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Spychalski M, Włodarczyk M, Winter K. Impact of COVID-19 pandemic on endoscopic submucosal dissection outcomes in early colorectal tumours. Br J Surg 2021; 108:e224-e225. [PMID: 33713112 PMCID: PMC7989635 DOI: 10.1093/bjs/znab079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/07/2021] [Indexed: 11/14/2022]
Affiliation(s)
| | - M Włodarczyk
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland
| | - K Winter
- Center of Bowel Treatment, Brzeziny, Poland
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Alkandari A, Thayalasekaran S, Bhandari M, Przybysz A, Bugajski M, Bassett P, Kandiah K, Subramaniam S, Galtieri P, Maselli R, Spychalski M, Hayee B, Haji A, Repici A, Kaminski M, Bhandari P. Endoscopic Resections in Inflammatory Bowel Disease: A Multicentre European Outcomes Study. J Crohns Colitis 2019; 13:1394-1400. [PMID: 30994915 DOI: 10.1093/ecco-jcc/jjz075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease is associated with an increased risk of colorectal cancer, with estimates ranging 2-18%, depending on the duration of colitis. The management of neoplasia in colitis remains controversial. Current guidelines recommend endoscopic resection if the lesion is clearly visible with distinct margins. Colectomy is recommended if complete endoscopic resection is not guaranteed. We aimed to assess the outcomes of all neoplastic endoscopic resections in inflammatory bowel disease. METHODS This was a multicentre retrospective cohort study of 119 lesions of visible dysplasia in 93 patients, resected endoscopically in inflammatory bowel disease. RESULTS A total of 6/65 [9.2%] lesions <20 mm in size were treated by ESD [endoscopic submucosal dissection] compared with 59/65 [90.8%] lesions <20 mm treated by EMR [endoscopic mucosal resection]; 16/51 [31.4%] lesions >20 mm in size were treated by EMR vs 35/51 [68.6%] by ESD. Almost all patients [97%] without fibrosis were treated by EMR, and patients with fibrosis were treated by ESD [87%], p < 0.001. In all, 49/78 [63%] lesions treated by EMR were resected en-bloc and 27/41 [65.9%] of the ESD/KAR [knife-assisted resection] cases were resected en-bloc, compared with 15/41 [36.6%] resected piecemeal. Seven recurrences occurred in the cohort. Seven complications occurred in the cohort; six were managed endoscopically and one patient with a delayed perforation underwent surgery. CONCLUSIONS Larger lesions with fibrosis are best treated by ESD, whereas smaller lesions without fibrosis are best managed by EMR. Both EMR and ESD are feasible in the management of endoscopic resections in colitis.
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Affiliation(s)
- A Alkandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - S Thayalasekaran
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - M Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - A Przybysz
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - M Bugajski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland
| | - P Bassett
- Statistics, Statsconsultancy, Amersham, UK
| | - K Kandiah
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - S Subramaniam
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - P Galtieri
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - R Maselli
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - M Spychalski
- University of Lodz, Center of Bowel Treatment, Brzeziny, Poland
| | - B Hayee
- Department of Gastroenterology, Kings Institute of Therapeutic Endoscopy, London, UK
| | - A Haji
- Department of Gastroenterology, Kings Institute of Therapeutic Endoscopy, London, UK
| | - A Repici
- Department of Gastroenterology, Humanitas Research Hospital, Milan, Italy
| | - M Kaminski
- Department of Oncological Gastroenterology, Maria Sklodowska-Curie Institute Oncology Center, Warsaw, Poland.,Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - P Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
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Abstract
OBJECTIVE Novel treatments for colorectal cancer (CRC) include chemoprevention. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the first to be studied and an inverse association was proven between their use and the development of invasive CRC. The numerous side effects of NSAIDs led, however, to the search for safer drugs. These have included Coxibs (selective COX-2 inhibitors). In this study, the role of coxibs in the chemoprevention of CRC is reviewed. RESULTS Numerous in-vitro and in-vivo experiments have shown the effectiveness of coxibs in the chemoprevention of CRC. These have led to the registration of celecoxib by the USA Food and Drug Administration for the treatment of familial adenomatous polyposis. Further studies of coxibs have revealed an increased risk of serious cardiovascular events when compared with placebo. This finding has considerably decreased the opportunities for chemoprevention of CRC. CONCLUSION The multi-directional activity of coxibs, which was the reason for their effectiveness against CRC development may be the key to proposing a new target area for chemoprevention. It has been shown that celecoxib partly inhibits the activity of NF-kappaB, transcription factor involved in inflammation and carcinogenesis pathways. Modulation of its activation may be the future of effective CRC chemoprevention.
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Affiliation(s)
- M Spychalski
- Department of General and Colorectal Surgery, Medical University of Lodz, Lodz, Poland.
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