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Malik TF, Mohan BP, Deliwala S, Kassab LL, Chandan S, Sharma NR, Adler DG. Cold Versus Hot Endoscopic Mucosal Resection for Sessile Serrated Colorectal Polyps ≥10 mm: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2024; 58:889-895. [PMID: 38019045 DOI: 10.1097/mcg.0000000000001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION We performed a systematic review and meta-analysis studying the efficacy and safety of cold versus hot endoscopic mucosal resection (EMR) for resection of sessile serrated polyps (SSPs) ≥10 mm. METHODS Multiple databases were searched until January 2023 for studies reporting outcomes of cold versus hot EMR for SSPs ≥10 mm. The primary outcome was the residual SSP rate. Secondary outcomes included technical success rate, R0 resection rate, and adverse events. We used standard meta-analysis methods using the random-effects model, and I2 % was used to assess heterogeneity. RESULTS Thirteen studies were included in the final analysis. In all, 1896 SSPs were included with a mean polyp size of 23.7 mm (range, 15.9 to 33). A total of 1452 SSPs were followed up for a median follow-up duration of 15.3 months (range, 6 to 37). The pooled residual SSP rate for cold EMR was 4.5% (95% CI: 1.0-17.4), and 5.1% (95% CI: 2.4-10.4) for hot EMR ( P =0.9). The pooled rates of technical success, R0 resection, immediate bleeding, and perforation were comparable. Hot EMR was significantly associated with lower piecemeal resection (59.2% vs. 99.3%, P <0.001), higher en-bloc resection (41.4% vs. 1.4%, P <0.001), and delayed bleeding rate (4% vs. 0.7%, P =0.05) compared to cold EMR. CONCLUSIONS Cold EMR has similar efficacy compared to hot EMR for resection of SSP ≥ 10 mm, despite limitations in piecemeal R0 resection rate reporting. Although hot EMR was associated with a higher rate of en-bloc resection, it also showed an increased risk of delayed bleeding compared to cold EMR.
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Affiliation(s)
- Talia F Malik
- Department of Internal Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Smit Deliwala
- Department of Gastroenterology & Hepatology, Emory University, Atlanta, GA
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Saurabh Chandan
- Department of Gastroenterology, CHI Creighton University Medical Center, Omaha, NE
| | - Neil R Sharma
- Department of Gastroenterology, Parkview Cancer Institute, Fort Wayne, IN
| | - Douglas G Adler
- Department of Gastroenterology, Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO
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Niu C, Bapaye J, Zhang J, Zhu K, Liu H, Farooq U, Zahid S, Elkhapery A, Okolo PI. Tip-in Versus Conventional Endoscopic Mucosal Resection for Colorectal Neoplasia: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2023; 57:983-990. [PMID: 37389930 DOI: 10.1097/mcg.0000000000001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
BACKGROUND Early-stage gastrointestinal neoplasms are frequently treated with conventional endoscopic mucosal resection (C-EMR). However, C-EMR frequently leads to incomplete resection of large colorectal lesions. Tip-in endoscopic mucosal resection (EMR), which was recently introduced for en bloc resection of colorectal neoplasms, minimizes slippage during the procedure. METHODS We conducted a systematic review and meta-analysis of published studies that compared Tip-in EMR with conventional EMR. We searched several electronic databases and included studies that reported on the primary outcomes of en bloc resection rate and complete resection rate, as well as secondary outcomes such as procedure time and procedure-related complications (including perforation and delayed bleeding rate). We used a random effects model to calculate odds ratios (ORs) with 95% CIs for dichotomous data and weighted mean differences with 95% CIs for continuous data. We also conducted several sensitivity analyses to assess the robustness of our findings. RESULTS A total of 11 studies involving 1244 lesions (684 in the Tip-in EMR group and 560 in C-EMR group) were included in the meta-analysis. Our meta-analysis showed that compared with conventional EMR, Tip-in EMR significantly increased the en bloc resection rate in patients with colorectal neoplasia (OR=3.61; 95% CI, 2.09-6.23; P <0.00001; I2 =0%) and had a higher complete resection rate (OR=2.49; 95% CI, 1.65-3.76; P <0.0001; I2 =0%). However, the procedure time and rates of procedure-related complications did not differ significantly between the 2 groups. CONCLUSIONS Tip-in EMR outperformed C-EMR for both the en bloc and complete resection of colorectal lesions with similar rates of procedural complications.
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Affiliation(s)
| | | | - Jing Zhang
- Harbin Medical University, Harbin, China
| | | | | | | | | | | | - Patrick I Okolo
- Division of Gastroenterology, Rochester General Hospital, Rochester, NY
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Niu C, Bapaye J, Zhang J, Liu H, Zhu K, Farooq U, Zahid S, Chathuranga D, Okolo PI. Systematic review and meta-analysis of cold snare polypectomy and hot snare polypectomy for colorectal polyps. J Gastroenterol Hepatol 2023; 38:1458-1467. [PMID: 37539860 DOI: 10.1111/jgh.16312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIM Cold snare polypectomy (CSP) has become increasingly utilized to resect colorectal polyps, given its efficacy and safety. This study aims to compare CSP and hot snare polypectomy (HSP) for resecting small (< 10 mm) and large (10-20 mm) colorectal lesions. METHODS Relevant publications were obtained from Cochrane Library, Embase, Google Scholar, PubMed, and Web of Science databases. The publication search was limited by English-language and human studies. Pooled mean difference and odds ratios (ORs) were calculated for outcomes of interest. RESULTS Twenty-three studies were included in this meta-analysis. Pooled OR of delayed post-polypectomy bleeding (DPPB) in the CSP group versus the HSP group was 0.29 (P = 0.0001, I2 = 29%). Subgroup analysis according to lesion size showed a significant reduction in the DPPB rate in lesion sizes 10-20 mm (pooled OR 0.08, P = 0.003, I2 = 0%) and < 10 mm (pooled OR 0.35, P = 0.001, I2 = 27%). Pooled OR of major bleeding in the CSP group was 0.23 (P = 0.0004, I2 = 0%). Subgroup analysis by lesion size revealed a significant decrease in the rate of major bleeding in the CSP group for both lesion sizes 10-20 mm (pooled OR 0.11, P = 0.04) and < 10 mm (pooled OR 0.26, P = 0.003). Complete resection, en bloc resection, and recurrence rate were comparable in the two groups. CONCLUSIONS Cold snare polypectomy was associated with a lower rate of DPPB and lower risk of major bleeding compared with HSP in both small and large polyps. CSP should be considered as the polypectomy technique of choice for colorectal polyps.
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Affiliation(s)
- Chengu Niu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Jay Bapaye
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Jing Zhang
- Harbin Medical University, Harbin, China
| | - Hongli Liu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Kaiwen Zhu
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Umer Farooq
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Salman Zahid
- Internal Medicine Residency Program, Rochester General Hospital, Rochester, New York, USA
| | - Dileepa Chathuranga
- Division of Gastroenterology, Rochester General Hospital, Rochester, New York, USA
| | - Patrick I Okolo
- Division of Gastroenterology, Rochester General Hospital, Rochester, New York, USA
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Utsumi T, Yamada Y, Diaz-Meco MT, Moscat J, Nakanishi Y. Sessile serrated lesions with dysplasia: is it possible to nip them in the bud? J Gastroenterol 2023; 58:705-717. [PMID: 37219625 PMCID: PMC10366009 DOI: 10.1007/s00535-023-02003-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023]
Abstract
The serrated neoplasia pathway constitutes an "alternative route" to colorectal cancer (CRC), and sessile serrated lesions with dysplasia (SSLDs) are an intermediate step between sessile serrated lesions (SSLs) and invasive CRC in this pathway. While SSLs show indolent growth before becoming dysplastic (> 10-15 years), SSLDs are considered to rapidly progress to either immunogenic microsatellite instable-high (MSI-H) CRC (presumably 75% of cases) or mesenchymal microsatellite stable (MSS) CRC. Their flat shapes and the relatively short window of this intermediate state make it difficult to detect and diagnose SSLDs; thus, these lesions are potent precursors of post-colonoscopy/interval cancers. Confusing terminology and the lack of longitudinal observation data of serrated polyps have hampered the accumulation of knowledge about SSLDs; however, a growing body of evidence has started to clarify their characteristics and biology. Together with recent efforts to incorporate terminology, histological studies of SSLDs have identified distinct dysplastic patterns and revealed alterations in the tumor microenvironment (TME). Molecular studies at the single-cell level have identified distinct gene alterations in both the epithelium and the TME. Mouse serrated tumor models have demonstrated the importance of TME in disease progression. Advances in colonoscopy provide clues to distinguish pre-malignant from non-malignant-SSLs. Recent progress in all aspects of the field has enhanced our understanding of the biology of SSLDs. The aim of this review article was to assess the current knowledge of SSLDs and highlight their clinical implications.
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Affiliation(s)
- Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Maria Teresa Diaz-Meco
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Jorge Moscat
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York City, NY, USA
| | - Yuki Nakanishi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, 54 Kawaharacho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan.
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Sadeghi A, Salarieh N, Ketabi Moghadam P. A step-by-step guide to approaching colon polyps. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2023; 16:347-356. [PMID: 37767319 PMCID: PMC10520385 DOI: 10.22037/ghfbb.v16i2.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/03/2023] [Indexed: 09/29/2023]
Abstract
Colorectal cancer (CRC) is considered one of the most prevalent cancers among Iranian men and women (1). Colorectal polyps, known as precursors of CRCs, are of great importance. Surveillance, locating, and removal of colorectal polyps make them the most modifiable factor apart from other genetic and environmental factors leading to CRCs. Colorectal polyps are defined as outpouchings from superficial and deep layers of mucosa of the colonic wall. They are classified as adenomas, serrated polyps, hyperplastic polyps, and hamartomas based on histological evaluation. Submucosal invasion precludes the possibility of endoscopic resection and should be ruled out via colonoscopic evaluation (2). Knowing this significance, the present study aims to present a brief review on classification, probability of endoscopic resection, complications of endoscopic polypectomy, as well as proper surveillance after polypectomy.
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Affiliation(s)
- Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naghmeh Salarieh
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pardis Ketabi Moghadam
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zheng L, Jiang L, Li D, Chen L, Jiang C, Xie L, Zhou L, Huang J, Liu M, Wang W. Antimicrobial prophylaxis in patients undergoing endoscopic mucosal resection for 10- to 20-mm colorectal polyps: A randomized prospective study. Medicine (Baltimore) 2022; 101:e31440. [PMID: 36550912 PMCID: PMC9771180 DOI: 10.1097/md.0000000000031440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Endoscopic mucosal resection (EMR) is frequently used for the removal of colorectal neoplasms. However, the use of prophylactic antibiotics in patients undergoing EMR is debatable. The aim of this randomized controlled trial was to assess whether antimicrobial prophylaxis is crucial in the perioperative period of EMR, especially for 10- to 20-mm lesions in this setting. METHODS Two hundred and sixty-four patients were randomized equally into 2 groups, the antibiotic (cefixime) group and the control group. The occurrence of adverse events was examined at 1 to 3 days after EMR. Plasma levels of inflammatory markers were analyzed at pre-operation, 1 day post-operation and 3 days post-operation. Blood samples collected at 1 day post-operation were used for culture. RESULTS A total of 264 and 268 polyps were removed by EMR in the antibiotic group and the control group, respectively. There were 5 cases of fever, with 2 in the antibiotic group and 3 in the control group. In the antibiotic group, 12 patients had abdominal pain and 10 suffered bleeding, whereas in the control group, abdominal pain and bleeding were observed in 10 and 11 patients, respectively. There were no significant differences in the proportion of patients with fever or the incidences of postoperative complications between the groups. No significant differences between the groups were reported in plasma levels of white blood cell count, erythrocyte sedimentation rate, C-reactive protein or procalcitonin at pre-operation or post-operation. No patients provided positive blood cultures. CONCLUSIONS The use the prophylactic antibiotics for EMR procedures in the perioperative period is no longer required when the lesions are 10 to 20 mm in size.
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Affiliation(s)
- Linfu Zheng
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Liping Jiang
- Meng Chao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
| | - Dazhou Li
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Longping Chen
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
| | - Chuanshen Jiang
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
| | - Longke Xie
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Linxin Zhou
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Jianxiao Huang
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Meiyan Liu
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
| | - Wen Wang
- Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Fuzhou, China
- Department of Gastroenterology, 900th Hospital of PLA, Fuzhou, China
- Department of Gastroenterology, Oriental Hospital Affiliated to Xiamen University, Fuzhou, China
- *Correspondence: Wen Wang, Department of Gastroenterology, 900th Hospital of PLA, Fujian Medical University, Oriental Hospital Affiliated to Xiamen University, Fuzhou 350025, China (e-mail: )
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Murakami T, Kurosawa T, Fukushima H, Shibuya T, Yao T, Nagahara A. Sessile serrated lesions: Clinicopathological characteristics, endoscopic diagnosis, and management. Dig Endosc 2022; 34:1096-1109. [PMID: 35352394 DOI: 10.1111/den.14273] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/30/2022] [Accepted: 02/13/2022] [Indexed: 02/08/2023]
Abstract
The 2019 World Health Organization (WHO) Classification of Tumours of the Digestive System (5th edition) introduced the term "sessile serrated lesion" (SSL) to replace the term "sessile serrated adenoma/polyp" (SSA/P). SSLs are early precursor lesions in the serrated neoplasia pathway that result in colorectal carcinomas with BRAF mutations, methylation for DNA repair genes, a CpG island methylator phenotype, and high levels of microsatellite instability. Some of these lesions can rapidly become dysplastic or invasive carcinomas that exhibit high lymphatic invasion and lymph node metastasis potential. The 2019 WHO classification noted that dysplasia arising in an SSL most likely is an advanced polyp, regardless of the morphologic grade of the dysplasia. Detecting SSLs with or without dysplasia is critical; however, detection of SSLs is challenging, and their identification by endoscopists and pathologists is inconsistent. Furthermore, indications for their endoscopic treatment have not been established. Moreover, SSLs are considered to contribute to the development of post-colonoscopy colorectal cancers. Herein, the clinicopathological and endoscopic characteristics of SSLs, including features determined using white light and image-enhanced endoscopy, therapeutic indications, therapeutic methods, and surveillance are reviewed based on the literature. This information may lead to more intensive research to improve detection, diagnosis, and rates of complete resection of these lesions and reduce post-colonoscopy colorectal cancer rates.
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Affiliation(s)
- Takashi Murakami
- Departments of 1Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Taro Kurosawa
- Departments of 1Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
- Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hirofumi Fukushima
- Departments of 1Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomoyoshi Shibuya
- Departments of 1Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Yao
- Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Departments of 1Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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Lai W, Chiu S, Wu C, Liang C, Yang S, Yao C, Kuo C, Lu L, Chiu Y, Wu K, Tai W, Chuah S. Incidence of interval colorectal cancer: A tertiary hospital report. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Wan‐Tz Lai
- Division of Pediatric Gastroenterology Chiayi Chang Gung Memorial Hospital Chiayi Taiwan
| | - Shao‐Ming Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Cheng‐Kun Wu
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Chih‐Ming Liang
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Shih‐Cheng Yang
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Chih‐Chien Yao
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Chung‐Mou Kuo
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Lung‐Sheng Lu
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Yi‐Chun Chiu
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Keng‐Liang Wu
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Wei‐Chen Tai
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
| | - Seng‐Kee Chuah
- Division of Hepatogastroenterology, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine Kaohsiung Taiwan
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Does precutting prior to endoscopic piecemeal resection of large colorectal neoplasias reduce local recurrence? A KASID multicenter study. Surg Endosc 2021; 36:3433-3441. [PMID: 34341906 DOI: 10.1007/s00464-021-08664-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/20/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND It would be expected that local recurrence could be reduced by performing precutting (with sufficient margins) prior to endoscopic piecemeal mucosal resection (EPMR). We explored the clinical outcomes and local recurrence after precutting EPMR of large colorectal neoplasias. METHODS Between January 2005 and December 2015, in total, 223 patients with colorectal neoplasias ≥ 2 cm in diameter removed via EPMR in four tertiary hospitals were enrolled. The patients were divided into a precut EPMR group (n = 62) and a non-precut EPMR group (n = 161). We retrospectively evaluated clinical outcomes and factors associated with local recurrence. RESULTS The mean total procedure time was significantly shorter in the non-precut EPMR group than in the precut EPMR group. However, the number of pieces, and the complete resection and recurrence rates, did not differ significantly [for the latter, precut 8.1% vs. non-precut 9.9%, P = 0.668]. The complete resection rate, number of pieces, and use of argon plasma coagulation (APC) were significantly associated with the local recurrence rate on univariate analysis. In the Cox's proportional hazards model, prophylactic APC [hazard ratio 0.307, 95% confidence interval (CI) 0.114-0.823; P = 0.019] and complete resection rate (odds ratio 0.083, 95% CI 0.011-0.655; P = 0.018) were significantly associated with the local recurrence rate. CONCLUSION Precutting prior to EPMR did not significantly reduce the local recurrence rate or the number of resected pieces. Histologically complete resection, reducing the number of pieces, and prophylactic APC seem to be important in terms of reducing local recurrence.
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Reappraisal of the characteristics, management, and prognosis of intramucosal colorectal cancers and their comparison with T1 carcinomas. Gastrointest Endosc 2021; 93:477-485. [PMID: 32590054 DOI: 10.1016/j.gie.2020.06.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The recent description of "invasive" forms of intramucosal carcinoma (IMC) has rekindled interest in studying the characteristics, management, and prognosis of IMCs and comparing them with T1 colorectal cancers (CRCs). METHODS This population-based study included 282 cases of IMC and 207 cases of T1 CRC diagnosed by colonoscopy after a positive fecal blood test through a screening program. RESULTS IMC presented mainly in the form of pedunculated polyps (68.4%) located in the distal colon (69.9%) ≥20 mm in size (60.6%). IMCs were resected endoscopically in 227 (80.5%) patients and surgically resected in 55 (19.5%) patients. Surgical patients had more right-sided, more sessile, and larger lesions. There was no sign of lymphovascular invasion. Compared with T1 CRCs, IMCs demonstrated lower rates of sessile polyps (31.6% vs 49.8%, P < .0001), primary and ultimate surgical treatment (19.5% vs 39.1% and 19.9% vs 78.7%, P < .0001, respectively), lymph node metastasis in surgical patients (0% vs 9.5%, P = .041), cancer recurrence and cancer-related mortality (0% vs 5.6% and 0% vs 2.5%, respectively), and bleeding after endoscopic resection (1.8% vs 8.7%, P = .001). By multivariate analysis of the pooled cohort (IMC + T1 CRC, n = 489), the factors significantly associated with first-line surgery were shown to be polyp characteristics and the gastroenterologist who performed the colonoscopy. CONCLUSIONS IMCs account for a quarter of all screening-detected CRCs. They have an excellent prognosis regardless of whether endoscopic or surgical treatment is performed. IMCs differ significantly from T1 carcinomas in terms of management and prognosis.
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Thoguluva Chandrasekar V, Aziz M, Patel HK, Sidhu N, Duvvuri A, Dasari C, Kennedy KF, Ashwath A, Spadaccini M, Desai M, Jegadeesan R, Sathyamurthy A, Vennalaganti P, Kohli D, Hassan C, Pellise M, Repici A, Sharma P, Bourke MJ. Efficacy and Safety of Endoscopic Resection of Sessile Serrated Polyps 10 mm or Larger: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2020; 18:2448-2455.e3. [PMID: 31786330 DOI: 10.1016/j.cgh.2019.11.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The best method for endoscopic resection of sessile serrated polyps (SSP) 10 mm or larger is unclear; studies report variable outcomes in comparison to conventional adenomas. We performed a systematic review and meta-analysis to assess the efficacy and safety of resection of SSPs 10 mm or larger in size. METHODS We searched the PubMed/MEDLINE, Google Scholar, Embase, and Cochrane databases for studies reporting data on endoscopic resection of SSPs 10 mm or larger, through May 31st, 2019. The primary outcome was rate of residual SSP, which was the rate of residual SSP found at the polypectomy site during the first follow-up colonoscopy. Secondary outcomes were: technical success (rate of complete macroscopic resection), R0 resection rate (complete histological resection with absence of any polyp tissue at the lateral and deep margins after en-bloc resection), and adverse events (immediate or delayed bleeding and perforation). We performed IQR,group analyses for outcomes based on polyp size and resection techniques. Pooled proportion rates (%) or odds ratio with 95% CIs with heterogeneity (I2) and P < .05. RESULTS A total of 14 studies met the inclusion criteria: 911 patients (50.2% male; mean age, 62.8 ± 4.9 years) who underwent resection of 1137 SSPs (574 SSPs ≥ 20 mm) with a median polyp size of 19.4 mm (interquartile range, 15.9-29.6 mm). Follow-up information was available for 832 SSPs with a median follow-up duration of 12 months (interquartile range, 6-22.5 months). Piecemeal resection was performed in 58.5% SSPs. The pooled residual SSP rate was 4.3% (95% CI, 2%-6.5%). There was a higher residual SSP rate for polyps ≥ 20 mm compared to 10-19 mm (5.9% vs 1.2%; odds ratio, 3.02; 95% CI, 1-9.2; P = .049). Cold endoscopic mucosal resection (EMR) had significantly lower rates of delayed bleeding (0 vs 2.3%; P = .03) and residual polyp rate (0.9% vs 5%; P=.01) compared to hot EMR, based on univariate analysis. In multi-variate analysis there was no difference in residual polyp rate. There was no significant difference in other outcomes based on the size or method of resection. CONCLUSIONS In a systematic review and meta-analysis, we found that SSPs ≥ 10 mm can be safely resected with low residual polyp rates. Polyp size ≥ 20 mm is a significant factor for residual polyp. Compared to hot EMR, cold EMR is associated with a lower rate of delayed bleeding. Randomized controlled trials comparing hot and cold resection are needed to standardize techniques and optimize outcomes.
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Affiliation(s)
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio
| | - Harsh K Patel
- Department of Gastroenterology and Hepatology, Ochsner Clinic Foundation, Jefferson, Louisiana
| | - Naaz Sidhu
- Westmead Hospital, University of Sydney Medical School, Sydney, Australia
| | - Abhiram Duvvuri
- Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas
| | - ChandraShekhar Dasari
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Kevin F Kennedy
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Ashwini Ashwath
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Marco Spadaccini
- Department of Gastroenterology and Hepatology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
| | - Madhav Desai
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Ramprasad Jegadeesan
- Department of Gastroenterology and Hepatology, Southern Illinois University, Springfield, Illinois
| | - Anjana Sathyamurthy
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Prashanth Vennalaganti
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Divyanshoo Kohli
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Cesare Hassan
- Department of Gastroenterology and Hepatology, Nuovo Regina Margherita Hospital, Digestive Endoscopy Unit, Rome, Italy
| | - Maria Pellise
- Department of Gastroenterology and Hepatology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Alessandro Repici
- Department of Gastroenterology and Hepatology, Humanitas Clinical and Research Center, Humanitas University, Rozzano, Italy
| | - Prateek Sharma
- Department of Gastroenterology and Hepatology, Veteran Affairs Medical Center, Kansas City, Missouri
| | - Michael J Bourke
- Westmead Hospital, University of Sydney Medical School, Sydney, Australia
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Mehta N, Abushahin A, Sadaps M, Alomari M, Vargo J, Patil D, Lopez R, Kalady M, Delaney CP, Gorgun E, Church J, Saito Y, Burke CA, Bhatt A. Recurrence with malignancy after endoscopic resection of large colon polyps with high-grade dysplasia: incidence and risk factors. Surg Endosc 2020; 35:2500-2508. [PMID: 32472496 DOI: 10.1007/s00464-020-07660-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the West, piecemeal endoscopic resection remains the primary treatment for large colon polyps (LCP), as most recurrences are believed to be benign and resectable with follow-up endoscopy. However, invasive malignancy at the site of prior piecemeal endoscopic mucosal resection has been reported in the Asian literature. This study aims to identify the incidence of and the risk factors for local recurrence with malignancy after endoscopic resection of LCP with high-grade dysplasia (HGD). METHODS In this retrospective cohort study, we identified patients undergoing complete endoscopic resection of LCPs (≥ 20 mm) with HGD at the Cleveland Clinic between January 2000 and December 2016. Demographic, endoscopic, and pathologic data were collected. All subsequent endoscopic and pathology reports were reviewed to identify recurrence. The cumulative incidence of malignancy at the polypectomy site was determined and univariate analysis was performed to assess risk factors. RESULTS A total of 254 LCPs with HGD were resected in 229 patients. Mean polyp size was 29.2 mm. There were 138 lesions resected in piecemeal fashion and 116 en-bloc. After a median follow-up of 28.7 months for the entire cohort, local recurrence with malignancy was diagnosed in six cases. Median time to malignancy diagnosis was 28.5 months. All malignant cases occurred after piecemeal resection and none after en-bloc resection (HR 11.4; 95% CI 0.48-273). CONCLUSION Malignancy after endoscopic resection of LCPs with HGD is uncommon and may be associated with piecemeal resection. When possible, en-bloc resection should be the goal for the management of LCPs.
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Affiliation(s)
- Neal Mehta
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Desk A30, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Ashraf Abushahin
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Meena Sadaps
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohammad Alomari
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John Vargo
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Patil
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Rocio Lopez
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Matthew Kalady
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Conor P Delaney
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Emre Gorgun
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - James Church
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Carol A Burke
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amit Bhatt
- Department of Gastroenterology and Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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13
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Zavyalov DV, Kashin SV, Olevskaya ER, Molchanov SV, Fedorova EA, Kamaletdinova YY, Safuanov AA, Korotkevich AG, May SA, Mersaidova KI, Meylah OV. ENDOSCOPIC PIECEMEAL RESECTION OF LARGE BENIGN COLORECTAL NEOPLASIA: RESULTS OF A RUSSIAN MULTICENTER STUDY. KOLOPROKTOLOGIA 2020; 19:73-79. [DOI: 10.33878/2073-7556-2020-19-1-73-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
Abstract
AIM: to assess the safety of endoscopic piecemeal mucosal resection (EPMR) of large epithelial colorectal lesions and to identify risk factors for tumor recurrence.PATIENTS AND METHODS: results of EPMR were evaluated in retrospective study, which was carried out in five regional endoscopic centers. The criterion for inclusion in the study was benign colorectal lesion of 20 mm and larger.RESULTS: we found that complications of EPMR occurred in 13% of cases. In 9.2% it was intraoperative bleeding, which was stopped endoscopically. Postoperative bleeding was detected in 1.2% of patients, perforation – in 2.4%. Tumor recurrence developed in 12%. We have revealed a direct correlation between tumor recurrence and intraoperative bleeding (p=0.013) and a size of lesion >4 cm (p=0.012); the inverse correlation between the tumor recurrence and the fullness of the lifting during the removal (p=0.008) and the male gender of the patient (p=0.043).CONCLUSION: significant risk factors of tumor recurrence after endoscopic piecemeal resection of large benign colorectal neoplasia were identified before the procedure (gender and tumor size) and intraoperatively (completeness of lifting and the intraoperative bleeding).
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Affiliation(s)
| | | | | | | | | | | | - A. A. Safuanov
- Republican Oncology Clinical Hospital of Bashkortostan Republic
| | | | - S. A. May
- Novokuznetsk City Clinical Hospital 29
| | - K. I. Mersaidova
- Municipal autonomic health care institution «City Clinical Hospital No. 40»
| | - O. V. Meylah
- Municipal autonomic health care institution «City Clinical Hospital No. 40»
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Oude Vrielink TJC, Vitiello V, Mylonas GP. Robotic surgery in cancer. BIOENGINEERING INNOVATIVE SOLUTIONS FOR CANCER 2020:245-269. [DOI: 10.1016/b978-0-12-813886-1.00012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Murakami T, Sakamoto N, Nagahara A. Clinicopathological features, diagnosis, and treatment of sessile serrated adenoma/polyp with dysplasia/carcinoma. J Gastroenterol Hepatol 2019; 34:1685-1695. [PMID: 31158302 DOI: 10.1111/jgh.14752] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Abstract
Sessile serrated adenoma/polyps (SSA/Ps) are early precursor lesions in the serrated neoplasia pathway, which results in BRAF-mutated colorectal carcinomas with not only high levels of microsatellite instability but also microsatellite stable. SSA/Ps with advanced histology, including cytological dysplasia or minimally invasive carcinomas, are important lesions because SSA/Ps are considered major contributors to "interval cancers" and these lesions can rapidly become dysplastic or invasive carcinomas. Clinicopathologically, SSA/Ps with dysplasia or invasive carcinoma were associated with advanced age, female sex, and proximal colon. Although SSA/Ps with submucosal invasive carcinoma were smaller and invaded less deeply into the submucosal layer than conventional tubular adenomas with submucosal invasive carcinoma, SSA/Ps with submucosal invasive carcinoma frequently had a mucinous component and exhibited a higher potential for lymphatic invasion and lymph node metastasis. In an SSA/P series, endoscopic characteristics, including (semi)pedunculated morphology, double elevation, central depression, and reddishness, may help accurately diagnose SSA/Ps with advanced histology. Removal of SSA/Ps with dysplasia or invasive carcinoma was recommended. Endoscopic treatment such as endoscopic mucosal resection or endoscopic submucosal dissection is useful for those lesions. However, surgical resection with lymph node dissection might be indicated when SSA/Ps with invasive carcinoma are endoscopically suspected, because these have the high risk of lymph node metastasis. Greater awareness may promote further research into improving the detection, recognition, and complete resection rates of SSA/Ps with dysplasia or invasive carcinoma and reduce the interval cancer rates.
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Affiliation(s)
- Takashi Murakami
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Naoto Sakamoto
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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16
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Seo M, Yang DH, Kim J, Song EM, Kim GU, Hwang SW, Park SH, Kim KJ, Ye BD, Byeon JS, Myung SJ, Yang SK. Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 29:473-480. [PMID: 30249563 DOI: 10.5152/tjg.2018.17400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS We aimed to investigate the factors associated with piecemeal resection of colorectal neoplasia (CRN), in spite of endoscopic submucosal dissection (ESD). MATERIALS AND METHODS We analyzed the retrospective data for colorectal ESD cases from January 2005 to April 2014. We also reviewed the piecemeal endoscopic mucosal resection (EMR) for CRNs ≥20 mm, performed over the same period. RESULTS En bloc resection was possible in 648 (85.7%) of 756 lesions in 740 patients. Multivariate analysis showed that hybrid ESD (odds ratio (OR), 29.07; 95% confidence interval (CI), 15.46-54.65; p<0.01) and mild or severe submucosal fibrosis (OR, 3.62; 95% CI, 1.94-6.76; p<0.01) were independently associated with piecemeal ESD. The en bloc ESD group showed higher histologic complete resection rate than the piecemeal ESD group (80.4% vs. 56.5%; p<0.01), and the piecemeal ESD group showed higher recurrence rate than in the en bloc ESD group (5.6% [4/72] vs. 0.7% [3/450]; p<0.01). Overall recurrence rate was 1.3% (7/522). CONCLUSION Hybrid ESD and submucosal fibrosis are independently associated with piecemeal ESD. Piecemeal ESD cases recurred more frequently than en bloc ESD cases.
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Affiliation(s)
- Myeongsook Seo
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Eun Mi Song
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Gwang Un Kim
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan School of Medicine Asan Medical Center, Seoul, Korea
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Katsinelos P, Lazaraki G, Chatzimavroudis G, Anastasiadis S, Georgakis N, Xanthis A, Gatopoulou A, Anastasiadou K, Kountouras J. A retrospective comparative study of argon plasma versus polypectome snare tip coagulation: effect on recurrence rate after resection of large laterally spreading type lesions. Ann Gastroenterol 2019; 32:178-184. [PMID: 30837791 PMCID: PMC6394265 DOI: 10.20524/aog.2019.0359] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 12/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background Endoscopic mucosal resection (EMR) is an established technique for treating large laterally spreading type (LST) lesions ≥20 mm. The aim of our study was to compare the use of argon plasma (APC) versus snare-tip coagulation on the recurrence rate of large LST lesions. Methods All patients with large LST lesions resected by EMR between January 2006 and December 2014 were enrolled. After piecemeal resection, patients underwent either APC or snare-tip coagulation of the rim of the resection area and any residual adenomatous tissue. Follow up included colonoscopy and biopsies. Medical records, including characteristics of patients and polyps, complications and recurrence were retrieved and collected. Results One hundred one patients were included in the final analysis. They were divided into the APC group (n=50) and the snare-tip coagulation group (n=51). The 2 groups were similar concerning patients’ characteristics, size of polyps and histology. Post-polypectomy coagulation syndrome was observed in 8 patients (7.9%) (APC group: n=5 and snare tip group: n=3). EMR-related bleeding occurred in 9 patients (8.9%) (APC group: n=4 and snare tip group: n=5). Total recurrence rate was 14.85% (16% and 13.7% in APC and snare-tip groups, respectively, P=0.34). Conclusion The effectiveness of snare-tip coagulation is comparable with that of APC with respect to recurrence rate after resection of large LST lesions. It thus represents a cost-effective alternative to APC.
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Affiliation(s)
| | - Georgia Lazaraki
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Grigoris Chatzimavroudis
- 2 Surgical Department, G. Gennimatas General Hospital, School of Medicine, Aristotle University of Thessaloniki, Macedonia, Greece
| | - Sotiris Anastasiadis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Nikolaos Georgakis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Andreas Xanthis
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Anthi Gatopoulou
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Kiriaki Anastasiadou
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
| | - Jannis Kountouras
- 2 Department of Gastroenterology, Ippokration General Hospital, Macedonia, Greece
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Purchiaroni F, Costamagna G, Hassan C. Quality in upper gastrointestinal endoscopic submucosal dissection. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:261. [PMID: 30094247 PMCID: PMC6064797 DOI: 10.21037/atm.2018.02.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 02/09/2018] [Indexed: 12/27/2022]
Abstract
Progress in the endoscopy technology field led to an increase in the diagnosis of early gastrointestinal (GI) superficial lesions and to an improvement of their treatment. Endoscopic submucosal dissection (ESD) has been developed in Japan with the aim of removing such lesions in one piece, in order to obtain a curative resection and to minimize the risk of local recurrence, and to preserve the native organ. ESD is widely used in Asia for the treatment of early upper and lower GI lesions and is currently gaining attention in Western countries too. However, ESD can be safely performed only by expert endoscopists and in specific clinical settings. Therefore, prior to decide whether ESD is feasible or not, the target lesion must be carefully assessed, in order to understand whether or not it is eligible for submucosal dissection. The aim of this paper is to review indications, limitations and technical aspects of upper GI ESD.
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Affiliation(s)
- Flaminia Purchiaroni
- Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Guido Costamagna
- Digestive Endoscopy Unit, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cesare Hassan
- Digestive Endoscopy Unit, Ospedale Nuova Regina Margherita, Rome, Italy
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19
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Mouchli MA, Ouk L, Scheitel MR, Chaudhry AP, Felmlee-Devine D, Grill DE, Rashtak S, Wang P, Wang J, Chaudhry R, Smyrk TC, Oberg AL, Druliner BR, Boardman LA. Colonoscopy surveillance for high risk polyps does not always prevent colorectal cancer. World J Gastroenterol 2018; 24:905-916. [PMID: 29491684 PMCID: PMC5829154 DOI: 10.3748/wjg.v24.i8.905] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/17/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the frequency and risk factors for colorectal cancer (CRC) development among individuals with resected advanced adenoma (AA)/traditional serrated adenoma (TSA)/advanced sessile serrated adenoma (ASSA).
METHODS Data was collected from medical records of 14663 subjects found to have AA, TSA, or ASSA at screening or surveillance colonoscopy. Patients with inflammatory bowel disease or known genetic predisposition for CRC were excluded from the study. Factors associated with CRC developing after endoscopic management of high risk polyps were calculated in 4610 such patients who had at least one surveillance colonoscopy within 10 years following the original polypectomy of the incident advanced polyp.
RESULTS 84/4610 (1.8%) patients developed CRC at the polypectomy site within a median of 4.2 years (mean 4.89 years), and 1.2% (54/4610) developed CRC in a region distinct from the AA/TSA/ASSA resection site within a median of 5.1 years (mean 6.67 years). Approximately, 30% (25/84) of patients who developed CRC at the AA/TSA/ASSA site and 27.8% (15/54) of patients who developed CRC at another site had colonoscopy at recommended surveillance intervals. Increasing age; polyp size; male sex; right-sided location; high degree of dysplasia; higher number of polyps resected; and piecemeal removal were associated with an increased risk for CRC development at the same site as the index polyp. Increasing age; right-sided location; higher number of polyps resected and sessile endoscopic appearance of the index AA/TSA/ASSA were significantly associated with an increased risk for CRC development at a different site.
CONCLUSION Recognition that CRC may develop following AA/TSA/ASSA removal is one step toward improving our practice efficiency and preventing a portion of CRC related morbidity and mortality.
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Affiliation(s)
- Mohamad A Mouchli
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lidia Ouk
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Marianne R Scheitel
- Knowledge and Delivery Center, Mayo Clinic, Rochester, MN 55905, United States
| | - Alisha P Chaudhry
- Biostatistics and Bioinformatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States
| | - Donna Felmlee-Devine
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Diane E Grill
- Division of Biomedical Statistics and Informatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States
| | - Shahrooz Rashtak
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Panwen Wang
- Biostatistics and Bioinformatics, Health Science Research, Center for Individualized Medicine Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Junwen Wang
- Biostatistics and Bioinformatics, Health Science Research, Center for Individualized Medicine Mayo Clinic, Scottsdale, AZ 85259, United States
- Department of Biomedical Informatics, Arizona State University, Scottsdale, AZ 85259, United States
| | - Rajeev Chaudhry
- Primary Care Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Center for Innovation, Mayo Clinic, Rochester, MN 55905, United States
| | - Thomas C Smyrk
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States
| | - Ann L Oberg
- Division of Biomedical Statistics and Informatics, Health Sciences Research, Mayo Clinic, Rochester, MN 55905, United States
| | - Brooke R Druliner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
| | - Lisa A Boardman
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
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Abstract
PUPRPOSE Benign polyps that are technically challenging and unsafe to remove via polypectomy are known as complex polyps. Concerns regarding safety and completeness of resection dictate they undergo advanced endoscopic techniques, such as endoscopic mucosal resection or surgery. We provide a comprehensive overview of complex polyps and current treatment options. METHODS A review of the English literature was conducted to identifyarticles describing the management of complex polyps of the colon and rectum. RESULTS Endoscopic mucosal resection is the standard of care for the majority of complex polyps. Only polyps that fail endoscopic mucosal resection or are highly suspicious of invasive cancer but which cannot be removed endoscopically warrant surgery. CONCLUSION Several factors influence the treatment of a complex polyp; therefore, there cannot be a "one-size-fitsall" approach. Treatment should be tailored to the lesion's characteristics, the risk of adverse events, and the resources available to the treating physician.
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Seo M, Song EM, Kim GU, Hwang SW, Park SH, Yang DH, Kim KJ, Ye BD, Myung SJ, Yang SK, Byeon JS. Local recurrence and subsequent endoscopic treatment after endoscopic piecemeal mucosal resection with or without precutting in the colorectum. Intest Res 2017; 15:502-510. [PMID: 29142518 PMCID: PMC5683981 DOI: 10.5217/ir.2017.15.4.502] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/12/2022] Open
Abstract
Background/Aims Precutting before endoscopic piecemeal mucosal resection (EPMR) may increase colorectal polyp resection effectiveness. We aimed to identify risk factors for recurrence after conventional EPMR (CEPMR) and precut EPMR (PEPMR) and investigated endoscopic treatment outcomes for recurrent cases. Methods The medical records of patients with colorectal polyps treated by EPMR were analyzed. Patients without follow-up surveillance colonoscopies were excluded. Results Among 359 lesions, the local recurrence rate on the first surveillance colonoscopy was 5.8% (18/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively. Among lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence on subsequent surveillance colonoscopy were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. Larger tumor size was the only independent risk factor for recurrence (odds ratio, 7.93; 95% confidence interval, 1.95–32.30; P<0.001). Endoscopic treatment was performed for all 27 recurrences. A combination of ≥2 endoscopic treatment modalities was used in 19 of 27 recurrences (70.4%). Surveillance colonoscopies were performed in 20 of 27 recurrences after endoscopic treatment. One (5.0%) had a re-recurrence and was treated by surgical resection because recurrence occurred at the appendiceal orifice. Nineteen of 20 lesions (95.0%) could be cured endoscopically, although 3 of the 19 showed second or third recurrences and were treated by repeat endoscopic resection. Conclusions The local recurrence rates after CEPMR and PEPMR were similar. Larger tumor size was an independent risk factor for local recurrence after EPMR. Endoscopic treatment of recurrences resulted in high cure rates, although combination methods were necessary in many cases.
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Affiliation(s)
- Myeongsook Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Mi Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwang Un Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Wook Hwang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Jo Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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22
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Huang E, Sarin A. Colonic Polyps: Treatment. Clin Colon Rectal Surg 2016; 29:306-314. [PMID: 31777461 DOI: 10.1055/s-0036-1584090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Colonic polyps are considered to be precursors of colon cancer based on several different molecular pathway models and should be resected with a principle of complete excisional biopsy. Several techniques are available for excisional biopsy, ranging from endoscopic techniques such as snare polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) to surgical colonic resection and colonic endolaparoscopic surgery (CELS). This article focuses on these modalities with contemporary recommendations for choice of modality based on the size and features of the polyp encountered upon endoscopy. In addition, the morphologically apparent risk factors for polyps harboring invasive malignancy are discussed along with implications for management. Current literature on the comparative risks and benefits of EMR, ESD, CELS, and surgical resection is reviewed, as well as recommendations regarding cancer risk and subsequent surveillance.
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Affiliation(s)
- Emily Huang
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Ankit Sarin
- Department of Surgery, Section of Colorectal Surgery, University of California San Francisco, San Francisco, California
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23
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Kim TO. Optimal Colonoscopy Surveillance Interval after Polypectomy. Clin Endosc 2016; 49:359-63. [PMID: 27484812 PMCID: PMC4977746 DOI: 10.5946/ce.2016.080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/12/2016] [Indexed: 12/27/2022] Open
Abstract
The detection and removal of adenomatous polyps and postpolypectomy surveillance are considered important for the control of colorectal cancer (CRC). Surveillance using colonoscopy is an effective tool for preventing CRC after colorectal polypectomy, especially if compliance is good. In current practice, the intervals between colonoscopies after polypectomy are variable. Different recommendations for recognizing at risk groups and defining surveillance intervals after an initial finding of colorectal adenomas have been published. However, high-grade dysplasia and the number and size of adenomas are known major cancer predictors. Based on this, a subgroup of patients that may benefit from intensive surveillance colonoscopy can be identified.
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Affiliation(s)
- Tae Oh Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
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24
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Law R, Das A, Gregory D, Komanduri S, Muthusamy R, Rastogi A, Vargo J, Wallace MB, Raju GS, Mounzer R, Klapman J, Shah J, Watson R, Wilson R, Edmundowicz SA, Wani S. Endoscopic resection is cost-effective compared with laparoscopic resection in the management of complex colon polyps: an economic analysis. Gastrointest Endosc 2016; 83:1248-57. [PMID: 26608129 DOI: 10.1016/j.gie.2015.11.014] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/07/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic resection (ER) is an efficacious treatment for complex colon polyps (CCPs). Many patients are referred for surgical resection because of concerns over procedural safety, incomplete polyp resection, and adenoma recurrence after ER. Efficacy data for both resection strategies are widely available, but a paucity of data exist on the cost-effectiveness of each modality. The aim of this study was to perform an economic analysis comparing ER and laparoscopic resection (LR) strategies in patients with CCP. METHODS A decision analysis tree was constructed using decision analysis software. The 2 strategies (ER vs LR) were evaluated in a hypothetical cohort of patients with CCPs. A hybrid Markov model with a 10-year time horizon was used. Patients entered the model after colonoscopic diagnosis at age 50. Under Strategy I, patients underwent ER followed by surveillance colonoscopy at 3 to 6 months and 12 months. Patients with failed ER and residual adenoma at 12 months were referred for LR. Under Strategy II, patients underwent LR as primary treatment. Patients with invasive cancer were excluded. Estimates regarding ER performance characteristics were obtained from a systematic review of published literature. The Centers for Medicare & Medicaid Services (2012-2013) and the 2012 Healthcare Cost and Utilization Project databases were used to determine the costs and loss of utility. We assumed that all procedures were performed with anesthesia support, and patients with adverse events in both strategies required inpatient hospitalization. Baseline estimates and costs were varied by using a sensitivity analysis through the ranges. RESULTS LR was found to be more costly and yielded fewer quality-adjusted life-years (QALYs) compared with ER. The cost of ER of a CCP was $5570 per patient and yielded 9.640 QALYs. LR of a CCP cost $18,717 per patient and yielded fewer QALYs (9.577). For LR to be more cost-effective, the thresholds of 1-way sensitivity analyses were (1) technical success of ER for complete resection in <75.8% of cases, (2) adverse event rates for ER > 12%, and (3) LR cost of <$14,000. CONCLUSIONS Our data suggest that ER is a cost-effective strategy for removal of CCPs. The effectiveness is driven by high technical success and low adverse event rates associated with ER, in addition to the increased cost of LR.
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Affiliation(s)
- Ryan Law
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ananya Das
- Arizona Digestive Health, Gilbert, Arizona, USA
| | - Dyanna Gregory
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Srinadh Komanduri
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Raman Muthusamy
- Division of Digestive Diseases, University of California-Los Angeles, Los Angeles, California, USA
| | - Amit Rastogi
- Division of Gastroenterology, The University of Kansas Hospital, Kansas City, Kansas, USA
| | - John Vargo
- Digestive Diseases Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic-Jacksonville, Jacksonville, Florida, USA
| | - G S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rawad Mounzer
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jason Klapman
- Gastrointestinal Oncology Department, Moffitt Cancer Center, Tampa, Florida, USA
| | - Janak Shah
- Department of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA
| | - Rabindra Watson
- Division of Digestive Diseases, University of California-Los Angeles, Los Angeles, California, USA
| | - Robert Wilson
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Steven A Edmundowicz
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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25
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Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, Senore C, Spada C, Bellisario C, Bhandari P, Rex DK. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65:806-20. [PMID: 25681402 DOI: 10.1136/gutjnl-2014-308481] [Citation(s) in RCA: 266] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/20/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of endoscopic resection of large colorectal polyps. DESIGN Relevant publications were identified in MEDLINE/EMBASE/Cochrane Central Register for the period 1966-2014. Studies in which ≥20 mm colorectal neoplastic lesions were treated with endoscopic resection were included. Rates of postendoscopic resection surgery due to non-curative resection or adverse events, as well as the rates of complete endoscopic removal, invasive cancer, adverse events, recurrence and mortality, were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random effect models. I2 statistic was used to describe the variation across studies due to heterogeneity. Meta-regression analysis was also performed. RESULTS 50 studies including 6442 patients and 6779 large polyps were included in the analyses. Overall, 503 out of 6442 patients (pooled rate: 8%, 95% CI 7% to 10%, I2=78.6%) underwent surgery due to non-curative endoscopic resection, and 31/6442 (pooled rate: 1%, 95% CI 0.7% to 1.4%, I2=0%) to adverse events. Invasive cancer at histology, non-curative endoscopic resection, synchronous lesions and recurrence accounted for 58%, 28%, 2.2% and 5.9% of all the surgeries, respectively. Endoscopic perforation occurred in 96/6595 (1.5%, 95% CI 1.2% to 1.7%) polyps, while bleeding in 423/6474 (6.5%, 95% CI 5.9% to 7.1%). Overall, 5334 patients entered in surveillance, 502/5836 (8.6%, 95% CI 7.9% to 9.3%) being lost at follow-up. Endoscopic recurrence was detected in 735/5334 patients (13.8%, 95% CI 12.9% to 14.7%), being an invasive cancer in 14/5334 (0.3%, 95% CI 0.1% to 0.4%). Endoscopic treatment was successful in 664/735 cases (90.3%, 95% CI 88.2% to 92.5%). Mortality related with management of large polyps was reported in 5/6278 cases (0.08%, 95% CI 0.01% to 0.15%). CONCLUSIONS Endoscopic resection of large polyps appeared to be an extremely effective and safe intervention. However, an adequate endoscopic surveillance is necessary for its long-term efficacy.
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Affiliation(s)
- C Hassan
- Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy
| | - A Repici
- Digestive Endoscopy Unit, Istituto Clinico Humanitas, Milan, Italy
| | - P Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - A Zullo
- Endoscopy Unit, 'Nuovo Regina Margherita Hospital', Rome, Italy
| | - M Bretthauer
- Department of Health Economy and Health Management, University of Oslo, Oslo, Norway Gastroenterology Unit, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - C Senore
- AOU S Giovanni Battista-CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Turin, Italy
| | - C Spada
- Digestive Endoscopy Unit, Catholic University, Rome, Italy
| | | | - P Bhandari
- Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - D K Rex
- Division of Gastroenterology/Hepatology, Indiana University Medical Center, Indianapolis, Indiana, USA
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Rutter MD, Chattree A, Barbour JA, Thomas-Gibson S, Bhandari P, Saunders BP, Veitch AM, Anderson J, Rembacken BJ, Loughrey MB, Pullan R, Garrett WV, Lewis G, Dolwani S. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut 2015; 64:1847-73. [PMID: 26104751 PMCID: PMC4680188 DOI: 10.1136/gutjnl-2015-309576] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 02/07/2023]
Abstract
These guidelines provide an evidence-based framework for the management of patients with large non-pedunculated colorectal polyps (LNPCPs), in addition to identifying key performance indicators (KPIs) that permit the audit of quality outcomes. These are areas not previously covered by British Society of Gastroenterology (BSG) Guidelines.A National Institute of Health and Care Excellence (NICE) compliant BSG guideline development process was used throughout and the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to structure the guideline development process. A systematic review of literature was conducted for English language articles up to May 2014 concerning the assessment and management of LNPCPs. Quality of evaluated studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist System. Proposed recommendation statements were evaluated by each member of the Guideline Development Group (GDG) on a scale from 1 (strongly agree) to 5 (strongly disagree) with >80% agreement required for consensus to be reached. Where consensus was not reached a modified Delphi process was used to re-evaluate and modify proposed statements until consensus was reached or the statement discarded. A round table meeting was subsequently held to finalise recommendations and to evaluate the strength of evidence discussed. The GRADE tool was used to assess the strength of evidence and strength of recommendation for finalised statements.KPIs, a training framework and potential research questions for the management of LNPCPs were also developed. It is hoped that these guidelines will improve the assessment and management of LNPCPs.
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Affiliation(s)
- Matthew D Rutter
- Department of Gastroenterology, University Hospital of North Tees, Stockton on Tees, UK School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Amit Chattree
- School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | - Jamie A Barbour
- Department of Gastroenterology, Queen Elizabeth Hospital, Gateshead, UK
| | | | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - John Anderson
- Department of Gastroenterology, Cheltenham General Hospital, Cheltenham, UK
| | | | | | - Rupert Pullan
- Department of Colorectal Surgery, Torbay Hospital, Torquay, UK
| | - William V Garrett
- Department of Colorectal Surgery, Medway Maritime Hospital, Gillingham, UK
| | - Gethin Lewis
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
| | - Sunil Dolwani
- Department of Gastroenterology, University Hospital Llandough, Cardiff, UK
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27
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He YQ, Wang X, Li AQ, Yang L, Zhang J, Kang Q, Tang S, Jin P, Sheng JQ. Factors for Endoscopic Submucosal Dissection in Early Colorectal Neoplasms: A Single Center Clinical Experience in China. Clin Endosc 2015; 48:405-10. [PMID: 26473124 PMCID: PMC4604279 DOI: 10.5946/ce.2015.48.5.405] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/18/2015] [Accepted: 03/13/2015] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Early colorectal (CR) neoplasm can be cured by endoscopic submucosal dissection (ESD), but clinical experience and factors associated with complications from ESD for CR neoplasms in China have not been reported. Methods Seventy-eight cases of early CR neoplasm treated with endoscopic resection performed between December 2012 and December 2013 at Beijing Military General Hospital were included. Factors associated with ESD complications and procedure times were evaluated. Results The en bloc resection rate was 88.5% (69/78), tumor size was 32.1±10.7 mm, and procedure time was 71.8±49.5 minutes. The major complication was perforation, which occurred in 8.97% of the ESD procedures. Multivariate logistic regression analysis indicated that only tumor size (p=0.022) was associated with ESD perforation. Tumor size (p<0.001) and the non-lifting sign (p=0.017) were independent factors for procedure time, and procedure time (p=0.016) was a key factor for en bloc resection. After a median 10 months (range, 4 to 16) of follow-up, no patients had local recurrence. Conclusions This study indicated that ESD is an applicable method for large early CR neoplasm in the colon and rectum. Tumor size and the non-lifting sign might be considerable factors for increased complication rate and procedural time of ESD.
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Affiliation(s)
- Yu-Qi He
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Xin Wang
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Ai-Qin Li
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Lang Yang
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Jian Zhang
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Qian Kang
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Shan Tang
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Peng Jin
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
| | - Jian-Qiu Sheng
- Department of Gastroenterology, Beijing Military General Hospital, Beijing, China
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Mounzer R, Das A, Yen RD, Rastogi A, Bansal A, Hosford L, Wani S. Endoscopic and surgical treatment of malignant colorectal polyps: a population-based comparative study. Gastrointest Endosc 2015; 81:733-740.e2. [PMID: 25708762 DOI: 10.1016/j.gie.2014.11.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Long-term population-based data comparing endoscopic therapy (ET) and surgery for management of malignant colorectal polyps (MCPs) are limited. OBJECTIVE To compare colorectal cancer (CRC)-specific survival with ET and surgery. DESIGN AND SETTING Population-based study. PATIENTS Patients with stage 0 and stage 1 MCPs were identified from the Surveillance Epidemiology and End Results (SEER) database (1998-2009). Demographic characteristics, tumor size, location, treatment modality, and survival were compared. Propensity-score matching and Cox proportional hazards regression models were used to evaluate the association between treatment and CRC-specific survival. INTERVENTIONS ET and surgery. MAIN OUTCOME MEASUREMENTS Mid-term (2.5 years) and long-term (5 years) CRC-free survival rates and independent predictors of CRC-specific mortality. RESULTS Of 10,403 patients with MCPs, 2688 (26%) underwent ET and 7715 (74%) underwent surgery. Patients undergoing ET were more likely to be older white men with stage 0 disease. Surgical patients had more right-sided lesions, larger MCPs, and stage 1 disease. There was no difference in the 2.5-year and 5-year CRC-free survival rates between the 2 groups in stage 0 disease. Surgical resection led to higher 2.5-year (97.8% vs 93.2%; P < .001) and 5-year (96.6% vs 89.8%; P < .001) CRC-free survival in stage 1 disease. These results were confirmed by propensity-score matching. ET was a significant predictor for CRC-specific mortality in stage 1 disease (hazard ratio 2.40; 95% confidence interval, 1.75-3.29; P < .001). LIMITATIONS Comorbidity index not available, selection bias. CONCLUSIONS ET and surgery had comparable mid- and long-term CRC-free survival rates in stage 0 disease. Surgical resection is the recommended treatment modality for MCPs with submucosal invasion.
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Affiliation(s)
- Rawad Mounzer
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Ananya Das
- Arizona Center for Digestive Health, Gilbert, Arizona, USA
| | - Roy D Yen
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Amit Rastogi
- University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Ajay Bansal
- University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, Missouri, USA
| | - Lindsay Hosford
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, Colorado, USA; Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center, Denver, Colorado, USA
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29
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Kim HG, Thosani N, Banerjee S, Chen A, Friedland S. Underwater endoscopic mucosal resection for recurrences after previous piecemeal resection of colorectal polyps (with video). Gastrointest Endosc 2014; 80:1094-1102. [PMID: 25012560 DOI: 10.1016/j.gie.2014.05.318] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 05/18/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Conventional endoscopic treatment of a recurrent adenoma after piecemeal EMR (PEMR) of a colorectal laterally spreading tumor (LST) is technically difficult with low en bloc resection rates because of the inability to snare fibrotic residual. OBJECTIVE To assess the feasibility of salvage underwater EMR (UEMR) for the treatment of recurrent adenoma after PEMR of a colorectal LST. DESIGN Retrospective, cross-sectional study. SETTING Single, tertiary-care referral center. PATIENTS Patients who have recurrent adenoma after PEMR of colorectal LST (≥2 cm). INTERVENTIONS UEMR versus EMR. MAIN OUTCOME MEASUREMENT En bloc resection rate, endoscopic complete removal rate, recurrence rate on follow-up colonoscopy, adjunctive ablation rate with argon plasma coagulation (APC) during salvage procedure, and independent predictive factors for successful en bloc resection and endoscopic complete removal. RESULTS Eighty salvage procedures (36 UEMRs vs 44 EMRs) were analyzed. En bloc resection rate (47.2% vs 15.9%, P = .002) and endoscopic complete removal rate (88.9% vs 31.8%, P < .001) were higher in the UEMR group than in the EMR group. APC ablation of visible residual during salvage procedure was lower in UEMR group than EMR group (11.1% vs 65.9%, P < .001). Recurrence rate on follow-up colonoscopy was significantly lower in the UEMR group than the EMR group (10% vs 39.4%, P = .02). UEMR was an independent predictor of successful en bloc resection and endoscopic complete removal. LIMITATIONS Retrospective, single-center study. CONCLUSIONS UEMR can be a useful and feasible technique as a salvage procedure for recurrent colorectal adenoma after PEMR.
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Affiliation(s)
- Hyun Gun Kim
- Institute for Digestive Research, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Nirav Thosani
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA
| | - Subhas Banerjee
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA
| | - Ann Chen
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA
| | - Shai Friedland
- Department of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
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Wei XB, Xin L, Hao J. Malignant recurrence and distal metastasis after complete local resection of colorectal "high-grade intraepithelial neoplasia": incidence and risk factors. Int J Colorectal Dis 2014; 29:1467-75. [PMID: 25155620 DOI: 10.1007/s00384-014-2001-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal high-grade intraepithelial neoplasia is defined as a high-grade neoplastic lesion with no invasion of submucosa. Because pathological evaluation has inevitable sampling errors, invasive cancer may be underdiagnosed as high-grade intraepithelial neoplasia by regarding submucosa invasion as an indispensable criterion for malignancy. This study was to evaluate the reliability of colorectal "high-grade intraepithelial neoplasia" diagnosis and identify predictive factors of underdiagnosis. METHODS Colorectal high-grade intraepithelial neoplasia patients treated with complete local excision were followed up. Clinicopathologic features were compared between cases with malignant recurrence or distal metastasis and those without. RESULTS Of 491 lesions reviewed, 13 (2.6 %) developed local malignant recurrence or distal metastasis, which were statistically significantly associated with rectal location (p = 0.047), sessile growth (p = 0.002), large diameter (p = 0.005), villous adenoma (p = 0.00), transanal local resection (p = 0.001), and piecemeal specimens (p = 0.009). Of the 13 cases, 11 were located in the rectum, including 10 in the low position (<=6 cm from the anal verge, mean 3.6 cm). Deeper pathological examination was performed on the paraffin-embedded tissue blocks of the 13 primary tumors and revealed no evidence of submucosa invasion. CONCLUSION The diagnosis of colorectal high-grade intraepithelial neoplasia based on local resection is relatively reliable. However, regarding invasion of submucosa as an indispensable criterion for malignancy may contribute to the choice of overly conservative treatment, especially in the situation that the radical resection requires removing the anus.
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Affiliation(s)
- Xu Biao Wei
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Yangpu District, Shanghai, 200433, People's Republic of China,
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Fu X, Qiu Y, Zhang Y. Screening, management and surveillance for the sessile serrated adenomas/polyps. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:1275-1285. [PMID: 24817924 PMCID: PMC4014208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/28/2014] [Indexed: 06/03/2023]
Abstract
The incidence and mortality rates from right-sided colorectal cancers (CRCs) have not decreased, compared with the significant reduction of CRCs in the left colon in recent years. It is likely that a significant proportion of right-sided CRCs evolve from undetected sessile serrated adenomas/polyps (SSA/Ps) in the primary colonoscopy. Increasing evidences suggest that SSA/Ps are high-risk lesions, with 15% of the SSA/P patients developing subsequent CRCs or adenomas with high-grade dysplasia. However, there are many issues in the screening, management and surveillance of SSA/Ps. Based on new evidences, this review addresses major issues in the diagnostic criteria for the serrated polyps of the colorectum, new endoscopic techniques (high-resolution magnifying endoscopy, narrow-band imaging, autofluorescence imaging, confocal laser endoscopy, and endocytoscopy) for the realtime identification of SSA/Ps, and the management of SSA/Ps by endoscopic mucosal resection, endoscopic sub-mucosal dissection or surgical resection in practice.
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Affiliation(s)
- Xiangsheng Fu
- Department of Gastroenterology, The Affiliated Hospital of Luzhou Medical CollegeSichuan, China, 646000
| | - Ye Qiu
- Department of Gastroenterology, The Affiliated Hospital of Luzhou Medical CollegeSichuan, China, 646000
| | - Yali Zhang
- The Institute for Digestive Medicine, Nanfang Hospital, Southern Medical UniversityGuangzhou, China, 510515
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Williams JG, Pullan RD, Hill J, Horgan PG, Salmo E, Buchanan GN, Rasheed S, McGee SG, Haboubi N. Management of the malignant colorectal polyp: ACPGBI position statement. Colorectal Dis 2013; 15 Suppl 2:1-38. [PMID: 23848492 DOI: 10.1111/codi.12262] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- J G Williams
- Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
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Kim MS, Kim NK, Park JH. Intramural recurrence without mucosal lesions after an endoscopic mucosal resection for early colorectal cancer. Ann Coloproctol 2013; 29:126-9. [PMID: 23862131 PMCID: PMC3710774 DOI: 10.3393/ac.2013.29.3.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/25/2013] [Indexed: 12/28/2022] Open
Abstract
Advances in endoscopic instruments and techniques have enabled increased detection and removal of early colorectal cancer (ECC), which is defined as a tumor whose invasion is limited to the mucosa or submucosa. Some cases can be treated by endoscopic mucosal resection (EMR). However, local recurrence frequently occurs after an EMR for ECC. The recurrence pattern is usually intramural recurrence with a mucosal lesion at the EMR's site. We report the cases of two patients with intramural recurrence without mucosal lesions after an EMR for ECC. These cases indicate that a local recurrence after an EMR for ECC can appear as an intramural recurrence without mucosal lesions at a previous EMR site or another site, although this presentation is very unusual.
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Affiliation(s)
- Min Sung Kim
- Department of Surgery, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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Tanaka S, Terasaki M, Hayashi N, Oka S, Chayama K. Warning for unprincipled colorectal endoscopic submucosal dissection: accurate diagnosis and reasonable treatment strategy. Dig Endosc 2013; 25:107-16. [PMID: 23368854 PMCID: PMC3615179 DOI: 10.1111/den.12016] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/01/2012] [Indexed: 12/17/2022]
Abstract
Piecemeal endoscopic mucosal resection (EMR) is generally indicated for laterally spreading tumors (LST) >2 cm in diameter. However, the segmentation of adenomatous parts does not affect the histopathological diagnosis and completeness of cure. Thus, possible indications for piecemeal EMR are both adenomatous homogenous-type granular-type LST (LST-G) and LST-G as carcinoma in adenoma without segmentalizing the carcinomatous part. Diagnosis of the pit pattern using magnifying endoscopy is essential for determining the correct treatment and setting segmentation borders. In contrast, endoscopic submucosal dissection (ESD) is indicated for lesions requiring endoscopic en bloc excision, as it is difficult to use the snare technique for en bloc excisions such as in non-granular-type LST (LST-NG), especially for the pseudodepressed type, tumors with a type VI pit pattern, shallow invasive submucosal carcinoma, largedepressed tumors and large elevated lesions, which are often malignant (e.g. nodular mixed-type LST-G). Other lesions, such as intramucosal tumor accompanied by submucosal fibrosis, induced by biopsy or peristalsis of the lesion; sporadic localized tumors that occur due to chronic inflammation, including ulcerative colitis; and local residual early carcinoma after endoscopic treatment, are also indications for ESD. In clinical practice, an efficient endoscopic treatment with segregation of ESD from piecemeal EMR should be carried out after a comprehensive evaluation of the completeness of cure, safety, clinical simplicity, and cost-benefit, based on an accurate preoperative diagnosis.
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Affiliation(s)
- Shinji Tanaka
- Department of Endoscopy, Hiroshima University HospitalHiroshima, Japan
| | - Motomi Terasaki
- Department of Gastroenterology and Metabolism, Hiroshima University HospitalHiroshima, Japan
| | - Nana Hayashi
- Department of Endoscopy, Hiroshima University HospitalHiroshima, Japan
| | - Shiro Oka
- Department of Endoscopy, Hiroshima University HospitalHiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University HospitalHiroshima, Japan
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Yang DH, Hong SN, Kim YH, Hong SP, Shin SJ, Kim SE, Lee BI, Lee SH, Park DI, Kim HS, Yang SK, Kim HJ, Kim SH, Kim HJ. Korean guidelines for postpolypectomy colonoscopy surveillance. Clin Endosc 2012; 45:44-61. [PMID: 22741132 PMCID: PMC3363120 DOI: 10.5946/ce.2012.45.1.44] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 12/16/2022] Open
Abstract
Postpolypectomy surveillance has become a major indication for colonoscopy as a result of increased use of screening colonoscopy in Korea. In this report, a careful analytic approach was used to address all available evidences to delineate the predictors for advanced neoplasia at surveillance colonoscopy and we elucidated the high risk findings of the index colonoscopy as follows: 3 or more adenomas, any adenoma larger than 10 mm, any tubulovillous or villous adenoma, any adenoma with high-grade dysplasia, and any serrated polyps larger than 10 mm. Surveillance colonoscopy should be performed five years after the index colonoscopy for those without any high-risk findings and three years after the index colonoscopy for those with one or more high risk findings. However, the surveillance interval can be shortened considering the quality of the index colonoscopy, the completeness of polypectomy, the patient's general condition, and family and medical history.
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Affiliation(s)
- Dong-Hoon Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Hong SN, Yang DH, Kim YH, Hong SP, Shin SJ, Kim SE, Lee BI, Lee SH, Park DI, Kim HS, Yang SK, Kim HJ, Kim SH, Kim HJ. Korean Guidelines for Post-polypectomy Colonoscopic Surveillance. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:99-117. [DOI: 10.4166/kjg.2012.59.2.99] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Sung Noh Hong
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Ho Kim
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Pil Hong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jae Shin
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Seong-Eun Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Bo In Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Suck-Ho Lee
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Dong Il Park
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University, Wonju College of Medicine, Wonju, Korea
| | - Suk-Kyun Yang
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jong Kim
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Santos CEOD, Malaman D, Pereira-Lima JC. Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas. ARQUIVOS DE GASTROENTEROLOGIA 2011; 48:242-7. [DOI: 10.1590/s0004-28032011000400005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 07/14/2011] [Indexed: 02/07/2023]
Abstract
CONTEXT: Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. OBJECTIVES: To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. METHODS: A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique. Complications and recurrence were analyzed. Patients were followed up for 18 months. RESULTS: There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). CONCLUSIONS: Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.
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