, France
| | - Arthur Berger
- Endoscopy and Gastroenterology Unit, Bordeaux University Hospital, Bordeaux, France
| | - Karim Aziz
- Endoscopy and Gastroenterology Unit, Saint Brieuc Hospital, Saint Brieuc, France
| | - Gabriel Rahmi
- Endoscopy and Gastroenterology Unit, Georges Pompidou European Hospital, Paris, France
| | - Emmanuel Coron
- Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland
- Digestive Diseases Institute, University Hospital Nantes, Nantes, France
| | - Eric Kull
- Endoscopy and Gastroenterology Unit, Metz Hospital, Metz, France
| | - Ludovic Caillo
- Endoscopy and Gastroenterology Unit, Nîmes University Hospital, Nîmes, France
| | | | - Stéphane Koch
- Endoscopy and Gastroenterology Unit, Besançon University Hospital, Besançon, France
| | - Fabien Subtil
- Biostatistics Unit, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, and Laboratoire de Biométrie et Biologie Évolutive, Lyon, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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Tate DJ, Desomer L, Argenziano ME, Mahajan N, Sidhu M, Vosko S, Shahidi N, Lee E, Williams SJ, Burgess NG, Bourke MJ. Treatment of adenoma recurrence after endoscopic mucosal resection. Gut 2023; 72:1875-1886. [PMID: 37414440 DOI: 10.1136/gutjnl-2023-330300] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/29/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE Residual or recurrent adenoma (RRA) after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps (LNPCPs) of ≥20 mm is a major limitation. Data on outcomes of the endoscopic treatment of recurrence are scarce, and no evidence-based standard exists. We investigated the efficacy of endoscopic retreatment over time in a large prospective cohort. DESIGN Over 139 months, detailed morphological and histological data on consecutive RRA detected after EMR for single LNPCPs at one tertiary endoscopy centre were prospectively recorded during structured surveillance colonoscopy. Endoscopic retreatment was performed on cases with evidence of RRA and was performed predominantly using hot snare resection, cold avulsion forceps with adjuvant snare tip soft coagulation or a combination of the two. RESULTS 213 (14.6%) patients had RRA (168 (78.9%) at first surveillance and 45 (21.1%) thereafter). RRA was commonly 2.5-5.0 mm (48.0%) and unifocal (78.7%). Of 202 (94.8%) cases which had macroscopic evidence of RRA, 194 (96.0%) underwent successful endoscopic therapy and 161 (83.4%) had a subsequent follow-up colonoscopy. Of the latter, endoscopic therapy of recurrence was successful in 149 (92.5%) of 161 in the per-protocol analysis, and 149 (73.8%) of 202 in the intention-to-treat analysis, with a mean of 1.15 (SD 0.36) retreatment sessions. No adverse events were directly attributable to endoscopic therapy. Further RRA after endoscopic therapy was endoscopically treatable in most cases. Overall, only 9 (4.2%, 95% CI 2.2% to 7.8%) of 213 patients with RRA required surgery.Thus 159 (98.8%, 95% CI 95.1% to 99.8%) of 161 cases with initially successful endoscopic treatment of RRA and follow-up remained surgery-free for a median of 13 months (IQR 25.0) of follow-up. CONCLUSIONS RRA after EMR of LNPCPs can be effectively treated using simple endoscopic techniques with long-term adenoma remission of >90%; only 16% required retreatment. Therefore, more technically complex, morbid and resource-intensive endoscopic or surgical techniques are required only in selected cases. TRIAL REGISTRATION NUMBERS NCT01368289 and NCT02000141.
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Affiliation(s)
- David J Tate
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Gastroenterology and Hepatology, University Hospital of Ghent, Gent, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Lobke Desomer
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Maria Eva Argenziano
- Department of Gastroenterology and Hepatology, University Hospital of Ghent, Gent, Belgium
| | - Neha Mahajan
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Mayenaaz Sidhu
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sergei Vosko
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Neal Shahidi
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Lee
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Stephen J Williams
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Nicholas G Burgess
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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11
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Obri M, Ichkhanian Y, Brown P, Almajed MR, Nimri F, Taha A, Agha Y, Jesse M, Singla S, Piraka C, Zuchelli TE. Full-thickness resection device for management of lesions involving the appendiceal orifice: Systematic review and meta-analysis. Endosc Int Open 2023; 11:E899-E907. [PMID: 37810898 PMCID: PMC10558260 DOI: 10.1055/a-2131-4891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/11/2023] [Indexed: 10/10/2023] Open
Abstract
Background and study aims Endoscopic resection of lesions involving the appendiceal orifice is technically challenging and is commonly referred for surgical resection. However, post-resection appendicitis is a concern. Many studies have varying rates of post-procedure appendicitis. We aim to report the rate of post-resection appendicitis by performing a systematic review and meta-analysis. Methods Studies that involved the use of a full-thickness resection device (FTRD) for management of appendiceal polyps were included. The primary outcome was appendicitis after FTRD and a subgroup analysis was performed on studies that only included FTRD performed at the appendiceal orifice. Results Appendicitis was encountered in 15% (95%CI: [11-21]) of the patients with 61% (95% CI: [44-76]) requiring surgical management. Pooled rates of technical success, histologic FTR, and histologic R0 resection in this sub-group (n=123) were 92% (95% CI: [85-96]), 98% (95% CI: [93-100]), and 72% (95% CI: [64-84%]), respectively. Post-resection histopathological evaluation revealed a mean resected specimen size of 16.8 ± 5.4 mm, with non-neoplastic pathology in 9 (7%), adenomas in 103 (84%), adenomas + high-grade dysplasia (HGD) in nine (7%), and adenocarcinoma in two (2%). The pooled rate for non-appendicitis-related surgical management (technical failure and/or high-risk lesions) was 11 % (CI: 7-17). Conclusions FTRD appears to be an effective method for managing appendiceal lesions. However, appendicitis post-resection occurs in a non-trivial number of patients and the R0 resection rate in appendiceal lesions is only 72%. Therefore, caution should be employed in the use of this technique, considering the relative risks of surgical intervention in each patient.
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Affiliation(s)
- Mark Obri
- Internal Medicine, Henry Ford Health System, Detroit, United States
| | | | - Patrick Brown
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | | | - Faisal Nimri
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Ashraf Taha
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Yasmine Agha
- Division of Gastroenterology, Henry Ford Health System, Detroit, United States
| | - Michelle Jesse
- Internal Medicine, Henry Ford Health System, Detroit, United States
| | - Sumit Singla
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Cyrus Piraka
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
| | - Tobias E. Zuchelli
- Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, United States
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12
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Mun EJ, Wagh MS. Recent advances and current challenges in endoscopic resection with the full-thickness resection device. World J Gastroenterol 2023; 29:4009-4020. [PMID: 37476589 PMCID: PMC10354579 DOI: 10.3748/wjg.v29.i25.4009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/27/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Endoscopic full-thickness resection (EFTR) has emerged as a viable technique in the management of mucosal and subepithelial lesions of the gastrointestinal tract (GIT) not amenable to conventional therapeutic approaches. While various devices and techniques have been described for EFTR, a single, combined full-thickness resection and closure device (full-thickness resection device, FTRD system, Ovesco Endoscopy AG, Tuebingen, Germany) has become commercially available in recent years. Initially, the FTRD system was limited to use in the colorectum only. Recently, a modified version of the FTRD has been released for EFTR in the upper GIT as well. This review provides a broad summary of the FTRD, highlighting recent advances and current challenges.
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Affiliation(s)
- Elijah J Mun
- Division of Gastroenterology, University of Colorado School of Medicine, Aurora, CO 80045, United States
| | - Mihir S Wagh
- Interventional Endoscopy, Division of Gastroenterology, University of Colorado School of Medicine, Aurora, CO 80045, United States
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13
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Tate DJ, Argenziano ME, Anderson J, Bhandari P, Boškoski I, Bugajski M, Desomer L, Heitman SJ, Kashida H, Kriazhov V, Lee RRT, Lyutakov I, Pimentel-Nunes P, Rivero-Sánchez L, Thomas-Gibson S, Thorlacius H, Bourke MJ, Tham TC, Bisschops R. Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2023. [PMID: 37285908 DOI: 10.1055/a-2077-0497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Endoscopic mucosal resection (EMR) is the standard of care for the complete removal of large (≥ 10 mm) nonpedunculated colorectal polyps (LNPCPs). Increased detection of LNPCPs owing to screening colonoscopy, plus high observed rates of incomplete resection and need for surgery call for a standardized approach to training in EMR. 1 : Trainees in EMR should have achieved basic competence in diagnostic colonoscopy, < 10-mm polypectomy, pedunculated polypectomy, and common methods of gastrointestinal endoscopic hemostasis. The role of formal training courses is emphasized. Training may then commence in vivo under the direct supervision of a trainer. 2 : Endoscopy units training endoscopists in EMR should have specific processes in place to support and facilitate training. 3: A trained EMR practitioner should have mastered theoretical knowledge including how to assess an LNPCP for risk of submucosal invasion, how to interpret the potential difficulty of a particular EMR procedure, how to decide whether to remove a particular LNPCP en bloc or piecemeal, whether the risks of electrosurgical energy can be avoided for a particular LNPCP, the different devices required for EMR, management of adverse events, and interpretation of reports provided by histopathologists. 4: Trained EMR practitioners should be familiar with the patient consent process for EMR. 5: The development of endoscopic non-technical skills (ENTS) and team interaction are important for trainees in EMR. 6: Differences in recommended technique exist between EMR performed with and without electrosurgical energy. Common to both is a standardized technique based upon dynamic injection, controlled and precise snare placement, safety checks prior to the application of tissue transection (cold snare) or electrosurgical energy (hot snare), and interpretation of the post-EMR resection defect. 7: A trained EMR practitioner must be able to manage adverse events associated with EMR including intraprocedural bleeding and perforation, and post-procedural bleeding. Delayed perforation should be avoided by correct interpretation of the post-EMR defect and treatment of deep mural injury. 8: A trained EMR practitioner must be able to communicate EMR procedural findings to patients and provide them with a plan in case of adverse events after discharge and a follow-up plan. 9: A trained EMR practitioner must be able to detect and interrogate a post-endoscopic resection scar for residual or recurrent adenoma and apply treatment if necessary. 10: Prior to independent practice, a minimum of 30 EMR procedures should be performed, culminating in a trainer-guided assessment of competency using a validated assessment tool, taking account of procedural difficulty (e. g. using the SMSA polyp score). 11: Trained practitioners should log their key performance indicators (KPIs) of polypectomy during independent practice. A guide for target KPIs is provided in this document.
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Affiliation(s)
- David J Tate
- Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium
- Faculty of Medicine, University of Ghent, Ghent, Belgium
| | - Maria Eva Argenziano
- Clinic of Gastroenterology, Hepatology and Emergency Digestive Endoscopy, Università Politecnica delle Marche, Ancona, Italy
| | - John Anderson
- Cheltenham General Hospital, Gloucestershire Hospitals Foundation Trust, Cheltenham, UK
| | - Pradeep Bhandari
- Endoscopy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marek Bugajski
- Department of Gastroenterology, Luxmed Oncology, Warsaw, Poland
| | - Lobke Desomer
- AZ Delta Roeselare, University Hospital Ghent, Ghent, Belgium
| | - Steven J Heitman
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Vladimir Kriazhov
- Endoscopy Department, Nizhny Novgorod Regional Clinical Oncology Center, Nizhny Novgorod, Russia Federation
| | - Ralph R T Lee
- The Ottawa Hospital - Civic Campus, University of Ottawa, Ottawa, Canada
| | - Ivan Lyutakov
- University Hospital Tsaritsa Yoanna-ISUL, Medical University Sofia, Sofia, Bulgaria
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Surgery and Physiology Department, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Liseth Rivero-Sánchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | | | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Tony C Tham
- Division of Gastroenterology, Ulster Hospital, Dundonald, Belfast, Northern Ireland
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, KU Leuven, Leuven, Belgium
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Zwager LW, Mueller J, Stritzke B, Montazeri NSM, Caca K, Dekker E, Fockens P, Schmidt A, Bastiaansen BAJ. Adverse events of endoscopic full-thickness resection: results from the German and Dutch nationwide colorectal FTRD registry. Gastrointest Endosc 2023; 97:780-789.e4. [PMID: 36410447 DOI: 10.1016/j.gie.2022.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Endoscopic full-thickness resection (eFTR) is emerging as a minimally invasive alternative to surgery for complex colorectal lesions. Previous studies have demonstrated favorable safety results; however, large studies representing a generalizable estimation of adverse events (AEs) are lacking. Our aim was to provide further insight in AEs after eFTR. METHODS Data from all registered eFTR procedures in the German and Dutch colorectal full-thickness resection device registries between July 2015 and March 2021 were collected. Safety outcomes included immediate and late AEs. RESULTS Of 1892 procedures, the overall AE rate was 11.3% (213/1892). No AE-related mortality occurred. Perforations occurred in 2.5% (47/1892) of all AEs, 57.4% (27/47) of immediate AEs, and 42.6% (20/47) of delayed AEs. Successful endoscopic closure was achieved in 29.8% of cases (13 immediate and 1 delayed), and antibiotic treatment was sufficient in 4.3% (2 delayed). The appendicitis rate for appendiceal lesions was 9.9% (13/131), and 46.2% (6/13) could be treated conservatively. The severe AE rate requiring surgery was 2.2% (42/1892), including delayed perforations in .9% (17/1892) and immediate perforations in .7% (13/1892). Delayed perforations occurred between days 1 and 10 (median, 2) after eFTR, and 58.8% (10/17) were located on the left side. Other severe AEs were appendicitis (.4%, 7/1892), luminal stenosis (.1%, 2/1892), delayed bleeding (.1%, 1/1892), pain after eFTR close to the dentate line (.1%, 1/1892), and grasper entrapment in the clip (.1%, 1/1892). CONCLUSIONS Colorectal eFTR is a safe procedure with a low risk for severe AEs in everyday practice and without AE-related mortality. These results further support the position of eFTR as an established minimally invasive technique for complex colorectal lesions.
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Affiliation(s)
- Liselotte W Zwager
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Julius Mueller
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Nahid S M Montazeri
- Biostatistics Unit, Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, the Netherlands
| | - Karel Caca
- Department of Gastroenterology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
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15
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Hanevelt J, Moons LMG, Hentzen JEKR, Wemeijer TM, Huisman JF, de Vos Tot Nederveen Cappel WH, van Westreenen HL. Colonoscopy-Assisted Laparoscopic Wedge Resection for the Treatment of Suspected T1 Colon Cancer. Ann Surg Oncol 2023; 30:2058-2065. [PMID: 36598625 DOI: 10.1245/s10434-022-12973-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Local en bloc resection of pT1 colon cancer has been gaining acceptance during the last few years. In the absence of histological risk factors, the risk of lymph-node metastases (LNM) is negligible and does not outweigh the morbidity and mortality of an oncologic resection. Colonoscopy-assisted laparoscopic wedge resection (CAL-WR) has proved to be an effective and safe technique for removing complex benign polyps. The role of CAL-WR for the primary resection of suspected T1 colon cancer has to be established. METHODS This retrospective study aimed to determine the radicality and safety of CAL-WR as a local en bloc resection technique for a suspected T1 colon cancer. Therefore, the study identified patients in whom high-grade dysplasia or a T1 colon carcinoma was suspected based on histology and/or macroscopic assessment, requiring an en bloc resection. RESULTS The study analyzed 57 patients who underwent CAL-WR for a suspected macroscopic polyp or polyps with biopsy-proven high-grade dysplasia or T1 colon carcinoma. For 27 of these 57 patients, a pT1 colon carcinoma was diagnosed at pathologic examination after CAL-WR. Histological risk factors for LNM were present in three cases, and 70% showed deep submucosal invasion (Sm2/Sm3). For patients with pT1 colon carcinoma, an overall R0-resection rate of 88.9% was achieved. A minor complication was noted in one patient (1.8%). CONCLUSIONS The CAL-WR procedure is an effective and safe technique for suspected high-grade dysplasia or T1-colon carcinoma. It may fill the gap for tumors that are macroscopic suspected for deep submucosal invasion, providing more patients an organ-preserving treatment option.
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Affiliation(s)
- Julia Hanevelt
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands.
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | | | | | - Jelle F Huisman
- Department of Gastroenterology and Hepatology, Isala, Zwolle, The Netherlands
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16
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van Toledo DEFWM, IJspeert JEG, Bleijenberg AGC, Bastiaansen BAJ, van Noesel CJM, Dekker E. Appendiceal lesions in serrated polyposis patients are easily overlooked but only seldomly lead to colorectal cancer. Endoscopy 2023. [PMID: 36827991 DOI: 10.1055/a-2025-0845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Serrated polyposis syndrome (SPS) is the most prevalent colonic polyposis syndrome and is associated with an increased colorectal cancer risk. A recent study in resected appendices of SPS patients reported that 6/23 (26.1 %) of identified serrated polyps had histological dysplasia. We evaluated the prevalence and clinical relevance of appendiceal lesions in a large SPS cohort. METHODS Prospective data from 2007 to 2020 for a cohort of 199 SPS patients were analyzed. Data were retrieved from endoscopy and pathology reports. Patients who underwent (pre)clearance colonoscopies, surveillance colonoscopies, or colorectal surgery including the appendix were separately evaluated for the presence of appendiceal lesions. The primary outcome was the prevalence of adenocarcinomas and serrated polyps/adenomas with advanced histology in the surgery group. RESULTS 171 patients were included, of whom 110 received endoscopic surveillance and 34 underwent surgery. Appendiceal lesion prevalence in the surgery group was 14 /34 (41.2 %, 95 %CI 24.7 %-59.3 %); none were advanced on histology. Detection rates in the (pre)clearance group were 1 /171 (0.6 %, 95 %CI 0.01 %-3.2 %) for advanced and 3 /171 (1.8 %, 95 %CI 0.04 %-5.0 %) for nonadvanced appendiceal lesions, all of which were sessile serrated lesions. During 522 patient-years of surveillance, no advanced appendiceal lesions were detected at endoscopy, and in 1 /110 patients (0.9 %, 95 %CI 0.02 %-5.0 %) was a nonadvanced lesion detected. CONCLUSION Appendiceal lesions are common in SPS patients. The discrepancy between the endoscopic detection rate of appendiceal lesions and the reported prevalence in surgically resected appendices suggests a substantial miss-rate of appendiceal lesions during colonoscopy. Advanced appendiceal lesions are however rare and no appendiceal adenocarcinomas occurred, implying limited clinical relevance of these lesions.
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Affiliation(s)
- David E F W M van Toledo
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
| | - Joep E G IJspeert
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
| | - Arne G C Bleijenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
| | - Carel J M van Noesel
- Department of Pathology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
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17
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Patenotte A, Yzet C, Wallenhorst T, Subtil F, Leblanc S, Schaefer M, Walter T, Lambin T, Fenouil T, Lafeuille P, Chevaux JB, Legros R, Rostain F, Rivory J, Jacques J, Lépilliez V, Pioche M. Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion. Endoscopy 2023; 55:192-197. [PMID: 35649429 DOI: 10.1055/a-1866-8080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion. METHODS In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15 mm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). RESULTS 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2 %) and, where possible, the en bloc and R0 resection rates were 95.8 % (115/120) and 76.7 % (92/120), respectively. Thirty-three resections (26.2 %) were for very low risk tumors, so considered curative, and 38 (30.2 %) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; n = 8), or significant budding (n = 9), and LVI + budding combination (n = 4). CONCLUSION ESD is feasible and safe for colorectal lesions with an FDIP ≤ 15 mm. It was curative in 26.6 % of patients and could be a valid option for a further 30.6 % of patients with low risk T1 cancers, especially for frail patients with co-morbidities.
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Affiliation(s)
- Adrien Patenotte
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Clara Yzet
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Timothée Wallenhorst
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Fabien Subtil
- Service de Biostatistique, Hospices Civils de Lyon and CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France
| | - Sarah Leblanc
- Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Marion Schaefer
- Endoscopy and Gastroenterology Unit, Brabois Hospitals, Nancy, France
| | - Thomas Walter
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Thomas Lambin
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Tanguy Fenouil
- Institute of Pathology - East site, Groupement hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Pierre Lafeuille
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | | | - Romain Legros
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Florian Rostain
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Rivory
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérémie Jacques
- Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
| | - Vincent Lépilliez
- Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
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18
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Schiemer M, Schmidt A. [Current endoscopic resection techniques in the colorectum: possibilities, perspectives, limitations]. Dtsch Med Wochenschr 2023; 148:84-93. [PMID: 36690004 DOI: 10.1055/a-1832-4090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since the first endoscopic polypectomies have been performed, the resection of premalignant lesions during colonoscopy has become a success story in the field of gastroenterology: Incidence and mortality of colorectal cancer have been significantly reduced with the implementation of screening programs. Most polyps in the lower gastrointestinal tract are small and easy to remove. However, larger polyps, early carcinomas and subepithelial lesions can be removed with modern endoscopic resection techniques as well. Minimally invasive endoscopic resections offer an organ-preserving alternative to surgery in a growing number of patients. In this review, we discuss the advantages and limitations of traditional and novel endoscopic resection techniques, including endoscopic mucosal resection, endoscopic submucosal dissection and endoscopic full thickness resection.
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19
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Wang K, Gao P, Cai M, Song B, Zhou P. Endoscopic full-thickness resection, indication, methods and perspectives. Dig Endosc 2023; 35:195-205. [PMID: 36355358 DOI: 10.1111/den.14474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022]
Abstract
Minimally invasive surgery has emerged as the dominant theme of modern surgery, in which endoscopic surgery plays a key role. The technique of endoscopic surgery has evolved continuously with extensive research, improving the treatment modalities as well as expanding the indications for its use. As an active perforation endoscopic technique, endoscopic full-thickness resection (EFTR) is mainly used in the treatment of submucosal tumors (SMTs) of the gastrointestinal tract. With decades of evolution, EFTR has gradually developed into a mature endoscopic operation. Based on clinical experience and current research, indications, techniques, clinical outcomes and future perspectives for EFTR are discussed in this paper. We performed a bibliometric study on EFTR literature and showed robust data through a brief meta-analysis on the topic.
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Affiliation(s)
- Kehao Wang
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Pingting Gao
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Mingyan Cai
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
| | - Baohui Song
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pinghong Zhou
- Endoscopy Center and Endoscopy Research Institute, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Collaborative Innovation Center of Endoscopy, Shanghai, China
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20
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Kim GE, Kothari S, Siddiqui UD. Nontunneling Full Thickness Techniques for Neoplasia. Gastrointest Endosc Clin N Am 2023; 33:155-168. [PMID: 36375880 DOI: 10.1016/j.giec.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Colorectal cancer is the third most common cancer worldwide and the fourth leading cause of cancer-related deaths in the world, second in the United States. Although most lesions are managed surgically especially when they have already invaded into the submucosal layer, endoscopic full-thickness resection (EFTR) has become an emerging technique that can serve as a safe and effective alternative management for locally invasive gastrointestinal cancers. This article discusses the indications and various techniques and limitations of nontunneled EFTRs of gastrointestinal cancer and reviews the current literature on the outcomes of EFTR.
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Affiliation(s)
- Grace E Kim
- Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, 15841 South Maryland Avenue MC4076, Chicago, IL 60637, USA.
| | - Shivangi Kothari
- Division of Gastroenterology/Hepatology, University of Rochester Medical Center & Strong Memorial Hospital, 2601 Elmwood Avenue, Box 646, Rochester, NY 14642, USA
| | - Uzma D Siddiqui
- Section of Gastroenterology, Hepatology, and Nutrition, Center for Endoscopic Research and Therapeutics and Advanced Endoscopy Training, University of Chicago, 35700 South Maryland Avenue MC 8043, Chicago, IL 60637, USA
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21
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Mueller J, Kuellmer A, Schiemer M, Thimme R, Schmidt A. Current status of endoscopic full-thickness resection with the full-thickness resection device. Dig Endosc 2023; 35:232-242. [PMID: 35997598 DOI: 10.1111/den.14425] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/21/2022] [Indexed: 01/24/2023]
Abstract
Endoscopic full-thickness resection (EFTR) using the full-thickness resection device (FTRD) is an integral part of diagnostic and therapeutic endoscopy. Since its market launch in Europe in 2014, its safety and effectiveness have been proven in numerous studies. Adaptations in design as well as new techniques, such as hybrid EFTR, expand the spectrum of the FTRD system. The following review is intended to provide an overview of the clinical application and current evidence of EFTR with the FTRD system.
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Affiliation(s)
- Julius Mueller
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Armin Kuellmer
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moritz Schiemer
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Robert Thimme
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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22
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Liu J, Li B, Zhou P, Cai M, Zhong Y. Technical feasibility of salvage endoscopic full-thickness resection for a giant gastrointestinal stromal tumor located in low rectum after imatinib: a case report. Gastroenterol Rep (Oxf) 2022; 11:goac078. [PMID: 36632625 PMCID: PMC9827538 DOI: 10.1093/gastro/goac078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/03/2022] [Accepted: 11/23/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jingyi Liu
- Endoscopy Center, Zhongshan Hospital of Fudan University,
Shanghai, P. R. China,Endoscopy Research Institute of Fudan University, Shanghai,
P. R. China,Shanghai Collaborative Innovation Center of Endoscopy,
Shanghai, P. R. China
| | - Bing Li
- Endoscopy Center, Zhongshan Hospital of Fudan University,
Shanghai, P. R. China,Endoscopy Research Institute of Fudan University, Shanghai,
P. R. China,Shanghai Collaborative Innovation Center of Endoscopy,
Shanghai, P. R. China
| | - Pinghong Zhou
- Endoscopy Center, Zhongshan Hospital of Fudan University,
Shanghai, P. R. China,Endoscopy Research Institute of Fudan University, Shanghai,
P. R. China,Shanghai Collaborative Innovation Center of Endoscopy,
Shanghai, P. R. China
| | - Mingyan Cai
- Corresponding authors. Yunshi Zhong, Endoscopy Center, Xuhui Hospital,
Zhongshan Hospital of Fudan University, 966 Huaihai Road, Xuhui District, Shanghai 200020,
P. R. China. Tel: +86-21-31270810; ; Mingyan
Cai, Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Xuhui
District, Shanghai 200032, P. R. China. Tel: +86-21-64041900;
| | - Yunshi Zhong
- Corresponding authors. Yunshi Zhong, Endoscopy Center, Xuhui Hospital,
Zhongshan Hospital of Fudan University, 966 Huaihai Road, Xuhui District, Shanghai 200020,
P. R. China. Tel: +86-21-31270810; ; Mingyan
Cai, Endoscopy Center, Zhongshan Hospital of Fudan University, 180 Fenglin Road, Xuhui
District, Shanghai 200032, P. R. China. Tel: +86-21-64041900;
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23
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Didden P, van Eijck van Heslinga RAH, Schwartz MP, Arensman LR, Vleggaar FP, de Graaf W, Koch AD, Doukas M, Lacle MM, Moons LMG. Relevance of polyp size for primary endoscopic full-thickness resection of suspected T1 colorectal cancers. Endoscopy 2022; 54:1062-1070. [PMID: 35255517 DOI: 10.1055/a-1790-5539] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND En bloc local excision of suspected T1 colorectal cancer (CRC) provides optimal tumor risk assessment with curative intent. Endoscopic full-thickness resection (eFTR) with an over-the-scope device has emerged as a local excision technique for T1 CRCs, but data on the upper size limit for achieving a histological complete (R0) resection are lacking. We aimed to determine the influence of polyp size on the R0 rate. METHODS eFTR procedures for suspected T1 CRCs performed between 2015 and 2021 were selected from the endoscopy databases of three tertiary centers. The main outcome was R0 resection, defined as tumor- and dysplasia-free margins (≥ 0.1 mm) for both the deep and lateral resection margins. Regression analysis was performed to identify risk factors for R1/Rx resection, mainly focusing on endoscopically estimated polyp size. RESULTS 136 patients underwent eFTR for suspected T1 CRC (median size 15 mm [IQR 13-18 mm]; 83.1 % cancer). The rates of technical success and R0 resection were 87.5 % (119/136; 95 %CI 80.9 %-92.1 %) and 79.7 % (106/136; 95 %CI 72.1 %-85.7 %), respectively. Increasing polyp size was significantly associated with R1/Rx resection (risk ratio 2.35 per 5-mm increase, 95 %CI 1.80-3.07; P < 0.001). The R0 rate was 89.9 % (80/89) for polyps ≤ 15 mm, 71.4 % (25/35) for 16-20 mm, and 11.1 % (1/9) for those > 20 mm. CONCLUSIONS eFTR is associated with a 90 % R0 rate for T1 CRCs of ≤ 15 mm. Performing eFTR for polyps 16-20 mm should depend on access, their mobility, and the availability of alternative resection techniques. eFTR for > 20-mm polyps results in a high R1 rate and should not be recommended.
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Affiliation(s)
- Paul Didden
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, The Netherlands
| | - L R Arensman
- Department of Pathology, Meander Medical Center, Amersfoort, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilmar de Graaf
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Michael Doukas
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands
| | - Miangela M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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24
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Høgh A, Deding U, Bjørsum-Meyer T, Buch N, Baatrup G. Endoscopic full-thickness resection (eFTR) in colon and rectum: indications and outcomes in the first 37 cases in a single center. Surg Endosc 2022; 36:8195-8201. [PMID: 35536486 DOI: 10.1007/s00464-022-09263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Segmental resection of the colon or rectum for cancer is major surgery with substantial procedure-related morbidity and mortality. A steep increase in the frequency of early cancer and advanced adenoma detection has been evident these late years. Introducing more minimal invasive resection techniques may decrease procedure-related complications and mortality. We aimed to describe the results from introducing endoscopic full-thickness resection (eFTR) in a unit specialized in advanced endoscopic resection of colon neoplasias. Primary outcomes were R0 resection rate and complications. METHODS endoscopic full-thickness resection was introduced in our unit in 2017. Patients were referred for eFTR based on indications: (i) completion of resection after unexpected cancer, (ii) suspicion of or clinically confirmed early cancer (T1) without signs of dissemination, or (iii) adenomas not suitable for other endoscopic resection techniques due to difficult position or recurrence. Data on eFTR procedures and follow-up were retrieved from patient journals. RESULTS Thirty-seven eFTR procedures were commenced in the period of March 2017 until June 2020, and one of these was abandoned. The overall R0 resection rate was 83.3%. In subgroups of indications i-iii, it was 87.5, 80.0, and 80.0%, respectively. Three perforations and one case of late bleeding occurred. One patient died within 30 days due to late perforation. Six technical failures were evident including operator-induced failures. Five of the technical failures occurred in the first half of the procedures indicating the learning curve of the endoscopist. CONCLUSION Implementation of the eFTR procedure has been largely successful, especially in patients referred for completion of resection after unexpected cancer. Complication rates were acceptable, and the technique and quality increased significantly during the study. Careful selection of patients for eFTR is crucial for achieving successful resection. Size and position of lesion seem more important than indication. eFTR is not effective for lesions > 30 mm.
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Affiliation(s)
- Anders Høgh
- Department of Surgery, Odense University Hospital, Svendborg, Denmark.
| | - Ulrik Deding
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Thomas Bjørsum-Meyer
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Buch
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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25
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Ichimasa K, Nakahara K, Kudo SE, Misawa M, Bretthauer M, Shimada S, Takehara Y, Mukai S, Kouyama Y, Miyachi H, Sawada N, Mori K, Ishida F, Mori Y. Novel "resect and analysis" approach for T2 colorectal cancer with use of artificial intelligence. Gastrointest Endosc 2022; 96:665-672.e1. [PMID: 35500659 DOI: 10.1016/j.gie.2022.04.1305] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/21/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Because of a lack of reliable preoperative prediction of lymph node involvement in early-stage T2 colorectal cancer (CRC), surgical resection is the current standard treatment. This leads to overtreatment because only 25% of T2 CRC patients turn out to have lymph node metastasis (LNM). We assessed a novel artificial intelligence (AI) system to predict LNM in T2 CRC to ascertain patients who can be safely treated with less-invasive endoscopic resection such as endoscopic full-thickness resection and do not need surgery. METHODS We included 511 consecutive patients who had surgical resection with T2 CRC from 2001 to 2016; 411 patients (2001-2014) were used as a training set for the random forest-based AI prediction tool, and 100 patients (2014-2016) were used to validate the AI tool performance. The AI algorithm included 8 clinicopathologic variables (patient age and sex, tumor size and location, lymphatic invasion, vascular invasion, histologic differentiation, and serum carcinoembryonic antigen level) and predicted the likelihood of LNM by receiver-operating characteristics using area under the curve (AUC) estimates. RESULTS Rates of LNM in the training and validation datasets were 26% (106/411) and 28% (28/100), respectively. The AUC of the AI algorithm for the validation cohort was .93. With 96% sensitivity (95% confidence interval, 90%-99%), specificity was 88% (95% confidence interval, 80%-94%). In this case, 64% of patients could avoid surgery, whereas 1.6% of patients with LNM would lose a chance to receive surgery. CONCLUSIONS Our proposed AI prediction model has a potential to reduce unnecessary surgery for patients with T2 CRC with very little risk. (Clinical trial registration number: UMIN 000038257.).
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Affiliation(s)
- Katsuro Ichimasa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kenta Nakahara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-Ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masashi Misawa
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Michael Bretthauer
- Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
| | - Shoji Shimada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yusuke Takehara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shunpei Mukai
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuta Kouyama
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hideyuki Miyachi
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Naruhiko Sawada
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Nagoya, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yuichi Mori
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan; Clinical Effectiveness Research Group, University of Oslo and Oslo University Hospital, Oslo, Norway
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26
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Cui Y, Thompson CC, Chiu PWY, Gross SA. Robotics in therapeutic endoscopy (with video). Gastrointest Endosc 2022; 96:402-410. [PMID: 35667390 DOI: 10.1016/j.gie.2022.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/13/2022] [Accepted: 05/24/2022] [Indexed: 02/08/2023]
Abstract
Since its inception, endoscopy has evolved from a solely diagnostic procedure to an expanding therapeutic field within gastroenterology. The incorporation of robotics in gastroenterology initially addressed shortcomings of flexible endoscopes in natural orifice transluminal endoscopy. Developing therapeutic endoscopic robotic platforms now offer operators improved ergonomics, visualization, dexterity, precision, and control and the possibility of increasing proficiency and standardization of complex endoscopic procedures including endoscopic submucosal dissection, endoscopic full-thickness resection, and endoscopic suturing. The following review discusses the history, potential applications, and tools currently available and in development for robotics in therapeutic endoscopy.
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Affiliation(s)
- YongYan Cui
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Wai Yan Chiu
- Department of Surgery, Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Seth A Gross
- Department of Gastroenterology, New York University Medical Center, New York, New York, USA
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McKechnie T, Govind S, Lee J, Lee Y, Hong D, Eskicioglu C. Endoscopic Full-Thickness Resection for Colorectal Lesions: A Systematic Review and Meta-Analysis. J Surg Res 2022; 280:440-449. [PMID: 36054955 DOI: 10.1016/j.jss.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/07/2022] [Accepted: 07/28/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Endoscopic full-thickness resection (EFTR) with an over-the-scope full-thickness resection device is a relatively new technique for the resection of colorectal lesions. Multiple centers have published the results of case series and observational cohorts regarding the use of this technique for managing difficult polyps. This study aims to aggregate the results of these studies to determine the effectiveness and safety of this technique in the resection of these technically challenging colonic lesions. METHODS MEDLINE, EMBASE, and CENTRAL were searched. Articles were included if they reported technical success rate for EFTR of colonic lesions. The primary outcome was technical success rate and secondary outcomes included rate of R0 resection and overall 30-d morbidity. DerSimonian and Laird random-effects meta-analysis of proportions was used to generate effect sizes for pooled outcomes. RESULTS From 2211 citations, 21 studies with 1539 patients (mean age 67.2 y, 39.5% female) undergoing 1551 procedures were included. Difficult to resect benign lesions were the most commonly excised lesions (hyperplastic: 35.9%; adenomas: 30.2%), followed by T1 adenocarcinomas (25.6%) and neuroendocrine tumors (6.1%). Technical success rate was 89% (95% confidence interval [CI] 87-92), and R0 resection rate was 79% (95% CI 76-82). Mean procedure time was 53.5 min and mean specimen size was 17.5 mm. Overall 30-d morbidity was 11% (95% CI 7-13), and incidences of perforation and postpolypectomy bleeding were 2% (95% CI 1-2) and 5% (95% CI 3-7), respectively. Lesion recurrence at 3-mo follow-up was 8%. CONCLUSIONS EFTR requires further large sample size, comparative studies with reporting of long-term oncologic data. However, preliminary findings indicate that it is a safe and effective technique with high rates of technical success and acceptable rates of R0 resection when employed by experienced endoscopists for high-risk colonic lesions.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shaylan Govind
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jay Lee
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Yung Lee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
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Wu ZW, Ding CH, Song YD, Cui ZC, Bi XQ, Cheng B. Colon Sparing Endoscopic Full-Thickness Resection for Advanced Colorectal Lesions: Is It Time for Global Adoption? Front Oncol 2022; 12:967100. [PMID: 35912240 PMCID: PMC9327091 DOI: 10.3389/fonc.2022.967100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The majority of colon lesions are <10 mm in size and are easily resected by endoscopists with appropriate basic training. Lesions ≥10 mm in size are difficult to remove technically and are associated with higher rates of incomplete resection. Currently, the main endoscopic approaches include endoscopic mucosal resection (EMR) for lesions without submucosal invasion, and endoscopic submucosal dissection (ESD) for relatively larger lesions involving the superficial submucosal layer. Both of these approaches have limitations, EMR cannot reliably ensure complete resection for larger tumors and recurrence is a key limitation. ESD reliably provides complete resection and an accurate pathological diagnosis but is associated with risk such as perforation or bleeding. In addition, both EMR and ESD may be ineffective in treating subepithelial lesions that extend beyond the submucosa. Endoscopic full-thickness resection (EFTR) is an emerging innovative endoscopic therapy which was developed to overcome the limitations of EMR and ESD. Advantages include enabling a transmural resection, complete resection of complex colorectal lesions involving the mucosa to the muscularis propria. Recent studies comparing EFTR with current resection techniques and radical surgery for relatively complicated and larger lesion have provided promising results. If the current trajectory of research and development is maintained, EFTR will likely to become a strong contender as an alternative standard of care for advanced colonic lesions. In the current study we aimed to address this need, and highlighted the areas of future research, while stressing the need for multinational collaboration provide the steppingstone(s) needed to bring EFTR to the mainstream.
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Affiliation(s)
- Zhong-Wei Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao-Hui Ding
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao-Dong Song
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zong-Chao Cui
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiu-Qian Bi
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Cheng
- Department of Emergency Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Bo Cheng,
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Zwager LW, Bastiaansen BAJ, Dekker E, Fockens P; Expert Panel Group. Setting up a regional expert panel for complex colorectal polyps. Gastrointest Endosc 2022; 96:84-91.e2. [PMID: 35150664 DOI: 10.1016/j.gie.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/01/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Advanced endoscopic resection techniques for complex colorectal polyps have evolved significantly over the past decade, leading to a management shift from surgical to endoscopic resection as the preferred treatment. However, in practice, interhospital consultation and appropriate referral management remain challenging, leading to unnecessary surgical resections. To support regional care for patients with complex colorectal polyps, facilitate peer consultations, and lower thresholds for referrals, an expert panel consultation platform was initiated in the northwestern region of the Netherlands. METHODS We initiated a regional expert panel in the northwestern region of the Netherlands for patients with complex colorectal polyps and studied the implementation, adaption, and clinical impact. All panel consultations between June 2019 and May 2021 were retrospectively analyzed, and user satisfaction among panel members was evaluated. RESULTS Eighty-eight patients with complex colorectal polyps from 11 of 15 participating centers (73.3%) were discussed in our panel. The most common reason for panel consultation was suspicion of invasive cancer in 36.4% (n = 32). After panel consultation, 43.2% of the consulting endoscopists (n = 38) changed their initial treatment strategy, and in 63.6% (n = 56) patients were referred to another endoscopy center. Of 26 cases submitted with a primary proposal for surgical treatment, surgery was avoided in 7 (26.9%). User satisfaction was rated high in most participating centers (91.7%). CONCLUSIONS Our study shows that implementation of and consultation with a regional expert panel can be a valuable tool for endoscopists to guide and optimize treatment of complex colorectal polyps and facilitate interhospital referrals in a regional network.
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Schmidt A. Endoscopic full-thickness resection for T1 colorectal cancer: here to stay! Endoscopy 2022; 54:486-487. [PMID: 35104896 DOI: 10.1055/a-1708-0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg, Germany
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Zwager LW, Bastiaansen BAJ, van der Spek BW, Heine DN, Schreuder RM, Perk LE, Weusten BLAM, Boonstra JJ, van der Sluis H, Wolters HJ, Bekkering FC, Rietdijk ST, Schwartz MP, Nagengast WB, Ten Hove WR, Terhaar Sive Droste JS, Rando Munoz FJ, Vlug MS, Beaumont H, Houben MHMG, Seerden TCJ, de Wijkerslooth TR, Gielisse EAR, Hazewinkel Y, de Ridder R, Straathof JWA, van der Vlugt M, Koens L, Fockens P, Dekker E. Endoscopic full-thickness resection of T1 colorectal cancers: a retrospective analysis from a multicenter Dutch eFTR registry. Endoscopy 2022; 54:475-485. [PMID: 34488228 DOI: 10.1055/a-1637-9051] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Complete endoscopic resection and accurate histological evaluation for T1 colorectal cancer (CRC) are critical in determining subsequent treatment. Endoscopic full-thickness resection (eFTR) is a new treatment option for T1 CRC < 2 cm. We aimed to report clinical outcomes and short-term results. METHODS Consecutive eFTR procedures for T1 CRC, prospectively recorded in our national registry between November 2015 and April 2020, were retrospectively analyzed. Primary outcomes were technical success and R0 resection. Secondary outcomes were histological risk assessment, curative resection, adverse events, and short-term outcomes. RESULTS We included 330 procedures: 132 primary resections and 198 secondary scar resections after incomplete T1 CRC resection. Overall technical success, R0 resection, and curative resection rates were 87.0 % (95 % confidence interval [CI] 82.7 %-90.3 %), 85.6 % (95 %CI 81.2 %-89.2 %), and 60.3 % (95 %CI 54.7 %-65.7 %). Curative resection rate was 23.7 % (95 %CI 15.9 %-33.6 %) for primary resection of T1 CRC and 60.8 % (95 %CI 50.4 %-70.4 %) after excluding deep submucosal invasion as a risk factor. Risk stratification was possible in 99.3 %. The severe adverse event rate was 2.2 %. Additional oncological surgery was performed in 49/320 (15.3 %), with residual cancer in 11/49 (22.4 %). Endoscopic follow-up was available in 200/242 (82.6 %), with a median of 4 months and residual cancer in 1 (0.5 %) following an incomplete resection. CONCLUSIONS eFTR is relatively safe and effective for resection of small T1 CRC, both as primary and secondary treatment. eFTR can expand endoscopic treatment options for T1 CRC and could help to reduce surgical overtreatment. Future studies should focus on long-term outcomes.
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Affiliation(s)
- Liselotte W Zwager
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
| | - Bas W van der Spek
- Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, the Netherlands
| | - Dimitri N Heine
- Department of Gastroenterology and Hepatology, Noordwest Hospital Group, Alkmaar, the Netherlands
| | - Ramon M Schreuder
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands
| | - Lars E Perk
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, the Hague, the Netherlands
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Jurjen J Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hedwig van der Sluis
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
| | - Hugo J Wolters
- Department of Gastroenterology and Hepatology, Martini Hospital, Groningen, the Netherlands
| | - Frank C Bekkering
- Department of Gastroenterology and Hepatology, IJsselland Hospital, Capelle aan den IJssel, the Netherlands
| | - Svend T Rietdijk
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Matthijs P Schwartz
- Department of Gastroenterology and Hepatology, Meander Medical Center, Amersfoort, the Netherlands
| | - Wouter B Nagengast
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - W Rogier Ten Hove
- Department of Gastroenterology and Hepatology, Alrijne Medical Group, Leiden, the Netherlands
| | | | - Francisco J Rando Munoz
- Department of Gastroenterology and Hepatology, Nij Smellinghe Hospital, Drachten, the Netherlands
| | - Marije S Vlug
- Department of Gastroenterology and Hepatology, Dijklander Hospital, Hoorn, the Netherlands
| | - Hanneke Beaumont
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VU, Amsterdam, the Netherlands
| | - Martin H M G Houben
- Department of Gastroenterology and Hepatology, Haga Teaching Hospital, the Hague, the Netherlands
| | - Tom C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands
| | - Thomas R de Wijkerslooth
- Department of Gastroenterology and Hepatology, Antoni van Leeuwenhoek Hospital (NKI /AVL), Amsterdam, the Netherlands
| | - Eric A R Gielisse
- Department of Gastroenterology and Hepatology, Rode Kruis Hospital, Beverwijk, the Netherlands
| | - Yark Hazewinkel
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rogier de Ridder
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jan-Willem A Straathof
- Department of Gastroenterology and Hepatology, Maxima Medical Center, Eindhoven, the Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
| | - Lianne Koens
- Department of Pathology, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, the Netherlands
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Gijsbers KM, van der Schee L, van Veen T, van Berkel AM, Boersma F, Bronkhorst CM, Didden PD, Haasnoot KJ, Jonker AM, Kessels K, Knijn N, van Lijnschoten I, Mijnals C, Milne AN, Moll FC, Schrauwen RW, Schreuder RM, Seerden TJ, Spanier MB, Terhaar Sive Droste JS, Witteveen E, de Vos tot Nederveen Cappel WH, Vleggaar FP, Laclé MM, ter Borg F, Moons LM. Impact of ≥ 0.1-mm free resection margins on local intramural residual cancer after local excision of T1 colorectal cancer. Endosc Int Open 2022; 10:E282-E290. [PMID: 35836740 PMCID: PMC9274442 DOI: 10.1055/a-1736-6960] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/15/2021] [Indexed: 02/07/2023] Open
Abstract
Background and study aims A free resection margin (FRM) > 1 mm after local excision of a T1 colorectal cancer (CRC) is known to be associated with a low risk of local intramural residual cancer (LIRC). The risk is unclear, however, for FRMs between 0.1 to 1 mm. This study evaluated the risk of LIRC after local excision of T1 CRC with FRMs between 0.1 and 1 mm in the absence of lymphovascular invasion (LVI), poor differentiation and high-grade tumor budding (Bd2-3). Patients and methods Data from all consecutive patients with local excision of T1 CRC between 2014 and 2017 were collected from 11 hospitals. Patients with a FRM ≥ 0.1 mm without LVI and poor differentiation were included. The main outcome was risk of LIRC (composite of residual cancer in the local excision scar in adjuvant resection specimens or local recurrence during follow-up). Tumor budding was also assessed for cases with a FRM between 0.1 and 1mm. Results A total of 171 patients with a FRM between 0.1 and 1 mm and 351 patients with a FRM > 1 mm were included. LIRC occurred in five patients (2.9 %; 95 % confidence interval [CI] 1.0-6.7 %) and two patients (0.6 %; 95 % CI 0.1-2.1 %), respectively. Assessment of tumor budding showed Bd2-3 in 80 % of cases with LIRC and in 16 % of control cases. Accordingly, in patients with a FRM between 0.1 and 1 mm without Bd2-3, LIRC was detected in one patient (0.8%; 95 % CI 0.1-4.4 %). Conclusions In this study, risks of LIRC were comparable for FRMs between 0.1 and 1 mm and > 1 mm in the absence of other histological risk factors.
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Affiliation(s)
- Kim M. Gijsbers
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Lisa van der Schee
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tessa van Veen
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Femke Boersma
- Department of Gastroenterology & Hepatology, Gelre Hospital, Apeldoorn, The Netherlands
| | | | - Paul D. Didden
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Krijn J.C. Haasnoot
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne M. Jonker
- Department of Pathology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Koen Kessels
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Department of Gastroenterology & Hepatology, St. Antonius Hospital, Nieuwegein,
The Netherlands
| | - Nikki Knijn
- Pathology-DNA, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Clinton Mijnals
- Department of Pathology, Amphia Hospital, Breda, The Netherlands
| | - Anya N. Milne
- Pathology-DNA, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Freek C.P. Moll
- Department of Pathology, Isala Clinics, Zwolle, The Netherlands
| | - Ruud W.M. Schrauwen
- Department of Gastroenterology & Hepatology, Bernhoven, Uden, The Netherlands
| | - Ramon-Michel Schreuder
- Department of Gastroenterology & Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Tom J. Seerden
- Department of Gastroenterology & Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Marcel B.W.M. Spanier
- Department of Gastroenterology & Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | | | - Emma Witteveen
- Department of Pathology, Noordwest Hospital, Alkmaar, The Netherlands
| | | | - Frank P. Vleggaar
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Miangela M. Laclé
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank ter Borg
- Department of Gastroenterology & Hepatology, Deventer Hospital, Deventer, The Netherlands
| | - Leon M.G. Moons
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Gijsbers KM, Laclé MM, Elias SG, Backes Y, Bosman JH, van Berkel AM, Boersma F, Boonstra JJ, Bos PR, Dekker PAT, Didden PD, Geesing JMJ, Groen JN, Haasnoot KJC, Kessels K, van Lent AUG, van der Schee L, Schrauwen RWM, Schreuder RM, Schwartz MP, Seerden TJ, Spanier MBWM, Terhaar Sive Droste JS, Tuynman JB, de Vos Tot Nederveen Cappel WH, van Westreenen EHL, Wolfhagen FHJ, Vleggaar FP, Ter Borg F, Moons LMG; Dutch T1 CRC Working Group. Full-Thickness Scar Resection After R1/Rx Excised T1 Colorectal Cancers as an Alternative to Completion Surgery. Am J Gastroenterol 2022; 117:647-53. [PMID: 35029166 DOI: 10.14309/ajg.0000000000001621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Local full-thickness resections of the scar (FTRS) after local excision of a T1 colorectal cancer (CRC) with uncertain resection margins is proposed as an alternative strategy to completion surgery (CS), provided that no local intramural residual cancer (LIRC) is found. However, a comparison on long-term oncological outcome between both strategies is missing. METHODS A large cohort of patients with consecutive T1 CRC between 2000 and 2017 was used. Patients were selected if they underwent a macroscopically complete local excision of a T1 CRC but positive or unassessable (R1/Rx) resection margins at histology and without lymphovascular invasion or poor differentiation. Patients treated with CS or FTRS were compared on the presence of CRC recurrence, a 5-year overall survival, disease-free survival, and metastasis-free survival. RESULTS Of 3,697 patients with a T1 CRC, 434 met the inclusion criteria (mean age 66 years, 61% men). Three hundred thirty-four patients underwent CS, and 100 patients underwent FTRS. The median follow-up period was 64 months. CRC recurrence was seen in 7 patients who underwent CS (2.2%, 95% CI 0.9%-4.6%) and in 8 patients who underwent FTRS (9.0%, 95% CI 3.9%-17.7%). Disease-free survival was lower in FTRS strategy (96.8% vs 89.9%, P = 0.019), but 5 of the 8 FTRS recurrences could be treated with salvage surgery. The metastasis-free survival (CS 96.8% vs FTRS 92.1%, P = 0.10) and overall survival (CS 95.6% vs FTRS 94.4%, P = 0.55) did not differ significantly between both strategies. DISCUSSION FTRS after local excision of a T1 CRC with R1/Rx resection margins as a sole risk factor, followed by surveillance and salvage surgery in case of CRC recurrence, could be a valid alternative strategy to CS.
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Deprez PH, Moons LMG, OʼToole D, Gincul R, Seicean A, Pimentel-Nunes P, Fernández-Esparrach G, Polkowski M, Vieth M, Borbath I, Moreels TG, Nieveen van Dijkum E, Blay JY, van Hooft JE. Endoscopic management of subepithelial lesions including neuroendocrine neoplasms: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54:412-429. [PMID: 35180797 DOI: 10.1055/a-1751-5742] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
1: ESGE recommends endoscopic ultrasonography (EUS) as the best tool to characterize subepithelial lesion (SEL) features (size, location, originating layer, echogenicity, shape), but EUS alone is not able to distinguish among all types of SEL.Strong recommendation, moderate quality evidence. 2: ESGE suggests providing tissue diagnosis for all SELs with features suggestive of gastrointestinal stromal tumor (GIST) if they are of size > 20 mm, or have high risk stigmata, or require surgical resection or oncological treatment.Weak recommendation, very low quality evidence. 3: ESGE recommends EUS-guided fine-needle biopsy (EUS-FNB) or mucosal incision-assisted biopsy (MIAB) equally for tissue diagnosis of SELs ≥ 20 mm in size.Strong recommendation, moderate quality evidence. 4: ESGE recommends against surveillance of asymptomatic gastrointestinal (GI) tract leiomyomas, lipomas, heterotopic pancreas, granular cell tumors, schwannomas, and glomus tumors, if the diagnosis is clear.Strong recommendation, moderate quality evidence. 5: ESGE suggests surveillance of asymptomatic esophageal and gastric SELs without definite diagnosis, with esophagogastroduodenoscopy (EGD) at 3-6 months, and then at 2-3-year intervals for lesions < 10 mm in size, and at 1-2-year intervals for lesions 10-20 mm in size. For asymptomatic SELs > 20 mm in size that are not resected, ESGE suggests surveillance with EGD plus EUS at 6 months and then at 6-12-month intervals.Weak recommendation, very low quality evidence. 6: ESGE recommends endoscopic resection for type 1 gastric neuroendocrine neoplasms (g-NENs) if they grow larger than 10 mm. The choice of resection technique should depend on size, depth of invasion, and location in the stomach.Strong recommendation, low quality evidence. 7: ESGE suggests considering removal of histologically proven gastric GISTs smaller than 20 mm as an alternative to surveillance. The decision to resect should be discussed in a multidisciplinary meeting. The choice of technique should depend on size, location, and local expertise.Weak recommendation, very low quality evidence. 8: ESGE suggests that, to avoid unnecessary follow-up, endoscopic resection is an option for gastric SELs smaller than 20 mm and of unknown histology after failure of attempts to obtain diagnosis.Weak recommendation, very low quality evidence. 9: ESGE recommends basing the surveillance strategy on the type and completeness of resection. After curative resection of benign SELs no follow-up is advised, except for type 1 gastric NEN for which surveillance at 1-2 years is advised.Strong recommendation, low quality evidence. 10: For lower or upper GI NEN with a positive or indeterminate margin at resection, ESGE recommends repeating endoscopy at 3-6 months and another attempt at endoscopic resection in the case of residual disease.Strong recommendation, low quality evidence.
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Affiliation(s)
- Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Leon M G Moons
- Divisie Interne Geneeskunde en Dermatologie, Maag-, Darm- en Leverziekten, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Dermot OʼToole
- Neuroendocrine Tumor Service, ENETS Centre of Excellence, St. Vincent's University Hospital and Department of Clinical Medicine, Trinity College Dublin, University of Dublin St. James's Hospital, Dublin, Ireland
| | - Rodica Gincul
- Service de Gastroentérologie et Endoscopie Digestive, Hôpital Privé Jean Mermoz, Lyon, France
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Pedro Pimentel-Nunes
- Department of Gastroenterology, Portuguese Oncology Institute of Porto; Department of Surgery and Physiology, Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal
| | | | - Marcin Polkowski
- Department of Gastroenterology, Hepatology and Clinical Oncology, Center for Postgraduate Medical Education, and Department of Oncological Gastroenterology, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Michael Vieth
- Institut of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Ivan Borbath
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Tom G Moreels
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Els Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, The Netherlands
| | - Jean-Yves Blay
- Centre Léon Bérard, Université Claude Bernard Lyon 1, Lyon, France
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
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Bulut M, Buch N, Knuhtsen S, Gögenur I, Bremholm L. Endoscopic full-thickness resection of benign and malignant colon lesions with one-year follow up in a Danish cohort. Scand J Gastroenterol 2022; 57:377-383. [PMID: 34904505 DOI: 10.1080/00365521.2021.2013526] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic full-thickness resection (EFTR) has been shown to be a feasible and safe technique in several studies since the introduction of the full-thickness resection device (FTRD®). This study aimed to describe our clinical experience and long-term follow up in in patients who underwent EFTR of benign and malignant colon lesions using FTRD. METHODS All patients with difficult adenomas or early adenocarcinomas referred for an EFTR to two centres in Denmark were included in this prospective consecutive study. The primary outcome was technical success with R0 resection and relapse-free follow up. The secondary outcome was procedure-related adverse events. RESULTS Twenty-six patients were enrolled in the study. Technical success was achieved in 81% patients and R0 resection rate was 86%. Full-thickness resection was achieved in 86% patients. In 13 patients with malignant lesions, we obtained follow-up in 10 cases (two patients underwent surgery and one was non-compliant). Findings of the three-month follow up showed no residual tumour in all 10 cases. At the 12-month follow up, one patient had a late relapse. There were no residual or recurrent adenomas in the benign subgroup. Overall, adverse events were observed in 11.5% (3/26) patients with a perforation rate of 7.7%. CONCLUSION EFTR with FTRD proves to be an additional technique for the treatment of difficult non-lifting colorectal lesions. For malignant lesions, EFTR is technically safe and feasible and can potentially treat small early low-risk tumours; however, some cases may require subsequent surgery according to the histological staging observed in the resected specimen.
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Affiliation(s)
- Mustafa Bulut
- Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Niels Buch
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Svend Knuhtsen
- Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - Ismail Gögenur
- Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Lasse Bremholm
- Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Leicher LW, Huisman JF, van Grevenstein WMU, Didden P, Backes Y, Offerhaus GJA, Laclé MM, Moll FCP, Geesing JMJ, Smakman N, Droste JSTS, Verdaasdonk EGG, Ter Borg F, Talsma AK, Erkelens GW, van der Zaag ES, Schrauwen RWM, van Wely BJ, Schot I, Vermaas M, van Bergeijk JD, Sietses C, Hazen WL, Wasowicz DK, Ramsoekh D, Tuynman JB, Alderlieste YA, Renger RJ, Oort FA, Bilgen EJS, Vleggaar FP, Vasen HFA, Cappel WHVTN, Moons LMG, van Westreenen HL. Colonoscopic-Assisted Laparoscopic Wedge Resection for Colonic Lesions: A Prospective Multicentre Cohort Study (LIMERIC-Study). Ann Surg 2022. [PMID: 35185125 DOI: 10.1097/SLA.0000000000005417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety and efficacy of a modified colonoscopic-assisted laparoscopic wedge resection. SUMMARY BACKGROUND DATA The use of segmental colectomy in patients with endoscopically unresectable colonic lesions results in significant morbidity and mortality. CAL-WR is an alternative procedure that may reduce morbidity. METHODS This prospective multicentre study was performed in 13 Dutch hospitals between January 2017 and December 2019. Inclusion criteria were (1) colonic lesions inaccessible using current endoscopic resection techniques (judged by an expert panel), (2) non-lifting residual/recurrent adenomatous tissue after previous polypectomy or (3) an undetermined resection margin after endoscopic removal of a low-risk pT1 colon carcinoma. Thirty-day morbidity, technical success rate and radicality were evaluated. RESULTS Of the 118 patients included (56% male, mean age 66 years, SD ± 8 years), 66 (56%) had complex lesions unsuitable for endoscopic removal, 34 (29%) had non-lifting residual/recurrent adenoma after previous polypectomy and 18 (15%) had uncertain resection margins after polypectomy of a pT1 colon carcinoma. CAL-WR was technically successful in 93% and R0 resection was achieved in 91% of patients. Minor complications (Clavien-Dindo I-II) were noted in 7 patients (6%) and an additional oncologic segmental resection was performed in 12 cases (11%). Residual tissue at the scar was observed in 5% of patients during endoscopic follow-up. CONCLUSIONS CAL-WR is an effective, organ-preserving approach that results in minor complications and circumvents the need for major surgery. CAL-WR therefore deserves consideration when endoscopic excision of circumscribed lesions is impossible or incomplete.
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S. Al Ghamdi S, Leeds I, Fang S, Ngamruengphong S. Minimally Invasive Endoscopic and Surgical Management of Rectal Neoplasia. Cancers (Basel) 2022; 14:cancers14040948. [PMID: 35205695 PMCID: PMC8869910 DOI: 10.3390/cancers14040948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022] Open
Abstract
Rectal cancer demonstrates a characteristic natural history in which benign rectal neoplasia precedes malignancy. The worldwide burden of rectal cancer is significant, with rectal cancer accounting for one-third of colorectal cancer cases annually. The importance of early detection and successful management is essential in decreasing its clinical burden. Minimally invasive treatment of rectal neoplasia has evolved over the past several decades, which has led to reduced local recurrence rates and improved survival outcomes. The approach to diagnosis, staging, and selection of appropriate treatment modalities is a multidisciplinary effort combining interventional endoscopy, surgery, and radiology tools. This review examines the currently available minimally invasive endoscopic and surgical management options of rectal neoplasia.
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Affiliation(s)
- Sarah S. Al Ghamdi
- Division of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Ira Leeds
- Division of Colon and Rectal Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Sandy Fang
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21224, USA;
| | - Saowanee Ngamruengphong
- Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD 21224, USA
- Correspondence:
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Dolan RD, Bazarbashi AN, McCarty TR, Thompson CC, Aihara H. Endoscopic full-thickness resection of colorectal lesions: a systematic review and meta-analysis. Gastrointest Endosc 2022; 95:216-224.e18. [PMID: 34627794 DOI: 10.1016/j.gie.2021.09.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 09/27/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Endoscopic full-thickness resection (EFTR) is a novel endoscopic technique for the resection of GI lesions not amenable to standard endoscopic therapy. The primary aim of this study was to perform a systematic review and meta-analysis to evaluate EFTR for the resection of colorectal lesions. METHODS Individualized searches were developed through October 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Random-effects models were used to determine pooled technical success, margin-negative (R0) resection, adverse events, procedure duration, and rate of recurrence at follow-up. Subgroup analysis was used to assess the impact of specific procedure techniques and regression analyses to determine influence of lesion size. Heterogeneity was assessed with I2 statistics and publication bias by funnel plots using Egger and Begg tests. RESULTS Fourteen studies (1936 subjects; 39.6% women) were included. Most EFTR lesions were located in the colon (75.8%) with the remaining in the rectum. Mean procedure duration was 45.4 ± 11.4 minutes. Pooled technical success was 87.6% (95% confidence interval [CI], 85.1-89.8; I2 = 33), R0 resection rate was 78.8% (95% CI, 75.7-81.5; I2 = 33), procedure-associated adverse events occurred in 12.2% (95% CI, 9.3-15.9; I2 = 61), and recurrence rate was 12.6% (95% CI, 11.1-14.4; I2 = 0) over an average weighted follow-up of 20.1 ± 3.8 weeks. Regression analyses revealed significantly lower R0 resection (odds ratio, .3; 95% CI, .2-.6; I2 = 61; P = .0003) and higher overall procedure-associated adverse event rates (odds ratio, 3.5; 95% CI, 1.8-7.2; I2 = 55; P = .0004) for lesions >20 mm. CONCLUSIONS EFTR overall appears to be an effective modality with high technical success and R0 resection rate with a relatively low risk of adverse events and recurrence, with greatest success when lesions are <20 mm.
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Affiliation(s)
- Russell D Dolan
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmad Najdat Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas R McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hiroyuki Aihara
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Tan CK, Wang LM, Goh L, Li JW, Lin J, Ang TL. Tis Not a Leiomyoma! Two Cases of Postendoscopic Full-Thickness Resection Leiomyomatous Pseudopolyps. Am J Gastroenterol 2022; 117:352-4. [PMID: 34962497 DOI: 10.14309/ajg.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Ichkhanian Y, Barawi M, Seoud T, Thakkar S, Kothari TH, Halabi ME, Ullah A, Edris W, Aepli P, Kowalski T, Shinn B, Shariaha RZ, Mahadev S, Mosko JD, Andrisani G, Di Matteo FM, Albrecht H, Giap AQ, Tang SJ, Naga YM, van Geenen E, Friedland S, Tharian B, Irani S, Ross AS, Jamil LH, Lew D, Nett AS, Farha J, Runge TM, Jovani M, Khashab MA. Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience. Endoscopy 2022; 54:16-24. [PMID: 33395714 DOI: 10.1055/a-1345-0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis. METHODS This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence. RESULTS 66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %). CONCLUSIONS The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases.
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Affiliation(s)
- Yervant Ichkhanian
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.,Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammed Barawi
- Division of Gastroenterology and Hepatology, Ascension St. John Hospital, Detroit, Michigan, USA
| | - Talal Seoud
- Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Shyam Thakkar
- Center for Advanced Endoscopy, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Truptesh H Kothari
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Maan El Halabi
- Department of Internal Medicine, Mount Sinai West, New York, New York, USA
| | - Asad Ullah
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Wedi Edris
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Klinikum, Offenbach, Germany
| | - Patrick Aepli
- Department of Gastroenterology and Hepatology, Luzerner Kantonsspital, Luzerne, Switzerland
| | - Thomas Kowalski
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Brianna Shinn
- Division of Gastroenterology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Reem Z Shariaha
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine/New York, Presbyterian Hospital, New York, New York, USA
| | - Jeffrey D Mosko
- The Center for Therapeutic Endoscopy and Endoscopic Oncology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gianluca Andrisani
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy
| | | | - Heinz Albrecht
- Department of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Andrew Q Giap
- Department of Gastroenterology, Kaiser Permanente, Anaheim, California, USA
| | - Shou-Jiang Tang
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yehia M Naga
- Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Shai Friedland
- Division of Gastroenterology, Department of Medicine, Stanford University, Stanford, California, USA
| | - Benjamin Tharian
- Department of Gastroenterology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Shayan Irani
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Andrew S Ross
- Division of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Beaumont Health-Royal Oak, Royal Oak, Michigan, USA.,Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Daniel Lew
- Pancreatic and Biliary Diseases Program, Cedars-Sinai Medical Center, West Hollywood, California, USA
| | - Andrew S Nett
- Division of Gastroenterology, Sutter Health, Sacramento, California, USA
| | - Jad Farha
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Thomas M Runge
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.,Division of Gastroenterology and Hepatology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Manol Jovani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA
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Rushfeldt CF, Nordbø M, Steigen SE, Dehli T, Gjessing P, Norderval S. Endoscopic full-thickness dissection (EFTD) in the rectum: a case series. Tech Coloproctol. [PMID: 34964075 PMCID: PMC8857165 DOI: 10.1007/s10151-021-02558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/29/2021] [Indexed: 01/13/2023]
Abstract
Abstract
Background
Rectal endoscopic full- thickness dissection (EFTD) using a flexible colonoscope is an alternative to the well-established trans-anal endoscopic microsurgery (TEM) and the trans-anal minimally invasive surgery (TAMIS) techniques for resecting dysplastic or malignant rectal lesions. This study evaluated EFTD safety by analyzing outcomes of the first patients to undergo rectal EFTD at the University Hospital of North-Norway.
Methods
The first 10 patients to undergo rectal EFTD at the University Hospital of North-Norway April, 2016 and January, 2021, were included in the study. The procedural indications for EFTD were therapeutic resection of non-lifting adenoma, T1 adenocarcinoma (AC), recurrent neuroendocrine tumor (NET) and re-excision of a T1-2 AC.
Results
EFTD rectal specimen histopathology revealed three ACs, five adenomas with high-grade dysplasia (HGD), one NET and one benign lesion. Six procedures had negative lateral and vertical resection margins and in three cases lateral margins could not be evaluated due to piece-meal dissection or heat damaged tissue. Two patients experienced delayed post-procedural hemorrhage, one of whom also presented with a concurrent post-procedural infection. No serious complications occurred.
Conclusion
Preliminary results from this introductory trial indicate that EFTD in the rectum can be conducted with satisfactory perioperative results and low risk of serious complications.
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Keane MG, Mony S, Wood LD, Kumbhari V, Khashab MA. Prophylactic appendiceal retrograde intraluminal stent placement (PARIS). VideoGIE 2021; 6:552-554. [PMID: 34917867 PMCID: PMC8646081 DOI: 10.1016/j.vgie.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Margaret G Keane
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Shruti Mony
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Laura D Wood
- Sol Goldamn Pancreatic Cancer Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Vivek Kumbhari
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
| | - Mouen A Khashab
- Johns Hopkins Hospital, Department of Gastroenterology and Hepatology, Baltimore, Maryland
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Chua JS, Dang H, Zwager LW, Dekkers N, Hardwick JCH, Langers AMJ, van der Kraan J, Perk LE, Bastiaansen BAJ, Boonstra JJ. Hybrid endoscopic mucosal resection and full-thickness resection for large colonic polyps harboring a small focus of invasive cancer: a case series. Endosc Int Open 2021; 9:E1686-E1691. [PMID: 34790531 PMCID: PMC8589547 DOI: 10.1055/a-1529-1447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
Endoscopic treatment of large laterally spreading tumors (LSTs) with a focus of submucosally invasive colorectal cancer (T1 CRC) can be challenging. We evaluated outcomes of a hybrid resection technique using piecemeal endoscopic mucosal resection (pEMR) and endoscopic full-thickness resection (eFTR) in patients with large colonic LSTs containing suspected T1 CRC. Six hybrid pEMR-eFTR procedures for T1 CRCs were registered in a nationwide eFTR registry between July 2015 and December 2019. In all cases, the invasive part of the lesion was successfully isolated with eFTR; with eFTR, histologically complete resection of the invasive part was achieved in 5 /6 patients (83.3 %). No adverse events occurred during or after the procedure. The median follow-up time was 10 months (range 6-27), with all patients having undergone ≥ 1 surveillance colonoscopy. One patient had a small adenomatous recurrence, which was removed endoscopically. In conclusion, hybrid pEMR-eFTR is a promising noninvasive treatment modality that seems feasible for a selected group of patients with large LSTs containing a small focus of T1 CRC.
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Affiliation(s)
- Jamie S. Chua
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Liselotte W. Zwager
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nik Dekkers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - James C. H. Hardwick
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra M. J. Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jolein van der Kraan
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lars E. Perk
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, the Hague, the Netherlands
| | - Barbara A. J. Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jurjen J. Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Affiliation(s)
- Michiel Bronswijk
- Department of Gastroenterology and Hepatology, Imelda General Hospital, and Imelda Clinical GI Research Center, Bonheiden, and Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Belgium
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Zwager LW, Bastiaansen BAJ, Fockens P. Reply to Dr. Bronswijk. Endoscopy 2021; 53:562. [PMID: 33887790 DOI: 10.1055/a-1348-1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Liselotte W Zwager
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, and Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, and Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Fockens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location AMC, and Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands
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Suzuki K, Saito S, Fukunaga Y. Current Status and Prospects of Endoscopic Resection Technique for Colorectal Tumors. J Anus Rectum Colon 2021; 5:121-128. [PMID: 33937551 PMCID: PMC8084529 DOI: 10.23922/jarc.2020-085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022]
Abstract
Currently, endoscopic submucosal dissection (ESD) is a well-established and common treatment for intramucosal colorectal cancer in Japan. However, colorectal ESD is technically more difficult to perform than esophageal and gastric ESD, and some lesions, such as fibrotic lesions, are difficult to dissect by endoscopy. Several techniques, such as the pocket-creation method and laparoscopically assisted endoscopic polypectomy, have been utilized for challenging targets. In recent years, endoscopic full-thickness resection (EFTR) using full-thickness resection devices have mainly been performed in Western countries. We have used laparoscopy and endoscopy cooperative surgery for colorectal tumors (LECS-CR) since 2011 for the challenging treatment of colorectal ESD. Improvements in ESD techniques have resulted in an increase in the literature on EFTR, and LECS-CR may be considered an effective endoscopic technique for colorectal ESD in the future.
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Affiliation(s)
- Keigo Suzuki
- Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichi Saito
- Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Romutis S, Matta B, Ibinson J, Hileman J, Istvanic S, Khalid A. Safety and efficacy of band ligation and auto-amputation as adjunct to EMR of colonic large laterally spreading tumors, and polyps not amenable to routine polypectomy. Ther Adv Gastrointest Endosc 2021; 14:26317745211001750. [PMID: 33855293 PMCID: PMC8013638 DOI: 10.1177/26317745211001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The safety and efficacy of colonic band ligation and auto-amputation (1) as adjunct to endoscopic mucosal resection of large laterally spreading tumors and (2) for polyps not amenable to routine polypectomy due to polyp burden or difficult location remain unknown. Methods: An institutional review board–approved retrospective single-institution study was undertaken of patients undergoing colonic band ligation and auto-amputation from 2014 to date. Patients with indications of ‘endoscopic mucosal resection for laterally spreading tumors’ and ‘polyp not amenable to snare polypectomy’ were included in the study. Data were collected on patient demographics, colonoscopy details (laterally spreading tumors/polyp characteristics, therapies applied, complications), pathology results, and follow-up (polyp eradication based on endoscopic appearance and biopsy results). Results: Patients undergoing endoscopic mucosal resection for laterally spreading tumors: Thirty-two patients (31 males, aged 68 ± 9.17 years) underwent endoscopic mucosal resection-band ligation and auto-amputation of 34 laterally spreading tumors (40 ± 10.9 mm). A median of 2 ± 1.09 bands were placed. Follow-up colonoscopy and biopsy results confirmed complete eradication in 21 laterally spreading tumors (70%). Nine (30%) laterally spreading tumors required additional endoscopic therapy to achieve complete eradication. Four (13%) patients underwent surgery for cancer, and two of them had resection specimens negative for cancer or residual adenoma. One patient suffered post-polypectomy syndrome. Patients undergoing band ligation and auto-amputation for polyps not amenable to snare polypectomy: Seven patients underwent band ligation and auto-amputation due to serrated polyposis syndrome (one patient) and innumerable polyps, or polyps in difficult locations (extension into diverticula: two patients; terminal ileum: two patients; appendiceal orifice: one patient; anal canal: one patient). The patient with serrated polyposis syndrome achieved dramatic decrease in polyp burden, but not eradication. Follow-up in five of the six remaining patients documented polyp eradication. The patient with serrated polyposis syndrome suffered from rectal pain and tenesmus following placement of 18 bands. Conclusions: Band ligation and auto-amputation in the colon may be a safe and effective adjunct to current endoscopic mucosal resection and polypectomy methods and warrants further study. Plain Language Summary Colonoscopy with rubber band placement to aid in complete removal of large polyps and polyps in technically challenging locations Colonoscopy is a commonly performed procedure for the early detection of colon and rectal cancer, and prevention through polyp removal.During colonoscopy, sometimes situations are encountered making polyp removal difficult. These can include the presence of larger polyps or the location of a polyp in an area that makes removal technically challenging or high risk.A particularly challenging situation arises when after extensive effort there is still polyp tissue remaining that cannot be removed using routine techniques. We are interested in exploring a technique which involves the placement of a rubber band after sucking a small area of the colon lining into a cap loaded onto the tip of the colonoscope. With time the rubber band strangulates the tissue and falls off along with captured tissue and passes out of the colon naturally.To assess the effectives of this technique we studied patients that have undergone this procedure at our GI unit. We identified 32 patients with 34 large polyps between 4cm to 6cm that we placed rubber bands on polyp tissue after we were unable to completely remove the polyp. On their follow up colonoscopy, complete polyp removal was successful in 21 polyps. We were also able to achieve complete polyp removal in 9 of the remaining large polyps after additional treatment. Four patients underwent surgery because cancer was found in analysis of polyp tissue.In 5 of 6 patients with polyps in difficult locations (e.g. partly within the lumen of the appendix), placement of a rubber band led to complete removal of polyp tissue.Two patients in our study population had mild adverse events that were managed with simple measures.We believe our results show promise for our described technique and this technique should be tested in larger studies.
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Affiliation(s)
- Stephanie Romutis
- VA Pittsburgh Health Care System, Pittsburgh, PA, USA/The University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Bassem Matta
- VA Pittsburgh Health Care System, Pittsburgh, PA, USA/The University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - John Hileman
- VA Pittsburgh Health Care System, Pittsburgh, PA, USA
| | | | - Asif Khalid
- The University of Pittsburgh Medical Center, PUH, M2, C-wing, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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Affiliation(s)
- Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Freiburg
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