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Tawheed A, Ismail A, El-Kassas M, El-Fouly A, Madkour A. Endoscopic resection of gastrointestinal tumors: Training levels and professional roles explored. World J Gastrointest Oncol 2025; 17:101832. [DOI: 10.4251/wjgo.v17.i4.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 01/26/2025] [Accepted: 02/11/2025] [Indexed: 03/25/2025] Open
Abstract
In this editorial, we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology. The study discusses the clinical characteristics of patients undergoing endoscopic resection for gastric cancers. We feel it is important to engage our endoscopy community in a discussion on the current evidence in the literature on the necessary number of cases for training in endoluminal surgery techniques, particularly endoscopic submucosal dissection. This includes the latest recommendations from the European Society of Gastrointestinal Endoscopy, as well as a summary of key studies on the learning curve for these techniques. Additionally, we explore the impact of an endoscopist’s specialty on endoscopy outcomes, drawing from current evidence in the literature to shape our perspective in this evolving field.
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Affiliation(s)
- Ahmed Tawheed
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Alaa Ismail
- Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Amr El-Fouly
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Ahmad Madkour
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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Jawaid S, Aboelezz AF, Daba G, Khalaf M, Ayoub F, Zabad N, Mercado M, Keihanian T, Othman M. Prospective feasibility study of a novel rigidizing stabilizing overtube in the resection of complex gastrointestinal polyps. Endoscopy 2025; 57:68-73. [PMID: 38991535 DOI: 10.1055/a-2350-4059] [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: 07/13/2024]
Abstract
BACKGROUND A novel rigidizing overtube (ROT) was developed to facilitate endoscopic removal of complex gastrointestinal polyps. We aimed to prospectively evaluate the efficacy and safety of the device in the management of large gastrointestinal polyps. METHODS A prospective, single-center study, conducted between May 2021 and April 2023, enrolled patients undergoing endoscopic resection of colon/duodenal polyps ≥25 mm. Primary outcomes were safety, technical success, and clinical success defined as the ability of ROT to facilitate endoscopic polyp removal without changing the initial resection method. RESULTS 97 patients (98 polyps), with a mean polyp size of 33.2 mm (median 31.1), were evaluated. Technical and clinical success rates were 100% and 84%, respectively. Ileocecal valve location was the only predictor of clinical failure (P = 0.02). The mean time to reach the lesion was 7.2 minutes (95%CI 5-8), with overall resection and procedure times of 53.6 minutes (95%CI 48-61) and 88.9 minutes (95%CI 79-95), respectively. No device-related adverse events occurred. Lower technical (67%) and clinical (67%) success rates were seen for duodenal polyps (n = 6). CONCLUSION The novel ROT was safe, with high technical and clinical success during resection of complex colon polyps. Future studies will determine timing of implementation during routine endoscopic resection.
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Affiliation(s)
- Salmaan Jawaid
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Ahmed F Aboelezz
- Department of Internal Medicine, Gastroenterology and Hepatology Unit, Tanta University, Tanta, Egypt
| | - Gehad Daba
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Mai Khalaf
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Fares Ayoub
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Noor Zabad
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Michael Mercado
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Tara Keihanian
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
| | - Mohamed Othman
- Division of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, United States
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Pattarajierapan S, Saito Y, Takamaru H, Toyoshima N, Wisedopas N, Wanpiyarat N, Lerttanatum N, Khomvilai S. Learning curve of colorectal endoscopic submucosal dissection of an endoscopist experienced hands-on training in Japan. J Gastroenterol Hepatol 2025; 40:226-234. [PMID: 39522556 DOI: 10.1111/jgh.16813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/23/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND AND AIM Colorectal endoscopic submucosal dissection is a technically demanding procedure with a steep learning curve. In Japan, the National Cancer Center Hospital allows overseas doctors to participate in hands-on training. We aimed to assess the colorectal endoscopic submucosal dissection performance and learning curve of an endoscopist who participated in hands-on training. METHODS In this retrospective analysis using a prospectively collected database, 100 consecutive superficial colorectal tumors from 100 patients treated with endoscopic submucosal dissection by a colorectal surgeon between January 2020 and May 2024 were included. The cases were grouped into three learning periods: phase I (the initial 30 cases under local expert supervision before training in Japan), phase II (the middle 30 cases), and phase III (the last 40 cases). The primary outcome was resection speed. RESULTS The median resection speed was 5, 11.7, and 13.2 cm2/h in phases I, II, and III, respectively. In matched data, the resection speeds in phases II and III were higher than that in phase I (P = 0.02 and P < 0.001, respectively). En bloc and R0 resection rates were 99% and 95%, respectively. The en bloc resection, R0 resection, and complication rates were not different between phases. Cumulative sum analysis of the resection speed revealed that proficiency was achieved after 36 cases. CONCLUSIONS An endoscopist who underwent a tutored approach and hands-on training in Japan achieved the proficiency benchmarks for colorectal endoscopic submucosal dissection after 36 cases. However, the endoscopist's extensive experience before training may contribute to excellent outcomes.
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Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Naoya Toyoshima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Naruemon Wisedopas
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Natcha Wanpiyarat
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nathawadee Lerttanatum
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Alric H, Barret M, Becar A, Perez Cuadrado Robles E, Belle A, Perrod G, Corre F, Chaussade S, Cellier C, Rahmi G. Endoscopic submucosal dissection versus endoscopic mucosal resection for laterally spreading rectal tumours. Colorectal Dis 2024. [PMID: 39694879 DOI: 10.1111/codi.17268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 10/29/2024] [Accepted: 11/08/2024] [Indexed: 12/20/2024]
Abstract
AIM Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are the two main techniques used for endoscopic resection of superficial rectal tumours. The aim of this study was to compare the outcomes of ESD and EMR in treating superficial rectal tumours. METHOD A retrospective observational study was conducted at two French centres including all patients treated with ESD or EMR for superficial rectal tumours. The primary outcome was the rate of local recurrence at the first follow-up endoscopy after endoscopic resection. Secondary outcomes included the curative resection rate, procedure duration, length of hospital stay, complication rates and the need for additional surgery. RESULTS A total of 254 patients were included, 159 treated with ESD and 95 treated with EMR. The local recurrence rate at the first follow-up endoscopy was 8.6% and was significantly lower in the ESD group than in the EMR group (4.3% vs. 16.9%; p = 0.005). The rates of en bloc and histologically complete resections were higher in the ESD group (88.1% vs. 42.7% and 85.5% vs. 38.9%, respectively; p < 0.001), while the curative resection rate was 90.6% in the EMR group and 92.5% in the ESD group (p = 0.59). Mostly due to poor histoprognostical criteria, 6.0% of patients underwent additional surgery (6.3% vs. 5.2% in the ESD vs. EMR group, respectively; p = 0.73). CONCLUSION ESD demonstrated higher rates of en bloc, R0 resection than EMR, translating into significantly lower rates of local recurrence at the first follow-up endoscopy.
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Affiliation(s)
- Hadrien Alric
- Service d'Hépato-gastroentérologie et Endoscopies Digestives, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Maximilien Barret
- Université Paris-Cité, Paris, France
- Service de Gastroentérologie, Endoscopie et Oncologie Digestive, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alix Becar
- Service d'Hépato-gastroentérologie et Endoscopies Digestives, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Enrique Perez Cuadrado Robles
- Service d'Hépato-gastroentérologie et Endoscopies Digestives, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Arthur Belle
- Service de Gastroentérologie, Endoscopie et Oncologie Digestive, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Guillaume Perrod
- Service d'Hépato-gastroentérologie et Endoscopies Digestives, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Félix Corre
- Université Paris-Cité, Paris, France
- Service de Gastroentérologie, Endoscopie et Oncologie Digestive, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stanislas Chaussade
- Université Paris-Cité, Paris, France
- Service de Gastroentérologie, Endoscopie et Oncologie Digestive, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christophe Cellier
- Service d'Hépato-gastroentérologie et Endoscopies Digestives, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
| | - Gabriel Rahmi
- Service d'Hépato-gastroentérologie et Endoscopies Digestives, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
- Université Paris-Cité, Paris, France
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Kim SH, Kim C, Keum B, Im J, Won S, Kim BG, Kim K, Kwon T, Hong D, Jeon HJ, Choi HS, Kim ES, Jeen YT, Chun HJ, Hwang JH. A Novel Retractable Robotic Device for Colorectal Endoscopic Submucosal Dissection. Gut Liver 2024; 18:677-685. [PMID: 38712393 PMCID: PMC11249931 DOI: 10.5009/gnl230280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/26/2023] [Accepted: 01/15/2024] [Indexed: 05/08/2024] Open
Abstract
Background/Aims : Appropriate tissue tension and clear visibility of the dissection area using traction are essential for effective and safe endoscopic submucosal dissection (ESD). In this study, we developed a retractable robot-assisted traction device and evaluated its performance in colorectal ESD. Methods : An experienced endoscopist performed ESD 18 times on an ex vivo porcine colon using the robot and 18 times using the conventional method. The outcome measures were procedure time, dissection speed, procedure-related adverse events, and blind dissection rate. Results : Thirty-six colonic lesions were resected from ex vivo porcine colon samples. The total procedure time was significantly shorter in robot-assisted ESD (RESD) than in conventional ESD (CESD) (20.1±4.1 minutes vs 34.3±8.3 minutes, p<0.05). The submucosal dissection speed was significantly faster in the RESD group than in the CESD group (36.8±9.2 mm2/min vs 18.1±4.7 mm2/min, p<0.05). The blind dissection rate was also significantly lower in the RESD group (12.8%±3.4% vs 35.1%±3.9%, p<0.05). In an in vivo porcine feasibility study, the robotic device was attached to a colonoscope and successfully inserted into the proximal colon without damaging the colonic wall, and ESD was successfully performed. Conclusions : The dissection speed and safety profile improved significantly with the retractable RESD. Thus, our robotic device has the potential to provide simple, effective, and safe multidirectional traction during colonic ESD.
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Affiliation(s)
- Sang Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chanwoo Kim
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Junghyun Im
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Seonghyeon Won
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Byung Gon Kim
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Kyungnam Kim
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Taebin Kwon
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Daehie Hong
- Department of Mechanical Engineering, Korea University, Seoul, Korea
| | - Han Jo Jeon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, CA, USA
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Khalaf MA, Ayoub F, Staggers KA, El-Haj JW, Jawaid S, Othman MO. Learning curve for endoscopic submucosal dissection (ESD) in the United States: Large, untutored, single-operator experience. Endosc Int Open 2024; 12:E905-E913. [PMID: 39055261 PMCID: PMC11272410 DOI: 10.1055/a-2337-3865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 05/29/2024] [Indexed: 07/27/2024] Open
Abstract
Background and study aims Endoscopic submucosal dissection (ESD) allows removal of tumors en-bloc. Western adoption of ESD has been hindered by its steep learning curve. Western data regarding ESD learning curve are limited. We analyzed the learning curve of a single endoscopist at a tertiary referral center in the United States. Patients and methods All consecutive ESDs performed by a single endoscopist at a tertiary referral center in the United States from 2015 through 2022 were identified. Descriptive statistics and CUSUM analysis were used to describe the learning curve for en-bloc, R0 resection, and resection speed. Results In our study, 503 patients with 515 lesions were included. Severe submucosal fibrosis was found in 17% of the lesions. The rates of en-bloc, R0, and curative resections were 81.9%, 71.1%, and 68.4%, respectively. CUSUM analysis showed that the learning curve plateaued at 268, 347, and 170 cases for en-bloc resection, R0 resection, and achieving a resection speed > 9 cm 2 /hr. Fibrosis significantly affected the R0 resection rate in the regression analysis (95% confidence interval 0.21-0.55). In colonic ESD curve analysis, the learning plateau was reached after 185 cases for both en-bloc and R0 resection. Conclusions Following ex-vivo training in an animal model, an untutored expert operator achieved competency in ESD between 250 and 350 procedures. Our data can inform development of future training programs in the West.
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Affiliation(s)
- Mai A Khalaf
- Gastroenterology, Baylor College of Medicine, Houston, United States
- Tropical Medicine and infectious diseases, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Fares Ayoub
- Gastroenterology, Baylor College of Medicine, Houston, United States
| | - Kristen A Staggers
- Department of Medicine, Baylor College of Medicine, Houston, United States
| | - Johanna W El-Haj
- College of Liberal Arts and Social Sciences, University of Houston, Houston, United States
| | - Salmaan Jawaid
- Gastroenterology, Baylor College of Medicine, Houston, United States
| | - Mohamed O. Othman
- Gastroenterology, Baylor College of Medicine, Houston, United States
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Tribonias G, Velegraki M, Tzouvala M, Fragaki M, Nikolaou P, Leontidis N, Arna D, Psistakis A, Mpellou G, Palatianou M, Psaroudakis I, Neokleous A, Paspatis G. Hybrid endoscopic approaches for complex colorectal polyps with a non-lifting sign: the Greek experience. Ann Gastroenterol 2024; 37:476-484. [PMID: 38974076 PMCID: PMC11226737 DOI: 10.20524/aog.2024.0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
Background Hybrid approaches combining endoscopic full-thickness resection (EFTR) with conventional techniques (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) have enabled the resection of difficult fibrotic colorectal adenomas exhibiting a "non-lifting" sign, and polyps in difficult positions. We present our cohort treated with either EMR+EFTR or ESD+EFTR as salvage hybrid endoscopic approaches for complex colorectal polyps not amenable to conventional techniques. Methods Retrospective analysis included technical success, histological confirmation of margin-free resection, assessment of adverse events and follow up with histological assessment. All patients underwent follow-up endoscopy at least 6 and 12 months post-resection. Results Fourteen patients underwent hybrid EFTR procedures (11 EMR+EFTR and 3 ESD+EFTR). Technical success was achieved in all cases where the full-thickness resection device (FTRD) was advanced to the site of the resection (100%). In 2 cases, the FTRD system could not be passed through the sigmoid colon because of severe chronic diverticulitis, subsequent fibrosis and stiffness. The mean lesion size in the EMR+EFTR group (41.7 mm; range 20-50 mm) was larger than the ESD+EFTR group (31.7 mm; range 30-35 mm). Six patients (42.9%) were histologically diagnosed with T1 carcinoma. The mean duration of hospitalization was 1.4 days. Follow-up endoscopy was available in all patients and no recurrence was observed with histological confirmation during a mean follow-up period of 15.4 months. Conclusion Hybrid procedures appear to be safe and effective treatments for complex colorectal lesions not amenable to EMR, ESD or EFTR alone, because of the lesion size, positive non-lifting sign, and difficult positions.
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Affiliation(s)
- Georgios Tribonias
- Gastroenterology Department, “Agios Panteleimon” General Hospital of Nikaia-Piraeus, Athens, Greece (Georgios Tribonias, Maria Tzouvala, Nikolaos Leontidis, Georgia Mpellou, Maria Palatianou, Antonios Neokleous)
| | - Magdalini Velegraki
- Gastroenterology Department, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Maria Fragaki, Pinelopi Nikolaou, Despoina Arna, Andreas Psistakis, Ioannis Psaroudakis, Gregorios Paspatis)
| | - Maria Tzouvala
- Gastroenterology Department, “Agios Panteleimon” General Hospital of Nikaia-Piraeus, Athens, Greece (Georgios Tribonias, Maria Tzouvala, Nikolaos Leontidis, Georgia Mpellou, Maria Palatianou, Antonios Neokleous)
| | - Maria Fragaki
- Gastroenterology Department, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Maria Fragaki, Pinelopi Nikolaou, Despoina Arna, Andreas Psistakis, Ioannis Psaroudakis, Gregorios Paspatis)
| | - Pinelopi Nikolaou
- Gastroenterology Department, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Maria Fragaki, Pinelopi Nikolaou, Despoina Arna, Andreas Psistakis, Ioannis Psaroudakis, Gregorios Paspatis)
| | - Nikolaos Leontidis
- Gastroenterology Department, “Agios Panteleimon” General Hospital of Nikaia-Piraeus, Athens, Greece (Georgios Tribonias, Maria Tzouvala, Nikolaos Leontidis, Georgia Mpellou, Maria Palatianou, Antonios Neokleous)
| | - Despoina Arna
- Gastroenterology Department, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Maria Fragaki, Pinelopi Nikolaou, Despoina Arna, Andreas Psistakis, Ioannis Psaroudakis, Gregorios Paspatis)
| | - Andreas Psistakis
- Gastroenterology Department, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Maria Fragaki, Pinelopi Nikolaou, Despoina Arna, Andreas Psistakis, Ioannis Psaroudakis, Gregorios Paspatis)
| | - Georgia Mpellou
- Gastroenterology Department, “Agios Panteleimon” General Hospital of Nikaia-Piraeus, Athens, Greece (Georgios Tribonias, Maria Tzouvala, Nikolaos Leontidis, Georgia Mpellou, Maria Palatianou, Antonios Neokleous)
| | - Maria Palatianou
- Gastroenterology Department, “Agios Panteleimon” General Hospital of Nikaia-Piraeus, Athens, Greece (Georgios Tribonias, Maria Tzouvala, Nikolaos Leontidis, Georgia Mpellou, Maria Palatianou, Antonios Neokleous)
| | - Ioannis Psaroudakis
- Gastroenterology Department, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Maria Fragaki, Pinelopi Nikolaou, Despoina Arna, Andreas Psistakis, Ioannis Psaroudakis, Gregorios Paspatis)
| | - Antonios Neokleous
- Gastroenterology Department, “Agios Panteleimon” General Hospital of Nikaia-Piraeus, Athens, Greece (Georgios Tribonias, Maria Tzouvala, Nikolaos Leontidis, Georgia Mpellou, Maria Palatianou, Antonios Neokleous)
| | - Gregorios Paspatis
- Gastroenterology Department, Venizeleion General Hospital, Heraklion, Crete, Greece (Magdalini Velegraki, Maria Fragaki, Pinelopi Nikolaou, Despoina Arna, Andreas Psistakis, Ioannis Psaroudakis, Gregorios Paspatis)
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Swiridoff N, Ziachehabi A, Wewalka F, Spaun G, Alibegovic V, Schöfl R. Retrospective Analysis of Rectal Endoscopic Submucosal Dissection at Ordensklinikum Linz and Kepler Universitätsklinikum Linz. J Clin Med 2024; 13:3530. [PMID: 38930059 PMCID: PMC11205019 DOI: 10.3390/jcm13123530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background and study aim: Endoscopic submucosal dissection is a minimally invasive endoscopic procedure for the removal of neoplastic benign and early malignant lesions in the gastrointestinal tract. In this study, we analyse the success and safety of rectal ESD at Linz hospitals, focusing on a specific endoscopist. Additionally, we examine whether there is a learning curve regarding success parameters. Methods: This retrospective study included all 102 patients who underwent endoscopic submucosal dissection of the rectum by a defined endoscopist at Ordensklinikum Hospital and Kepler University Hospital between December 2010 and May 2021. With the collected data, a descriptive statistic was carried out and regression analyses were performed. Results: The en bloc resection rate was 78.4% and the rate of lesions removed in healthy tissue was 55.6%. The average procedure time was 179 min and the complication rate was 7.8%. In total, 26.4% of cases showed carcinoma; in 25.9% of these cases, an oncologically curative resection was achieved with ESD. Follow-up data were available for 61.1% of cases, with recurrence being diagnosed in 3.6% of cases. A learning curve was observed regarding the rate of lesions removed in healthy tissue and the procedure time, but not regarding the en bloc resection rate. Conclusions: Endoscopic submucosal dissection is a safe method for the removal of large rectal adenomas and early carcinomas. The en bloc resection rate of the analysed procedures is within the range of comparable European studies. The rate of lesions removed in healthy tissue is below the R0 resection rate of the comparative literature; however, a learning curve could be observed in this parameter.
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Affiliation(s)
- Nikolaj Swiridoff
- Interne IV (Gastroenterology), Ordensklinikum Linz Barmherzige Schwestern, 4010 Linz, Austria (R.S.)
| | - Alexander Ziachehabi
- Clinic for Internal Medicine 2—Gastroenterology and Hepatology, Endocrinology and Metabolism, Nephrology, Rheumatology, Kepler University Hospital, 4020 Linz, Austria
| | - Friedrich Wewalka
- Interne IV (Gastroenterology), Ordensklinikum Linz Barmherzige Schwestern, 4010 Linz, Austria (R.S.)
| | - Georg Spaun
- General and Visceral Surgery, Ordensklinikum Linz Barmherzige Schwestern, 4010 Linz, Austria
| | - Vedat Alibegovic
- Pathology, Ordensklinikum Linz Barmherzige Schwestern, 4010 Linz, Austria
| | - Rainer Schöfl
- Interne IV (Gastroenterology), Ordensklinikum Linz Barmherzige Schwestern, 4010 Linz, Austria (R.S.)
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Taghiakbari M, Kim DHD, Djinbachian R, von Renteln D. Endoscopic resection of large non-pedunculated colorectal polyps: current standards of treatment. EGASTROENTEROLOGY 2024; 2:e100025. [DOI: 10.1136/egastro-2023-100025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
Colorectal cancer is a significant public health concern, and large non-pedunculated colorectal polyps pose a substantial risk for malignancy and incomplete resection, which may lead to interval cancer. The choice of resection technique is influenced by various factors, including polyp size, morphology, location, submucosal invasion depth and endoscopist expertise. For non-cancerous superficial large non-pedunculated polyps, conventional hot or cold snare polypectomy, endoscopic mucosal resection and endoscopic submucosal dissection are common techniques for non-surgical therapeutic endoscopic resection of these polyps. This manuscript provides a comprehensive review of literature on current endoscopic resection techniques for large non-pedunculated colorectal polyps, emphasising indications, advantages, limitations and outcomes.
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10
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Yu Z, Jiang D, Huang W, Luo R, Wang H, Su J, Liu J, Xu C, Hou Y. Comparison of two pathological processing methods for large endoscopic submucosal dissection (ESD) specimens. J Clin Pathol 2023; 76:757-762. [PMID: 37852629 DOI: 10.1136/jcp-2022-208491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/03/2022]
Abstract
AIMS Accurate histopathological evaluation of the endoscopic submucosal dissection (ESD) specimens is essential for clinicians to guide further triage and management. This study aimed to report a novel processing technique for large ESD (≥4 cm) specimens. METHODS 92 patients with colorectal neoplasms who had undergone ESD were included. 46 ESD specimens were treated with conventional handling process, while the rest 46 cases were given the optimised method. Macrobiocassettes and L-shaped embedding moulds were applied in the optimised method. We evaluated the efficacy of this improved procedure in terms of the number of paraffin blocks, storage space and time consumption of pathological assessment. RESULTS The average diameter of ESD specimens was 4.5±0.4 cm and 4.7±0.5 cm in the control and test group (p=0.023), respectively. In control group, 398 paraffin blocks of 46 cases were obtained. With the same cases number and larger lesion size, only 276 blocks were achieved in test group (p<0.001). As for the storage space, the total volume of paraffin blocks and slides (4554.0 cm3 and 1207.5 cm3) of optimised method was significantly reduced compared with the control group (6208.8 cm3 and 1741.3 cm3) (p=0.001, p<0.001). In addition, the optimised method was superior to the conventional one in shortening time consumption of pathological assessment (164.5 min and 269.0 min, p<0.001). CONCLUSIONS The optimised technique not only reduced the workload and storage space, but also facilitated accurate pathological assessment.
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Affiliation(s)
- Zixiang Yu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Dongxian Jiang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Wen Huang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Haixing Wang
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jieakesu Su
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jia Liu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
- Department of Pathology, School of Basic Medical Sciences & Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Pathology, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, Fujian, China
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Steinbrück I, Faiss S, Dumoulin FL, Oyama T, Pohl J, von Hahn T, Schmidt A, Allgaier HP. Predictive Factors for the Outcome of Unsupervised Endoscopic Submucosal Dissection During the Initial Learning Curve with Prevalence-Based Indication. Dig Dis Sci 2023; 68:3614-3624. [PMID: 37421512 DOI: 10.1007/s10620-023-08026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND For an adequate educational strategy of ESD in non-Asian settings with prevalence-based indication it is essential to define adequate lesions, suitable for the beginner without on-site expert-supervision. AIMS We analyzed possible predictors for outcome parameters of effectiveness and safety during the initial learning curve. METHODS The first 120 ESDs of four operators (n = 480), performed between 2007 and 2020 in four tertiary hospitals, were enrolled. Uni-/multivariable regression analysis was done with sex, age, pretreated lesion, lesion size, organ, and organ-based localization as possible independent predictors for en bloc resection (EBR), complication, and resection speed. RESULTS Rates of EBR, complication, and resection speed were 84.5%, 14.2%, and 6.20 (± 4.45) cm2/h. Independent predictors for EBR were pretreated lesion (OR 0.27 [0.13-0.57], p < 0.001) and non-colonic ESD (OR 2.29 [1.26-4.17] (rectum)/5.72 [2.36-13.89] (stomach)/7.80 [2.60-23.42] (esophagus), p < 0.001), for complication pretreated lesion (OR 3.04 [1.46-6.34], p < 0.001) and lesion size (OR 1.02 [1.004-1.04], p = 0.012) and for resection speed pretreated lesion (RC - 3.10 [- 4.39 to - 1.81], p < 0.001), lesion size (RC 0.13 [0.11-0.16], p < 0.001) and male patient (RC - 1.11 [- 1.85 to - 0.37], p < 0.001). We found no significant difference in the incidence of technically unsuccessful resections in esophageal (1/84), gastric (3/113), rectal (7/181), and colonic (3/101) ESDs (p = 0.76). Technical failure was mainly caused by complication and fibrosis/pretreatment. CONCLUSION During the initial learning curve of an unsupervised ESD program with prevalence-based indication, pretreated lesions and colonic ESDs should be avoided. In contrast, lesion size and organ-based localizations have less predictive value for the outcome.
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Affiliation(s)
- Ingo Steinbrück
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital of University of Freiburg, Wirthstraße 11, 79110, Freiburg, Germany.
| | - Siegbert Faiss
- Department of Gastroenterology, Sana Klinikum Lichtenberg, Academic Teaching Hospital of University of Berlin, Fanningerstraße 32, 10365, Berlin, Germany
| | - Franz Ludwig Dumoulin
- Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Academic teaching Hospital of University of Bonn, Prinz-Albert-Straße 40, 53113, Bonn, Germany
| | - Tsuneo Oyama
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, 3400-28 Nakagomi, Saku, Nagano, 3850051, Japan
| | - Jürgen Pohl
- Department of Gastroenterology, Asklepios Klinik Altona, Academic Teaching Hospital of University of Hamburg, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany
| | - Thomas von Hahn
- Department of Gastroenterology, Hepatology and Endoscopy, Asklepios Klinik Barmbek, Academic Teaching Hospital of University of Hamburg, Rübenkamp 220, 22307, Hamburg, Germany
| | - Arthur Schmidt
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Hans-Peter Allgaier
- Department of Medicine and Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Academic Teaching Hospital of University of Freiburg, Wirthstraße 11, 79110, Freiburg, Germany
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12
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Meier B, Elsayed I, Seitz N, Wannhoff A, Caca K. Efficacy and safety of combined EMR and endoscopic full-thickness resection (hybrid EFTR) for large nonlifting colorectal adenomas. Gastrointest Endosc 2023; 98:405-411. [PMID: 36990126 DOI: 10.1016/j.gie.2023.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/05/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND AIMS Endoscopic full-thickness resection (EFTR) with a full-thickness resection device (FTRD) has become the standard technique for selected nonlifting colorectal adenomas, but tumor size is the major limitation. However, large lesions might be approached in combination with EMR. Herein, we report the largest single-center experience to date of combined EMR and EFTR (hybrid EFTR) in patients with large (≥25 mm) nonlifting colorectal adenomas not amenable to EMR or EFTR alone. METHODS This is a single-center retrospective analysis of consecutive patients who underwent hybrid EFTR of large (≥25 mm) nonlifting colorectal adenomas. Outcomes of technical success (successful advancement of the FTRD with consecutive successful clip deployment and snare resection), macroscopic complete resection, adverse events, and endoscopic follow-up were evaluated. RESULTS Seventy-five patients with nonlifting colorectal adenomas were included. Mean lesion size was 36.5 mm (range, 25-60 mm), and 66.6% were located in the right side of the colon. Technical success was 100% with macroscopic complete resection in 97.3%. Mean procedure time was 83.6 minutes. Adverse events occurred in 6.7%, leading to surgical therapy in 1.3%. Histology revealed T1 carcinoma in 16%. Endoscopic follow-up was available in 93.3% (mean follow-up time, 8.1 months; range, 3-36) and showed no signs of residual or recurrent adenoma in 88.6%. Recurrence (11.4%) was treated endoscopically. CONCLUSIONS Hybrid EFTR is safe and effective for advanced colorectal adenoma that cannot be approached by EMR or EFTR alone. Hybrid EFTR expands the indication of EFTR substantially in selected patients.
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Affiliation(s)
- Benjamin Meier
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Ismaeil Elsayed
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Nadine Seitz
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Andreas Wannhoff
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Karel Caca
- Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany
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Kawaguti FS, Kimura CMS, Moura RN, Safatle-Ribeiro AV, Nahas CSR, Marques CFS, de Rezende DT, Segatelli V, Cotti GCDC, Ribeiro Junior U, Maluf-Filho F, Nahas SC. Impact of a Routine Colorectal Endoscopic Submucosal Dissection in the Surgical Management of Nonmalignant Colorectal Lesions Treated in a Referral Cancer Center. Dis Colon Rectum 2023; 66:e834-e840. [PMID: 36574289 DOI: 10.1097/dcr.0000000000002554] [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: 02/08/2023]
Abstract
BACKGROUND Recent data show an increasing number of abdominal surgeries being performed for the treatment of nonmalignant colorectal polyps in the West but in settings in which colorectal endoscopic submucosal dissection is not routinely performed. This study evaluated the number of nonmalignant colorectal lesions referred to surgical treatment in a tertiary cancer center that incorporated magnification chromoendoscopy and endoscopic submucosal dissection as part of the standard management of complex colorectal polyps. OBJECTIVE The study aimed to estimate the number of patients with nonmalignant colorectal lesions referred to surgical resection at our institution after the standardization of routine endoscopic submucosal dissection and to describe outcomes for patients undergoing colorectal endoscopic submucosal dissection. DESIGN Single-center retrospective study from a prospectively collected database of endoscopic submucosal dissections and colorectal surgeries performed between January 2016 and December 2019. SETTING Reference cancer center. PATIENTS Consecutive adult patients with complex nonmalignant colorectal polyps were included. INTERVENTIONS Patients with nonmalignant colorectal polyps were treated by endoscopic submucosal dissection or surgery (elective colectomy, rectosigmoidectomy, low anterior resection, or proctocolectomy). MAIN OUTCOMES MEASURES The primary outcome measure was the percentage of patients referred to colorectal surgery for nonmalignant lesions. RESULTS In the study period, 1.1% of 825 colorectal surgeries were performed for nonmalignant lesions, and 97 complex polyps were endoscopically removed by endoscopic submucosal dissection. The en bloc, R0, and curative resection rates of endoscopic submucosal dissection were 91.7%, 83.5%, and 81.4%, respectively. The mean tumor size was 59 (SD 37.8) mm. Perforations during endoscopic submucosal dissection occurred in 3 cases, all treated with clipping. One patient presented with a delayed perforation 2 days after the endoscopic resection and underwent surgery. The mean follow-up period was 3 years, with no tumor recurrence in this cohort. LIMITATIONS Single-center retrospective study. CONCLUSIONS A workflow that includes assessment of the lesions with magnification chromoendoscopy and resection through endoscopic submucosal dissection can lead to a very low rate of abdominal surgery for nonmalignant colorectal lesions. See Video Abstract at http://links.lww.com/DCR/C123 . IMPACTO DE LA DISECCIN SUBMUCOSA ENDOSCPICA COLORRECTAL DE RUTINA EN EL MANEJO QUIRRGICO DE LESIONES COLORRECTALES NO MALIGNAS TRATADAS EN UN CENTRO ONCOLGICO DE REFERENCIA ANTECEDENTES:Datos recientes muestran un número cada vez mayor de cirugías abdominales realizadas para el tratamiento de pólipos colorrectales no malignos en Occidente, pero no en los entornos donde la disección submucosa endoscópica colorrectal se realiza de forma rutinaria. El estudio evaluó el número de lesiones colorrectales no malignas referidas a tratamiento quirúrgico en un centro oncológico terciario, que incorporó cromoendoscopia de aumento y disección submucosa endoscópica como parte del manejo estándar de pólipos colorrectales complejos.OBJETIVO:Estimar el número de pacientes con lesiones colorrectales no malignas referidos para resección quirúrgica en nuestra institución, después de la estandarización de la disección submucosa endoscópica de rutina y describir los resultados para los pacientes sometidos a disección submucosa endoscópica colorrectal.DISEÑO:Estudio retrospectivo de un solo centro, a partir de una base de datos recolectada prospectivamente de disecciones submucosas endoscópicas y cirugías colorrectales realizadas entre enero de 2016 y diciembre de 2019.AJUSTE:Centro oncológico de referencia.PACIENTES:Pacientes adultos consecutivos con pólipos colorrectales no malignos complejos.INTERVENCIONES:Pacientes con pólipos colorrectales no malignos tratados mediante disección submucosa endoscópica o cirugía (colectomía electiva, rectosigmoidectomía, resección anterior baja o proctocolectomía).PRINCIPALES MEDIDAS DE RESULTADO:La medida de resultado primario fue el porcentaje de pacientes remitidos a cirugía colorrectal por lesiones no malignas.RESULTADOS:En el período, 1,1% de 825 cirugías colorrectales fueron realizadas por lesiones no malignas y 97 pólipos complejos fueron extirpados por. disección submucosa endoscópica. Las tasas de resección en bloque, R0 y curativa de disección submucosa endoscópica fueron 91,7%, 83,5% y 81,4%, respectivamente. El tamaño tumoral medio fue de 59 (DE 37,8) mm. Se produjeron perforaciones durante la disección submucosa endoscópica en 3 casos, todos tratados con clipaje. Un paciente presentó una perforación diferida 2 días después de la resección endoscópica y fue intervenido quirúrgicamente. El seguimiento medio fue de 3 años, sin recurrencia tumoral en esta cohorte.LIMITACIONES:Estudio retrospectivo de un solo centro.CONCLUSIONES:Un flujo de trabajo que incluye la evaluación de las lesiones con cromoendoscopia de aumento y resección a través de disección submucosa endoscópica, puede conducir a una tasa muy baja de cirugía abdominal para lesiones colorrectales no malignas. Consulte Video Resumen en http://links.lww.com/DCR/C123 . (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Fábio S Kawaguti
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | - Cintia Mayumi Sakurai Kimura
- Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | - Renata Nobre Moura
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | | | - Caio Sergio Rizkallah Nahas
- Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | | | - Daniel Tavares de Rezende
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | - Vanderlei Segatelli
- Division of Pathology, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | | | - Ulysses Ribeiro Junior
- Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | - Fauze Maluf-Filho
- Division of Endoscopy, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | - Sergio Carlos Nahas
- Division of Gastrointestinal Surgery, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
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14
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Dang H, Dekkers N, Steyerberg EW, Baldaque-Silva F, Omae M, Haasnoot KJ, van Tilburg L, Nobbenhuis K, van der Kraan J, Langers AM, van Hooft JE, de Graaf W, Koch AD, Didden P, Moons LM, Hardwick JC, Boonstra JJ. Predicting procedure duration of colorectal endoscopic submucosal dissection at Western endoscopy centers. Endosc Int Open 2023; 11:E724-E732. [PMID: 37941732 PMCID: PMC10629487 DOI: 10.1055/a-2122-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 06/27/2023] [Indexed: 11/10/2023] Open
Abstract
Background and study aims Overcoming logistical obstacles for the implementation of colorectal endoscopic submucosal dissection (ESD) requires accurate prediction of procedure times. We aimed to evaluate existing and new prediction models for ESD duration. Patients and methods Records of all consecutive patients who underwent single, non-hybrid colorectal ESDs before 2020 at three Dutch centers were reviewed. The performance of an Eastern prediction model [GIE 2021;94(1):133-144] was assessed in the Dutch cohort. A prediction model for procedure duration was built using multivariable linear regression. The model's performance was validated using internal validation by bootstrap resampling, internal-external cross-validation and external validation in an independent Swedish ESD cohort. Results A total of 435 colorectal ESDs were analyzed (92% en bloc resections, mean duration 139 minutes, mean tumor size 39 mm). The performance of current unstandardized time scheduling practice was suboptimal (explained variance: R 2 =27%). We successfully validated the Eastern prediction model for colorectal ESD duration <60 minutes (c-statistic 0.70, 95% CI 0.62-0.77), but this model was limited due to dichotomization of the outcome and a relatively low frequency (14%) of ESDs completed <60 minutes in the Dutch centers. The model was more useful with a dichotomization cut-off of 120 minutes (c-statistic: 0.75; 88% and 17% of "easy" and "very difficult" ESDs completed <120 minutes, respectively). To predict ESD duration as continuous outcome, we developed and validated the six-variable cESD-TIME formula ( https://cesdtimeformula.shinyapps.io/calculator/ ; optimism-corrected R 2 =61%; R 2 =66% after recalibration of the slope). Conclusions We provided two useful tools for predicting colorectal ESD duration at Western centers. Further improvements and validations are encouraged with potential local adaptation to optimize time planning.
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Affiliation(s)
- Hao Dang
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Nik Dekkers
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Ewout W. Steyerberg
- Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Francisco Baldaque-Silva
- Endoscopy Unit, Center for Upper Digestive Diseases, Karolinska Hospital, Stockholm, Sweden
- Advanced Endoscopy Center Carlos Moreira da Silva, Pedro Hispano Hospital, Matosinhos, Portugal
| | - Masami Omae
- Endoscopy Unit, Center for Upper Digestive Diseases, Karolinska Hospital, Stockholm, Sweden
| | - Krijn J.C. Haasnoot
- Gastroenterology & Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Kate Nobbenhuis
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Jolein van der Kraan
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Jeanin E. van Hooft
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Wilmar de Graaf
- Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands
| | - Arjun D. Koch
- Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Netherlands
| | - Paul Didden
- Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Leon M.G. Moons
- Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - James C.H. Hardwick
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
| | - Jurjen J. Boonstra
- Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, Netherlands
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15
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Libânio D, Pimentel-Nunes P, Bastiaansen B, Bisschops R, Bourke MJ, Deprez PH, Esposito G, Lemmers A, Leclercq P, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, Fuccio L, Bhandari P, Dinis-Ribeiro M. Endoscopic submucosal dissection techniques and technology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Review. Endoscopy 2023; 55:361-389. [PMID: 36882090 DOI: 10.1055/a-2031-0874] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
ESGE suggests conventional endoscopic submucosal dissection (ESD; marking and mucosal incision followed by circumferential incision and stepwise submucosal dissection) for most esophageal and gastric lesions. ESGE suggests tunneling ESD for esophageal lesions involving more than two-thirds of the esophageal circumference. ESGE recommends the pocket-creation method for colorectal ESD, at least if traction devices are not used. The use of dedicated ESD knives with size adequate to the location/thickness of the gastrointestinal wall is recommended. It is suggested that isotonic saline or viscous solutions can be used for submucosal injection. ESGE recommends traction methods in esophageal and colorectal ESD and in selected gastric lesions. After gastric ESD, coagulation of visible vessels is recommended, and post-procedural high dose proton pump inhibitor (PPI) (or vonoprazan). ESGE recommends against routine closure of the ESD defect, except in duodenal ESD. ESGE recommends corticosteroids after resection of > 50 % of the esophageal circumference. The use of carbon dioxide when performing ESD is recommended. ESGE recommends against the performance of second-look endoscopy after ESD. ESGE recommends endoscopy/colonoscopy in the case of significant bleeding (hemodynamic instability, drop in hemoglobin > 2 g/dL, severe ongoing bleeding) to perform endoscopic hemostasis with thermal methods or clipping; hemostatic powders represent rescue therapies. ESGE recommends closure of immediate perforations with clips (through-the-scope or cap-mounted, depending on the size and shape of the perforation), as soon as possible but ideally after securing a good plane for further dissection.
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Affiliation(s)
- Diogo Libânio
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Pedro Pimentel-Nunes
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, FMUP, Porto, Portugal.,Gastroenterology, Unilabs, Portugal
| | - Barbara Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia.,Western Clinical School, University of Sydney, Sydney, Australia
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianluca Esposito
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Leclercq
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy. Endoscopy Unit, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Helmut Messmann
- Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, Krankenhaus Barmherzige Brueder Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.,University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, Gastroenterology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Portuguese Oncology Institute - Porto, Portugal.,MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
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16
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Learning curve of endoscopic submucosal dissection (ESD) with prevalence-based indication in unsupervised Western settings: a retrospective multicenter analysis. Surg Endosc 2022; 37:2574-2586. [PMID: 36344898 DOI: 10.1007/s00464-022-09742-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS As there is still no consensus about the adequate training strategy for ESD in Western countries, we evaluated unsupervised prevalence-based learning curves including detailed organ-specific subgroup analysis. METHODS The first 120 ESDs of four operators (n = 480) were divided into three groups (1: ESD 1-40, 2: ESD 41-80, 3: ESD 81-120). Outcome parameters were rates of technical success, en bloc and R0 resection, the resection speed, rates of conversion to EMR, curative resection, adverse events, surgery due to adverse events, and recurrence. In addition, we analyzed the achievement of quality benchmarks indicating levels of expertise. RESULTS After exclusion of pretreated lesions, 438 procedures were enrolled in the final analysis. Technical success rates were > 96% with significant improvements regarding rate of en bloc resection (from 82.6 to 91.2%), resection speed (from 4.54 to 7.63 cm2/h), and rate of conversion to EMR (from 22.0 to 8.1%). No significant differences could be observed for rates of R0 resection (65.9 vs. 69.6%), curative resection (55.8 vs. 55.7%), adverse events (16.3 vs. 11.7%), surgery due to adverse events (1.5 vs. 1.3%), and recurrence (12.5 vs. 4.5%). Subgroup and benchmark analysis revealed an improvement in esophageal, gastric, and rectal ESD with achievement of competence levels for the esophagus and stomach within 80 and most of the benchmarks for proficiency level within 120 procedures. Some of the benchmarks could also be achieved in rectal ESD. CONCLUSIONS This trial confirms safety and feasibility of unsupervised ESD along the initial learning curve with prevalence-based indication and exclusion of colonic cases.
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17
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Perivoliotis K, Baloyiannis I, Mamaloudis I, Volakakis G, Valaroutsos A, Tzovaras G. Change point analysis validation of the learning curve in laparoscopic colorectal surgery: Experience from a non-structured training setting. World J Gastrointest Endosc 2022; 14:387-401. [PMID: 35978712 PMCID: PMC9265254 DOI: 10.4253/wjge.v14.i6.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/23/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The introduction of minimal invasive principles in colorectal surgery was a major breakthrough, resulting in multiple clinical benefits, at the cost, though, of a notably steep learning process. The development of structured nation-wide training programs led to the easier completion of the learning curve; however, these programs are not yet universally available, thus prohibiting the wider adoption of laparoscopic colorectal surgery.
AIM To display our experience in the learning curve status of laparoscopic colorectal surgery under a non-structured training setting.
METHODS We analyzed all laparoscopic colorectal procedures performed in the 2012-2019 period under a non-structured training setting. Cumulative sum analysis and change-point analysis (CPA) were introduced.
RESULTS Overall, 214 patients were included. In terms of operative time, CPA identified the 110th case as the first turning point. A plateau was reached after the 145th case. Subgroup analysis estimated the 58th for colon and 52nd case for rectum operations as the respective turning points. A learning curve pattern was confirmed for pathology outcomes, but not in the conversion to open surgery and morbidity endpoints.
CONCLUSION The learning curves in our setting validate the comparability of the results, despite the absence of National or Surgical Society driven training programs.
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Affiliation(s)
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Ioannis Mamaloudis
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Georgios Volakakis
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - Alex Valaroutsos
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
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18
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Pimentel-Nunes P, Libânio D, Bastiaansen BAJ, Bhandari P, Bisschops R, Bourke MJ, Esposito G, Lemmers A, Maselli R, Messmann H, Pech O, Pioche M, Vieth M, Weusten BLAM, van Hooft JE, Deprez PH, Dinis-Ribeiro M. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2022; 54:591-622. [PMID: 35523224 DOI: 10.1055/a-1811-7025] [Citation(s) in RCA: 313] [Impact Index Per Article: 104.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
ESGE recommends that the evaluation of superficial gastrointestinal (GI) lesions should be made by an experienced endoscopist, using high definition white-light and chromoendoscopy (virtual or dye-based).ESGE does not recommend routine performance of endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)-CT prior to endoscopic resection.ESGE recommends endoscopic submucosal dissection (ESD) as the treatment of choice for most superficial esophageal squamous cell and superficial gastric lesions.For Barrett's esophagus (BE)-associated lesions, ESGE suggests the use of ESD for lesions suspicious of submucosal invasion (Paris type 0-Is, 0-IIc), for malignant lesions > 20 mm, and for lesions in scarred/fibrotic areas.ESGE does not recommend routine use of ESD for duodenal or small-bowel lesions.ESGE suggests that ESD should be considered for en bloc resection of colorectal (but particularly rectal) lesions with suspicion of limited submucosal invasion (demarcated depressed area with irregular surface pattern or a large protruding or bulky component, particularly if the lesions are larger than 20 mm) or for lesions that otherwise cannot be completely removed by snare-based techniques.ESGE recommends that an en bloc R0 resection of a superficial GI lesion with histology no more advanced than intramucosal cancer (no more than m2 in esophageal squamous cell carcinoma), well to moderately differentiated, with no lymphovascular invasion or ulceration, should be considered a very low risk (curative) resection, and no further staging procedure or treatment is generally recommended.ESGE recommends that the following should be considered to be a low risk (curative) resection and no further treatment is generally recommended: an en bloc R0 resection of a superficial GI lesion with superficial submucosal invasion (sm1), that is well to moderately differentiated, with no lymphovascular invasion, of size ≤ 20 mm for an esophageal squamous cell carcinoma or ≤ 30 mm for a stomach lesion or of any size for a BE-related or colorectal lesion, and with no lymphovascular invasion, and no budding grade 2 or 3 for colorectal lesions.ESGE recommends that, after an endoscopically complete resection, if there is a positive horizontal margin or if resection is piecemeal, but there is no submucosal invasion and no other high risk criteria are met, this should be considered a local-risk resection and endoscopic surveillance or re-treatment is recommended rather than surgery or other additional treatment.ESGE recommends that when there is a diagnosis of lymphovascular invasion, or deeper infiltration than sm1, or positive vertical margins, or undifferentiated tumor, or, for colorectal lesions, budding grade 2 or 3, this should be considered a high risk (noncurative) resection, and complete staging and strong consideration for additional treatments should be considered on an individual basis in a multidisciplinary discussion.ESGE recommends scheduled endoscopic surveillance with high definition white-light and chromoendoscopy (virtual or dye-based) with biopsies of only the suspicious areas after a curative ESD.
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Affiliation(s)
- Pedro Pimentel-Nunes
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Department of Surgery and Physiology, Porto Faculty of Medicine, Portugal
| | - Diogo Libânio
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Barbara A J Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology & Metabolism, Amsterdam University Medical Center, The Netherlands
| | - Pradeep Bhandari
- Department of Gastroenterology, Queen Alexandra Hospital, Portsmouth, UK
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, TARGID, Leuven, Belgium
| | - Michael J Bourke
- Department of Gastroenterology, Westmead Hospital, Sydney, Australia and Western Clinical School, University of Sydney, Sydney, Australia
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sant' Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaud Lemmers
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Helmut Messmann
- Department of Gastroenterology, Universitätsklinikum Augsburg, Augsburg, Bayern, Germany
| | - Oliver Pech
- Department of Gastroenterology and Interventional Endoscopy, St. John of God Hospital, Regensburg, Germany
| | - Mathieu Pioche
- Endoscopy and Gastroenterology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Michael Vieth
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Bas L A M Weusten
- Department of Gastroenterology and Hepatology, St. Antonius Hospital Nieuwegein and University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pierre H Deprez
- Department of Hepatogastroenterology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mario Dinis-Ribeiro
- Department of Gastroenterology, Porto Comprehensive Cancer Center, and RISE@CI-IPOP (Health Research Network), Porto, Portugal
- MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
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19
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Winter K, Włodarczyk M, Włodarczyk J, Dąbrowski I, Małecka-Wojciesko E, Dziki A, Spychalski M. Risk Stratification of Endoscopic Submucosal Dissection in Colon Tumors. J Clin Med 2022; 11:jcm11061560. [PMID: 35329886 PMCID: PMC8949025 DOI: 10.3390/jcm11061560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/27/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Endoscopic submucosal dissection (ESD) is a technique proven effective in the treatment of early neoplastic lesions in the gastrointestinal tract. However, in the case of colon lesions, many doubts remain. The purpose of our study is to stratify the success rates of the ESD procedure in the colon. Materials and Methods: A retrospective analysis of 601 patients who underwent ESD procedure for colorectal neoplasm from 2016 to 2019 in Center of Bowel Treatment, Brzeziny, Poland. Excluding 335 rectal neoplasms, we selected 266 patients with lesions located in the colon. Results: Lesions located in the left colon were characterized by the statistically higher en bloc resection and success rate, compared with the right colon—87.76% vs. 73.95% (p = 0.004) and 83.67% vs. 69.75% (p = 0.007), respectively. The success rate was significantly lower in lesions with submucosal cancer, compared to low- and high-grade dysplasia (p < 0.001). Polyps located in the right colon were characterized by a slightly higher complication rate compared to the left colon, without statistical significance—13.45% vs. 9.52% (p = 0.315). Conclusions: Our results show that colonic ESD has a high success rate, especially in the left colon, with a low risk of complications, slightly higher than in the right colon.
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Affiliation(s)
- Katarzyna Winter
- Center of Bowel Treatment, 95-060 Brzeziny, Poland; (I.D.); (M.S.)
- Clinical Department of General and Oncological Gastroenterology, University Clinical Hospital No. 1, Medical University of Lodz, 90-153 Lodz, Poland
- Correspondence: ; Tel.: +48-426-776-664; Fax: +48-678-6480
| | - Marcin Włodarczyk
- Department of General and Oncological Surgery, Medical University of Lodz, 90-153 Lodz, Poland; (M.W.); (J.W.)
| | - Jakub Włodarczyk
- Department of General and Oncological Surgery, Medical University of Lodz, 90-153 Lodz, Poland; (M.W.); (J.W.)
| | - Igor Dąbrowski
- Center of Bowel Treatment, 95-060 Brzeziny, Poland; (I.D.); (M.S.)
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-153 Lodz, Poland;
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Haller Square 1, 90-419 Lodz, Poland;
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20
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Performance of perioperative antibiotics against post-endoscopic submucosal dissection coagulation syndrome: a multicenter randomized controlled trial. Gastrointest Endosc 2022; 95:349-359. [PMID: 34499904 DOI: 10.1016/j.gie.2021.08.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS This study aimed to evaluate the efficacy of perioperative antibiotics against post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) in patients undergoing colorectal ESD. METHODS A prospective, multicenter, randomized controlled, parallel, superiority trial was conducted at 21 Japanese tertiary institutions. Patients with superficial colorectal lesions ≥20 mm and those undergoing ESD management for a single lesion were eligible. Patients with perforation during and after ESD were withdrawn. Before the ESD procedure, participants were randomly assigned (1:1) to either undergo conventional treatment (nonantibiotic group) or investigational treatment (antibiotic group). In the antibiotic group, 3 g of ampicillin-sulbactam was administered just before, 8 hours after, and the morning after ESD. The primary endpoint was the incidence of PECS. The onset of PECS was defined as localized abdominal pain (both spontaneous pain and tenderness) and fever (≥37.6°C) or inflammatory response (leukocytosis [≥10,000 cells/μL] or elevated C-reactive protein level [≥.5 mg/dL]). RESULTS From February 5, 2019 to September 7, 2020, 432 patients were enrolled and assigned to the antibiotic group (n = 216) or nonantibiotic group (n = 216). After withdrawal of 52 patients, 192 in the antibiotic group and 188 in the nonantibiotic group were analyzed. PECS occurred in 9 of 192 patients (4.7%) in the antibiotic group and 14 of 188 patients (7.5%) in the nonantibiotic group, with an odds ratio of .61 (95% confidence interval, .23-1.56; P = .29). CONCLUSIONS Perioperative use of antibiotics was not effective in reducing the incidence of PECS in patients undergoing colorectal ESD. (Clinical trial registration number: UMIN000035178.).
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21
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Mann R, Gajendran M, Umapathy C, Perisetti A, Goyal H, Saligram S, Echavarria J. Endoscopic Management of Complex Colorectal Polyps: Current Insights and Future Trends. Front Med (Lausanne) 2022; 8:728704. [PMID: 35127735 PMCID: PMC8811151 DOI: 10.3389/fmed.2021.728704] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/27/2021] [Indexed: 12/16/2022] Open
Abstract
Most colorectal cancers arise from adenomatous polyps and sessile serrated lesions. Screening colonoscopy and therapeutic polypectomy can potentially reduce colorectal cancer burden by early detection and removal of these polyps, thus decreasing colorectal cancer incidence and mortality. Most endoscopists are skilled in detecting and removing the vast majority of polyps endoscopically during a routine colonoscopy. Polyps can be considered “complex” based on size, location, morphology, underlying scar tissue, which are not amenable to removal by conventional endoscopic polypectomy techniques. They are technically more challenging to resect and carry an increased risk of complications. Most of these polyps were used to be managed by surgical intervention in the past. Rapid advancement in endoscopic resection techniques has led to a decreasing role of surgery in managing these complex polyps. These endoscopic resection techniques do require an expert in the field and advanced equipment to perform the procedure. In this review, we discuss various advanced endoscopic techniques for the management of complex polyps.
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Affiliation(s)
- Rupinder Mann
- Department of Internal Medicine, Saint Agnes Medical Center, Fresno, CA, United States
- *Correspondence: Rupinder Mann
| | - Mahesh Gajendran
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Chandraprakash Umapathy
- Division of Gastroenterology, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
| | - Abhilash Perisetti
- Department of Gastroenterology and Hepatology, The University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Health, Fort Wayne, IN, United States
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, Scranton, PA, United States
| | - Shreyas Saligram
- Division of Gastroenterology, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
| | - Juan Echavarria
- Division of Gastroenterology, Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX, United States
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22
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Mavrogenis G, Ntourakis D, Wang Z, Tsevgas I, Zachariadis D, Kokolas N, Kaklamanis L, Bazerbachi F. The learning experience for endoscopic submucosal dissection in a non-academic western hospital: a single operator's untutored, prevalence-based approach. Ann Gastroenterol 2021; 34:836-844. [PMID: 34815650 PMCID: PMC8596216 DOI: 10.20524/aog.2021.0649] [Citation(s) in RCA: 1] [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: 01/23/2021] [Accepted: 03/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background Studies of learning experience in endoscopic submucosal dissection (ESD) commonly originate from the East. Little is known about the performance of ESD in low-volume western centers. Furthermore, it is unclear whether ESD can be self-taught without a tutored approach. Methods We performed a retrospective analysis of consecutive ESDs, performed in an untutored prevalence-based fashion by a single operator at a private Greek hospital from 2016-2020. Out of 60 lesions, standard ESD was applied for 54 and enucleation for 6; 41 were mucosal and 19 submucosal; 3 esophageal, 24 gastric, one duodenal, 12 colonic, and 20 rectal. Results Pathology revealed carcinoma (n=14), neuroendocrine tumor (n=7), precancerous lesion (n=27), or other submucosal tumors (n=12). The rates of en bloc and R0 resection were 98% and 91%, respectively. The median resection speed was <3 cm2/h for the first 20 cases, but improved progressively to ≥9 cm2/h after 40 cases. Two patients underwent laparoscopic surgery for colonic perforation, and one received a blood transfusion because of delayed bleeding (serious adverse event rate: 5%). No deaths occurred. The median hospital stay was 1.3 days. Variables associated with improvement in ESD speed during the second period of the study were the application of countertraction and the experience acquired through other endosurgical techniques. Conclusions ESD was safe and effective in a low-volume center, with an acceptable adverse events rate. At least 40 mixed cases were needed to achieve a high resection speed. Additive experience gained through other endosurgical procedures probably contributed to the improvement in performance.
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Affiliation(s)
- Georgios Mavrogenis
- Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Ioannis Tsevgas, Dimitrios Zachariadis)
| | - Dimitrios Ntourakis
- Department of Surgery, School of Medicine, European University of Cyprus, Nicosia, Cyprus (Dimitrios Ntourakis)
| | - Zhen Wang
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA (Zhen Wang)
| | - Ioannis Tsevgas
- Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Ioannis Tsevgas, Dimitrios Zachariadis)
| | - Dimitrios Zachariadis
- Division of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece (Georgios Mavrogenis, Ioannis Tsevgas, Dimitrios Zachariadis)
| | - Nikolaos Kokolas
- Department of Anesthesiology, Mediterraneo Hospital, Athens, Greece (Nikolaos Kokolas)
| | - Loukas Kaklamanis
- Department of Pathology, Onassis Cardiac Surgery Center, Athens, Greece (Loukas Kaklamanis)
| | - Fateh Bazerbachi
- CentraCare, St Cloud Hospital, Interventional Endoscopy Program, St Cloud, MN, USA (Fateh Bazerbachi)
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Chua JS, Dang H, Zwager LW, Dekkers N, Hardwick JCH, Langers AMJ, van der Kraan J, Perk LE, Bastiaansen BAJ, Boonstra JJ. Hybrid endoscopic mucosal resection and full-thickness resection for large colonic polyps harboring a small focus of invasive cancer: a case series. Endosc Int Open 2021; 9:E1686-E1691. [PMID: 34790531 PMCID: PMC8589547 DOI: 10.1055/a-1529-1447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/08/2021] [Indexed: 11/23/2022] Open
Abstract
Endoscopic treatment of large laterally spreading tumors (LSTs) with a focus of submucosally invasive colorectal cancer (T1 CRC) can be challenging. We evaluated outcomes of a hybrid resection technique using piecemeal endoscopic mucosal resection (pEMR) and endoscopic full-thickness resection (eFTR) in patients with large colonic LSTs containing suspected T1 CRC. Six hybrid pEMR-eFTR procedures for T1 CRCs were registered in a nationwide eFTR registry between July 2015 and December 2019. In all cases, the invasive part of the lesion was successfully isolated with eFTR; with eFTR, histologically complete resection of the invasive part was achieved in 5 /6 patients (83.3 %). No adverse events occurred during or after the procedure. The median follow-up time was 10 months (range 6-27), with all patients having undergone ≥ 1 surveillance colonoscopy. One patient had a small adenomatous recurrence, which was removed endoscopically. In conclusion, hybrid pEMR-eFTR is a promising noninvasive treatment modality that seems feasible for a selected group of patients with large LSTs containing a small focus of T1 CRC.
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Affiliation(s)
- Jamie S. Chua
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hao Dang
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Liselotte W. Zwager
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Nik Dekkers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - James C. H. Hardwick
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra M. J. Langers
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jolein van der Kraan
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Lars E. Perk
- Department of Gastroenterology and Hepatology, Haaglanden Medical Center, the Hague, the Netherlands
| | - Barbara A. J. Bastiaansen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Jurjen J. Boonstra
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Arthursson V, Rosén R, Norlin JM, Gralén K, Toth E, Syk I, Thorlacius H, Rönnow CF. Cost comparisons of endoscopic and surgical resection of stage T1 rectal cancer. Endosc Int Open 2021; 9:E1512-E1519. [PMID: 34540543 PMCID: PMC8445687 DOI: 10.1055/a-1522-8762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/19/2021] [Indexed: 10/28/2022] Open
Abstract
Background and study aims Management of T1 rectal cancer is complex and includes several resection methods, making cost comparisons challenging. The aim of this study was to compare costs of endoscopic and surgical resection and to investigate hypothetical cost scenarios for the treatment of T1 rectal cancer. Patients and methods Retrospective population-based cost minimization study on prospectively collected data on T1 rectal cancer patients treated using endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), open, laparoscopic, or robotic resection, in Skåne County, Sweden (2011-2017). The hypothetical cost scenarios were based on the distribution of high-risk features of lymph node metastases in a national cohort (2009-2017). Results Eighty-five patients with T1 RC undergoing ESD (n = 16), TEM (n = 17), open (n = 35), laparoscopic (n = 9), and robotic (n = 8) resection were included. ESD had a total 1-year cost of 5165 € and was significantly ( P < 0.05) less expensive compared to TEM (14871€), open (21 453 €), laparoscopic (22 488 €) and robotic resection (26 562 €). Risk factors for lymph node metastases were seen in 68 % of 779 cases of T1 rectal cancers included in the national cohort. The hypothetical scenario of performing ESD on all T1 RC had the lowest total 1-year per patient cost compared to all other alternatives. Conclusions This is the first study analyzing total 1-year costs of endoscopic and surgical methods to resect T1 rectal cancer, which showed that the cost of ESD was significantly lower compared to TEM and surgical resection. In fact, based on hypothetical cost scenarios, ESD is still justifiable from a cost perspective even when all high-risk cases are followed by surgery in accordance to guidelines.
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Affiliation(s)
- Victoria Arthursson
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Roberto Rosén
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | | | - Ervin Toth
- Department of Clinical Sciences, Section of Gastroenterology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Ingvar Syk
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Henrik Thorlacius
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Carl-Fredrik Rönnow
- Department of Clinical Sciences, Malmö, Section of Surgery, Skåne University Hospital, Lund University, Malmö, Sweden
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25
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Spychalski M, Włodarczyk M, Winter K, Włodarczyk J, Dąbrowski I, Dziki A. Volume of surgical interventions for benign colorectal
tumors – an analysis of 3510 surgical and endoscopic
resections in the single colorectal center in Poland. POLISH JOURNAL OF SURGERY 2021; 93:11-19. [DOI: 10.5604/01.3001.0015.2617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction:
Colorectal cancer is the most frequent neoplasm of the whole gastrointestinal track. Due to screening colonoscopy program, colorectal lesions are often diagnosed at early stage. The vast majority of them are possible to remove endoscopically. However, a substantial percentage of benign lesion in Western centers are still operated.
The aim of this article was to determine the percentage of surgical resections due to benign adenomas in the reference center of endoscopic submucosal dissection (ESD) and colorectal surgery in Poland.
Materials and Methods:
Retrospective analysis of 3 510 patients operated from 2015 to 2019 in Center of Bowel Treatment in Brzeziny.
Results:
We have analyzed 3 510 endoscopic and surgical procedures performed in the colon: 601 ESDs; 1 002 endoscopic mucosal resections (EMRs); and 1,907 surgical resections. Out of 601 ESDs, 57 invaded the submucosa, of which 29 (4.8%) were non-therapeutic ESDs. In 5 patients, due to occurrence of post-ESD perforation, an additional surgical intervention was necessary. Out of the 1,002 EMRs, 22 cases (2.2%) were diagnosed with deeply infiltrating cancers, which required a surgery. The overall percentage of the need for surgery in the endoscopically treated patients (ESD + mucosectomy) was 3.5% (56/1 603). Among resection surgeries, 15 of them (0.8%) ended with the diagnosis of a benign lesion in the postoperative histopathological examination.
Conclusions:
Inclusion advanced endoscopic techniques such as ESD to routine clinical practice in colorectal centers gives clear benefits for the patients. Well defined and standardized process of qualifying for appropriate treatment allows to significantly reduce the percentage of abdominal approach surgery due to benign colorectal lesions.
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Affiliation(s)
| | - Marcin Włodarczyk
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland
| | | | - Jakub Włodarczyk
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland
| | | | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland
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Inoue T, Nakagawa K, Yamasaki Y, Shichijo S, Kanesaka T, Maekawa A, Higashino K, Uedo N, Ishihara R, Takeuchi Y. Underwater endoscopic mucosal resection versus endoscopic submucosal dissection for 20-30 mm colorectal polyps. J Gastroenterol Hepatol 2021; 36:2549-2557. [PMID: 33724540 DOI: 10.1111/jgh.15494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/03/2021] [Accepted: 03/12/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Endoscopic submucosal dissection (ESD) for large polyps provides a high en bloc resection rate, accurate pathological diagnosis, and low recurrence rate. However, ESD requires advanced techniques, and underwater endoscopic mucosal resection (UEMR) is an alternative. We investigated the efficacy and safety of UEMR for 20-30 mm colorectal lesions compared with ESD. METHODS We retrospectively evaluated systematically collected data of patients who underwent UEMR or ESD for 20-30 mm sessile colorectal lesions. Outcome measures were the incidence of local recurrence, procedure time, en bloc resection rate, and incidence of adverse events. We performed propensity score matching and inverse probability weighting adjustment to control for possible confounders. RESULTS We evaluated 125 patients undergoing UEMR and 306 patients undergoing ESD. Using propensity score matching, we analyzed 74 lesions in each group. UEMR had a shorter procedure time than ESD [6.7 min (95% confidence interval (CI), 5.3-8.1 min) vs 64.8 min (95% CI, 57.4-72.2 min), respectively]. Although the en bloc resection rate with UEMR was inferior to ESD [61% (95% CI, 49-72%) vs 99% (95% CI, 93-100%), respectively], there was no significant difference in the local recurrence rate between the procedures [0% (95% CI, 0-4.0%) in each group]. Inverse probability weighting adjustment revealed that neither ESD nor UEMR had a significant association with local recurrence. CONCLUSIONS Underwater endoscopic mucosal resection for 20-30 mm colorectal lesions was comparable with ESD regarding long-term outcomes, with a shorter procedure time, despite the lower en bloc resection rate.
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Affiliation(s)
- Takahiro Inoue
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasushi Yamasaki
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.,Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Akira Maekawa
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Higashino
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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Akahoshi K, Komori K, Akahoshi K, Tamura S, Osada S, Shiratsuchi Y, Kubokawa M. Advances in endoscopic therapy using grasping-type scissors forceps (with video). World J Gastrointest Surg 2021; 13:772-787. [PMID: 34512901 PMCID: PMC8394375 DOI: 10.4240/wjgs.v13.i8.772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/24/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is a globally accepted minimally invasive therapy for early-stage gastrointestinal tract tumors. Although numerous electrosurgical knives have been developed for ESD, technical difficulties and high complication rates (bleeding and perforation) have limited their use worldwide. The grasping-type scissors forceps [clutch cutter (CC)] is the first forceps-type resection device developed with reference to hemostatic forceps. The aim was to allow easy and safe ESD throughout the gastrointestinal tract, as a biopsy technique, using one device. The CC can grasp the target tissue accurately and pull it away from the underlying muscle layer prior to energizing the tissue, for safe and effective incision and hemostasis during ESD. Reported clinical studies showed that ESD using the CC (ESD-CC) is a safe (perforation rate: 0%-3.6%; delayed bleeding rate: 0%-4.2%), technically efficient (en-bloc resection rate: 88.9%-100%), and single-device method for dissecting early-stage gastrointestinal tract tumors. The ESD-CC technique is simple and easy to learn because it can be completed simply by repeating the grasp, pull, and coagulate and/or incise actions using an electrosurgical current. The reported self-completion rate by non-experts was significantly better with the CC than with conventional knives (61.7% vs 24.5%, respectively; P < 0.001). Furthermore, the CC is used for other endoscopic therapies, such as endoscopic polypectomy for large pedunculated polyps, endoscopic myotomy for Zenker’s diverticulum, endoscopic treatment of buried bumper syndrome, and endoscopic necrosectomy for wall-off pancreatic necrosis. The initial reports using CC for these therapies have shown favorable results. In this review, we describe the structural features of the CC, how to use the instrument, efficacies of ESD-CC, and other unique endoscopic therapies using the CC.
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Affiliation(s)
- Kazuya Akahoshi
- Endoscopy Center, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Keishi Komori
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Kazuaki Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Shinichi Tamura
- Endoscopy Center, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Shigeki Osada
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Yuki Shiratsuchi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Masaru Kubokawa
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
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28
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Spychalski M, Włodarczyk M, Winter K, Włodarczyk J, Dąbrowski I, Dziki A. Outcomes of 601 Colorectal Endoscopic Submucosal Dissections in a Single Western Center: Is Right Colon Location Still a Major Concern? Surg Laparosc Endosc Percutan Tech 2021; 31:578-583. [PMID: 33935259 DOI: 10.1097/sle.0000000000000940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD), as a minimally invasive procedure for removal of early gastrointestinal neoplasms, is a standard approach in Asian countries. Outcomes of ESD in Western European countries significantly differ, which makes it more difficult to apply this procedure to daily-basis clinical routine. The aim of this study is to analyze the safety and efficiency of colorectal ESD based on a large series of cases performed by a single operator after finishing the learning curve period in a western referral center. MATERIALS AND METHODS We retrospectively studied 601 patients who underwent ESD procedure for colorectal neoplasm from January 2016 to December 2019 in a tertiary colorectal ESD center in Poland. RESULTS The overall en bloc resection was achieved in 88.02%. Complete histologic resection rate (R0) was reported at a level of 86.36%. Lesions located in the right colon were characterized by statistically lower en bloc, R0 resection, and success rate (73.95%, 71.43%, 69.75%, respectively). In 9.82% (n=59) of cases, the ESD procedure-related complications have been observed. Post-ESD bleeding occurred in 23 patients (3.83%) and perforation in 32 patients (5.32%). Twenty-seven patients were treated endoscopically (4.49%) and 5 required surgery (0.83%). Analysis of complications showed that tumors located within the right colon were characterized by the highest perforation rate at 10.92%. Within the rectum there were minimal number of perforations (2.69%), whereas the bleeding rate was 4.48%. CONCLUSIONS Our results represent the largest material concerning ESD of colorectal lesions in the West and show that ESD is characterized by a high rate of successful resections with a low risk of complications. Thus, confirming that it is possible to obtain results similar to Asian centers and that colorectal ESD procedures can be implemented in clinical routine in western countries. Nevertheless, ESD in the right colon is still related with high rate of complications, so qualification for the ESD procedure should be very careful and discussed with the patient and should be performed by an experienced endoscopist after the learning curve.
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Affiliation(s)
| | | | - Katarzyna Winter
- Center of Bowel Treatment, Brzeziny
- Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
| | | | | | - Adam Dziki
- Departments of General and Colorectal Surgery
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29
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Jung Y, Baik GH, Ko WJ, Ko BM, Kim SH, Jang JS, Jang JY, Lee WS, Cho YK, Lim SG, Moon HS, Yoo IK, Cho JY. Diode Laser-Can It Replace the Electrical Current Used in Endoscopic Submucosal Dissection? Clin Endosc 2021; 54:555-562. [PMID: 33435658 PMCID: PMC8357600 DOI: 10.5946/ce.2020.229] [Citation(s) in RCA: 3] [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: 08/19/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background/Aims A new medical fiber-guided diode laser system (FDLS) is expected to offer high-precision cutting with simultaneous hemostasis. Thus, this study aimed to evaluate the feasibility of using the 1,940-nm FDLS to perform endoscopic submucosal dissection (ESD) in the gastrointestinal tract of an animal model.
Methods In this prospective animal pilot study, gastric and colorectal ESD using the FDLS was performed in ex vivo and in vivo porcine models. The completeness of en bloc resection, the procedure time, intraprocedural bleeding, histological injuries to the muscularis propria (MP) layer, and perforation were assessed.
Results The en bloc resection and perforation rates in the ex vivo study were 100% (10/10) and 10% (1/10), respectively; those in the in vivo study were 100% (4/4) and 0% for gastric ESD and 100% (4/4) and 25% (1/4) for rectal ESD, respectively. Deep MP layer injuries tended to occur more frequently in the rectal than in the gastric ESD cases, and no intraprocedural bleeding occurred in either group.
Conclusions The 1,940-nm FDLS was capable of yielding high en bloc resection rates without intraprocedural bleeding during gastric and colorectal ESD in animal models.
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Affiliation(s)
- Yunho Jung
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Weon Jin Ko
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Bong Min Ko
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Seong Hwan Kim
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Jin Seok Jang
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jae-Young Jang
- Department of Gastroenterology and Hepatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Wan-Sik Lee
- Department of Internal Medicine, Chonnam National University Hwasun Hospital, Gwangju, Korea
| | - Young Kwan Cho
- Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea
| | - Sun Gyo Lim
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Hee Seok Moon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - In Kyung Yoo
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Korea
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30
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Vanella G, Coluccio C, Antonelli G, Angeletti S, Micheli F, Barbato A, De Rossi G, Marchetti A, Mereu E, Pepe P, Corleto VD, D’Ambra G, Ruggeri M, Di Giulio E. Improving assessment and management of large non-pedunculated colorectal lesions in a Western center over 10 years: lessons learned and clinical impact. Endosc Int Open 2020; 8:E1252-E1263. [PMID: 33015326 PMCID: PMC7508662 DOI: 10.1055/a-1220-6261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/28/2020] [Indexed: 11/02/2022] Open
Abstract
Background and study aims Outcomes of endoscopic assessment and management of large colorectal (CR) non-pedunculated lesions (LNPLs) are still under evaluation, especially in Western settings. We analyzed the clinical impact of changes in LNPL management over the last decade in a European center. Patients and methods All consecutive LNPLs ≥ 20 mm endoscopically assessed (2008-2019) were retrospectively included. Lesion, patient, and resection characteristics were compared among clinically relevant subgroups. Multivariate logistic regression (for predictors of submucosal invasion [SMI] and recurrence), Kaplan-Meier curves and ROC curves (for temporal cut-offs in trends analyses) were used. Results A total of 395 LNPLs were included (30 mm [range 20-40]; SMI = 9.6 %; primary endoscopic resection [ER] = 88.4 %). Pseudo-depression and JNET classification independently predicted SMI beyond single morphologies/location. After complete ER, involvement of ileocecal valve/dentate line, piece-meal resection and high-grade dysplasia independently predicted recurrence. Rates of 5-year recurrence-free, surgery-free and cancer-free survival were 77.5 %, 98.6 % and 100 %, respectively, with 93.8 % recurrences endoscopically managed and no death attributable to ER or CR cancer (versus 3.4 % primary surgery mortality). ROC curves identified the period ≥ 2015 (following Endoscopic Submucosal Dissection [ESD] introduction and education on pre-resective lesion assessment) as associated with improved lesions' characterization, increased en-bloc resection of SMI lesions (87.5 % vs 37.5 %; p = 0.0455), reduced primary surgery (7.5 % vs 16.7 %; p = 0.0072), surgical referral of benign lesions (5.1 % vs 14.8 %; p = 0.0019), and recurrences. Conclusions ESD introduction and educational interventions allowed ER of more complex lesions, offset by increased complementary surgery for complications or intrinsic histological risk. Nevertheless, overall, they have reduced surgery demand and increased appropriateness and safety of LNPL management in our center.
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Affiliation(s)
- Giuseppe Vanella
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Chiara Coluccio
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Giulio Antonelli
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Stefano Angeletti
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Federica Micheli
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Antonio Barbato
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Gaia De Rossi
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Alessandro Marchetti
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Elena Mereu
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Paola Pepe
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Vito Domenico Corleto
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Giancarlo D’Ambra
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Maurizio Ruggeri
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Emilio Di Giulio
- Endoscopy Unit, Sant’Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
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31
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Miyakawa A, Kuwai T, Sakuma Y, Kubota M, Nakamura A, Itobayashi E, Shimura H, Suzuki Y, Shimura K. Learning curve for endoscopic submucosal dissection of early colorectal neoplasms with a monopolar scissor-type knife: use of the cumulative sum method. Scand J Gastroenterol 2020; 55:1234-1242. [PMID: 32853052 DOI: 10.1080/00365521.2020.1807597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Although scissor-type knives such as the Stag-Beetle (SB) Knife Jr are expected to result in a safe and easy colorectal endoscopic submucosal dissection (CR-ESD), information regarding the learning curve is lacking. Therefore, this study evaluated the learning curve with using SB Knife Jr. MATERIALS AND METHODS We retrospectively reviewed 507 CR-ESD procedures performed in 464 patients using SB Knife Jr. The primary endpoint was a learning curve to achieve a satisfactory complete resection rate. The secondary endpoints were learning curves to achieve a satisfactory en bloc resection rate, curative resection rate, and resection speed. RESULTS The complete, en bloc, and curative resection rates were 91.9%, 95.9%, and 84.0%, respectively. Moving average analysis showed that 39 cases were required for a complete resection rate of >80%, 41 for an en bloc resection rate of >90%, and 50 for a curative resection rate of >75%. We divided the procedure into three phases using the cumulative sum method: I, II, and III (cases 1-36, 37-119, and 120-507, respectively). Although we found no significant between-phase differences, the complete resection rate showed an increasing trend in Phase III (83.3 vs. 89.2 vs. 93.3%; p = .099). The en bloc resection rate (91.7 vs. 91.6 vs. 97.2%; p = .047) and resection speed (20.5 vs. 7.2 vs. 6.8 min/cm2; p < .001) were greater in Phase III. Despite the larger specimen size (27.3 vs. 38.2 vs. 40.4 mm; p < .001) and more severe fibrosis (p < .001) in Phase III, the procedure time was shorter (73.8 vs. 57.8 vs. 54.2 min; p = .041). The curative resection rate was not significantly different between phases. CONCLUSIONS SB Knife Jr enables safe and easy CR-ESD during the introductory period compared to the conventional tip-type knife and has an acceptable learning curve. Therefore, using this knife will encourage the widespread adoption of CR-ESD in Asian general hospitals and non-Asian countries.
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Affiliation(s)
- Akihiro Miyakawa
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Toshio Kuwai
- Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan
| | - Yukie Sakuma
- Clinical Research Center, Asahi General Hospital, Asahi, Japan
| | - Manabu Kubota
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Akira Nakamura
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Ei Itobayashi
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Haruhisa Shimura
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, Asahi, Japan
| | - Kenji Shimura
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
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32
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Rajendran A, Pannick S, Thomas-Gibson S, Oke S, Anele C, Sevdalis N, Haycock A. Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy. Colorectal Dis 2020; 22:1085-1100. [PMID: 31925890 DOI: 10.1111/codi.14960] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023]
Abstract
AIM The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD). METHOD A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded. RESULTS A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases. CONCLUSION There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.
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Affiliation(s)
- A Rajendran
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK.,Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - S Pannick
- Department of Surgery and Cancer, Imperial College, London, UK
| | - S Thomas-Gibson
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - S Oke
- Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - C Anele
- Department of Surgery and Cancer, Imperial College, London, UK
| | - N Sevdalis
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, UK
| | - A Haycock
- The Wolfson Unit for Endoscopy, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College, London, UK
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33
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Zorron Cheng Tao Pu L, Yamamura T, Nakamura M, Esaki M, Kaosombatwattana U, Rodriguez MR, Edwards S, Burt AD, Singh R, Hirooka Y, Fujishiro M. Learning curve for mastery of colorectal endoscopic submucosal dissection: Perspectives from a large Japanese cohort. JGH Open 2020; 4:611-616. [PMID: 32782946 PMCID: PMC7411630 DOI: 10.1002/jgh3.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Leonardo Zorron Cheng Tao Pu
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
- Department of Gastroenterology and HepatologyNagoya University Nagoya Japan
| | | | - Masanao Nakamura
- Department of Gastroenterology and HepatologyNagoya University Nagoya Japan
| | - Masaya Esaki
- Department of EndoscopyNagoya University Hospital Nagoya Japan
| | | | - Miguel R Rodriguez
- Department of Gastroenterology and HepatologyNagoya University Nagoya Japan
| | - Suzanne Edwards
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
| | - Alastair D Burt
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
| | - Rajvinder Singh
- Faculty of Health and Medical SciencesThe University of Adelaide Adelaide South Australia Australia
- Department of GastroenterologyLyell McEwin Hospital Adelaide South Australia Australia
| | - Yoshiki Hirooka
- Department of Liver, Biliary Tract and Pancreas DiseasesFujita Health University Toyoake Japan
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34
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Taşkın OÇ, Aslan F, Kulaç İ, Yılmaz S, Adsay V, Kapran Y. Pathologic Evaluation of Large Colorectal Endoscopic Submucosal Dissections: An Analysis of 279 Cases With Emphasis on the Importance of Multidisciplinary Work and Establishing Examination Protocols. Int J Surg Pathol 2020; 28:600-608. [PMID: 32349582 DOI: 10.1177/1066896920918309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background. Endoscopic submucosal dissections (ESDs) allow removal of large gastrointestinal tumors and help patients avoid major oncologic surgery. In this study, the challenges and development of approaches toward successfully handling ESDs were analyzed in 279 colorectal specimens (114 rectal, 47 left, 118 right colonic; 90% adenoma with/without carcinoma). Methods. Each specimen was processed according to an established protocol including gross photography, mapping, and total submission for histopathologic examination. Results. Mean lesion size was 4.2 cm (range: 0.5-22 cm; 28% ≥5 cm; 6% ≥10 cm). Invasive carcinoma was present in 38 cases (14%), which had a mean overall tumor size of 3.8 cm (range: 1.1-17.5 cm), and mean largest size of the invasive component was 0.93 cm (range: 0.04-3 cm). Fifteen cases were staged as pT1a (submucosal invasion of <1000 µm) and 13 cases as pT1b (submucosal invasion of ≥1000 µm). En-bloc and R0 resection rates were 99.3% and 90.6%, respectively. Conclusion. Various histopathologic challenges were encountered, which were carefully evaluated by dedicated pathologists with familiarity to the subtleties in handling and reporting these specimens. We recommend these specimens to be prepared in the endoscopy suite, submitted to the Pathology Department oriented, pinned, and placed into copious amount of fixative. Total sampling, gross photography, mapping, and proper fixation are crucial components in the histopathologic evaluation. Micromeasurement of invasion depth and substaging per European/Japanese guidelines as well as accurate measurement of the distance from the resection margins are highly recommended. In conclusion, ESD is an adequate method that can be successfully implemented in a tertiary care center to perform en-bloc and margin-free resections of clinically selected large colorectal superficial lesions.
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Affiliation(s)
- Orhun Çığ Taşkın
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Fatih Aslan
- Department of Gastroenterology, Koç University Hospital, Istanbul, Turkey
| | - İbrahim Kulaç
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Serpil Yılmaz
- Department of Pathology, VKV American Hospital, Istanbul, Turkey
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Yersu Kapran
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
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Review on colorectal endoscopic submucosal dissection focusing on the technical aspect. Surg Endosc 2020; 34:3766-3787. [PMID: 32342217 DOI: 10.1007/s00464-020-07599-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) enables removal of broad-based colorectal polyps or lateral spreading tumors with a higher rate of en bloc resection and a lower risk of local recurrence. However, it is technically demanding. Over the past 20 years, various equipment and innovative techniques have been developed to reduce the difficulty of ESD. The information in the literature is scattered. Our aim is to provide a comprehensive review on the setup and technical aspects of colorectal ESD. METHODS We searched the PubMed database and systemically reviewed all original and review articles related to colorectal ESD. Further manual search according to reference lists of identified articles were done. The selected articles were categorized and reviewed. Original figures were created to help readers understand some of the ESD techniques. RESULTS A total of 216 articles were identified, in which 25 of them were review articles and 191 of them were original articles. They were categorized and reviewed. An in-depth appraisal of the setting, equipment, and technical aspects of colorectal ESD was performed. CONCLUSIONS Although ESD is a technically demanding procedure that requires expert endoscopic skills, it can be mastered. With good peri-procedural preparation, sufficient knowledge of the equipment, and thorough understanding of the useful endoscopic tricks and maneuvers, colorectal ESD can be performed smoothly and safely.
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Lymphovascular Infiltration, Not Depth of Invasion, is the Critical Risk Factor of Metastases in Early Colorectal Cancer: Retrospective Population-based Cohort Study on Prospectively Collected Data, Including Validation. Ann Surg 2020; 275:e148-e154. [PMID: 32187031 DOI: 10.1097/sla.0000000000003854] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify clinical and histopathological risk factors of LNM in T1 CRC. SUMMARY OF BACKGROUND DATA The requisite of additional surgery after locally resected T1 CRC is dependent on the risk of LNM. Depth of submucosal invasion is used as a key predictor of lymphatic metastases although data are conflicting on its actual impact. METHODS Retrospective population-based cohort study on prospectively collected data on all patients with T1 CRC undergoing surgical resection in Sweden, 2009-2017 and Denmark 2016-2018. The Danish cohort was used for validation. Potential risk factors of LNM investigated were; age, sex, tumor location, submucosal invasion, grade of differentiation, mucinous subtype, lymphovascular, and perineural invasion. RESULTS One hundred fifty out of the 1439 included patients (10%) had LNM. LVI (P < 0.001), perineural invasion (P < 0.001), mucinous subtype (P = 0.006), and age <60 years (P < 0.001) were identified as independent risk factors whereas deep submucosal invasion was only a dependent (P = 0.025) risk factor and not significant in multivariate analysis (P = 0.075). The incidence of LNM was 51/882 (6%) in absence of the independent risk factors. The Danish validation cohort, confirmed our findings regarding the role of submucosal invasion, LVI, and age. CONCLUSIONS This is a large study on LNM in T1 CRC, including validation, showing that LVI and perineural invasion, mucinous subtype, and low age constitute independent risk factors, whereas depth of submucosal invasion is not an independent risk factor of LNM. Thus, our findings provide a useful basis for management of patients after local excision of early CRC.
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Piessevaux H. How to predict and achieve success with a very long procedure in an endoscopy unit: Is it time for a break? Endosc Int Open 2019; 7:E1097-E1098. [PMID: 31479504 PMCID: PMC6715453 DOI: 10.1055/a-0889-7945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Hubert Piessevaux
- Department of Hepatogastroenterology, Cliniques universitaires Saint-Luc – Université catholique de Louvain, Brussels, Belgium
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Thorlacius H, Rönnow CF, Toth E. European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety. Acta Oncol 2019; 58:S10-S14. [PMID: 30724676 DOI: 10.1080/0284186x.2019.1568547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is an advanced method allowing en bloc resection of large and complex lesions in colon and rectum. Herein, the European experience of colorectal ESD was systematically reviewed in the medical literature to determine the clinical efficacy and safety of colorectal ESD in Europe. MATERIAL AND METHODS A systematic search of PubMed for full-text studies including more than 20 cases of colorectal ESD emanating from European centres was performed. Data were independently extracted by two authors using predefined data fields, including efficacy and safety. RESULTS We included 15 studies containing a total of 1404 colorectal ESD cases (41% in the colon) performed between 2007 and 2018. Lesion size was 40 mm (range 24-59 mm) and procedure time was 102 min (range 48-176 min). En bloc resection rate was 83% (range 67-93%) and R0 resection rate was 70% (range 35-91%). Perforation rate was 7% (range 0-19%) and bleeding rate was 5% (range 0-12%). The percentage of ESD cases undergoing emergency surgery was 2% (range 0-6%). Additional elective surgery was performed in 3% of all cases due to histopathological findings showing deep submucosal invasion or more advanced cancer. The recurrence rate was 4% (range 0-12%) after a median follow-up time of 12 months (range 3-24 months). CONCLUSIONS This review shows that ESD is effective and safe for treating large and complex colorectal lesions in Europe although there is room for improvement. Thus, it is important to develop standardized and high-quality educational programs in colorectal ESD in Europe.
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Affiliation(s)
- Henrik Thorlacius
- Department of Clinical Sciences, Section of Surgery Skåne University Hospital Lund University, Malmö, Sweden
| | - Carl-Fredrik Rönnow
- Department of Clinical Sciences, Section of Surgery Skåne University Hospital Lund University, Malmö, Sweden
| | - Ervin Toth
- Department of Clinical Sciences, Section of Gastroenterology, Skåne University Hospital Lund University, Malmö, Sweden
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