Applicability of endoscopic submucosal dissection after unsuccessful endoscopic mucosal resection in colorectal laterally spreading tumors: a single center experience
Abstract
Aim: Endoscopic mucosal resection might technically be unsuccessful (interrupted endoscopic mucosal resection) in some cases when treating large colorectal laterally spreading tumors. In the literature, data on the outcomes of the endoscopic submucosal dissection method in endoscopic mucosal resection interrupted tumors are lacking. In this study, we evaluated the results of patients who underwent endoscopic submucosal dissection for endoscopic mucosal resection interrupted laterally spreading tumors.
Materials and Methods: Between February 2019 and April 2021, 8 patients with endoscopic mucosal resection interrupted colorectal laterally spreading tumors underwent endoscopic submucosal dissection. The primary endpoint was en bloc, R0, and curative resection rates of endoscopic submucosal dissection.
Results: In all cases, endoscopic submucosal dissection was successfully completed. The mean tumor size was 61.5 mm (35–100 mm). The rate of en bloc resection, R0 resection and curative resection was 100%, 87.5% and 87.5% respectively. Intra-procedural perforation occurred in 1 patient (12.5%) and was successfully treated with clip application. Delayed bleeding occurred in 1 patient (12.5%), and was successfully treated with endoluminal hemostasis. Furthermore, histopathological examination revealed that laterally spreading tumors in 4 patients (50.0%) had submucosal invasion. Surgical resection was performed after endoscopic submucosal dissection in 1 patient owing to the presence of deep submucosal invasion.
Conclusion: Endoscopic submucosal dissection is an effective and relatively safe method in endoscopic mucosal resection interrupted colorectal laterally spreading tumors.
Keywords
Interrupted endoscopic mucosal resection endoscopic submucosal dissection laterally spreading tumors
References
- Moss A, Williams SJ, Hourigan LF, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut. 2015; 64 (1): 57-65.
- Tanaka H, Oka S, Tanaka S, et al. Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: Large multicenter 10‐year study. Digestive Endoscopy. 2021; 33 (4): 608-15.
- Rahmi G, Tanaka S, Ohara Y, et al. Efficacy of endoscopic submucosal dissection for residual or recurrent superficial colorectal tumors after endoscopic mucosal resection. Journal of Digestive Diseases. 2015; 16 (1): 14-21.
- Kuroki Y, Hoteya S, Mitani T, et al. Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. Journal of Gastroenterology and Hepatology. 2010; 25 (11): 1747-53.
- Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digestive Endoscopy. 2015; 27 (4): 417-34.
- Hayashi N, Tanaka S, Hewett DG, et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification. Gastrointestinal Endoscopy. 2013; 78 (4): 625-32.
- Makino T, Kanmura S, Sasaki F, et al. Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography. Endoscopy International Open. 2015; 03 (04): 363-7.
- Sakamoto H, Hayashi Y, Miura Y, et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endoscopy International Open. 2017; 05 (02): 123-9.
- Suzuki Y, Tanuma T, Nojima M, et al. Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction. Endoscopy International Open. 2020; 08 (07): 840-7.
- Kim ER, Chang DK. Management of Complications of Colorectal Submucosal Dissection. Clinical Endoscopy. 2019; 52 (2): 114-9.
- Tominaga K, Fujinuma S, Endo T, Saida Y, Takahashi K, Maetani I. Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias. World Journal of Gastroenterology. 2009; 15 (19): 2351-6.
- Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. International Journal of Clinical Oncology. 2020; 25 (1): 1-42.
- Tseng M-Y, Lin J-C, Huang T-Y, et al. Endoscopic Submucosal Dissection for Early Colorectal Neoplasms: Clinical Experience in a Tertiary Medical Center in Taiwan. Gastroenterology Research and Practice. 2013:891565.1-7.
- Ma MX, Bourke MJ. Endoscopic submucosal dissection in the West: Current status and future directions. Digestive Endoscopy. 2018; 30 (3). 310-20.
- Kuroha M, Shiga H, Kanazawa Y, et al. Factors Associated with Fibrosis during Colorectal Endoscopic Submucosal Dissection: Does Pretreatment Biopsy Potentially Elicit Submucosal Fibrosis and Affect Endoscopic Submucosal Dissection Outcomes? Digestion. 2021; 102 (4): 590-8.
- Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015; 47 (09): 829-54.
- Rutter MD, Chattree A, Barbour JA, et al. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut. 2015; 64 (12): 1847-73
- Kobayashi N, Saito Y, Sano Y, et al. Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth? Endoscopy. 2007; 39 (08): 701-5.
- Han KS, Sohn DK, Choi DH, et al. Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointestinal Endoscopy. 2008; 67 (1): 97-102.
- Kaosombatwattana U, Yamamura T, Limsrivilai J, et al. Preoperative endoscopic predictors of severe submucosal fibrosis in colorectal tumors undergoing endoscopic submucosal dissection. Endoscopy International Open. 2019; 07 (04): 421-30.
- Harada H, Nakahara R, Murakami D, et al. Saline-pocket endoscopic submucosal dissection for superficial colorectal neoplasms: a randomized controlled trial (with video). Gastrointestinal Endoscopy. 2019; 90 (2): 278-87.
Kolorektal lateral yayılımlı tümörlerde başarısız endoskopik mukozal rezeksiyon sonrası endoskopik submukozal diseksiyonun uygulanabilirliği: tek merkez deneyimi
Abstract
Amaç: Geniş kolorektal lateral yayılımlı tümörlerin tedavisinde endoskopik mukozal rezeksiyon bazı durumlarda teknik olarak başarısız (tamamlanmamış endoskopik mukozal rezeksiyon) olabilir. Endoskopik mukozal rezeksiyon tamamlanmamış tümörlerde endoskopik submukozal diseksiyon yönteminin uygulanabilirliği ile ilgili literatürde kısıtlı veri mevcuttur. Biz bu çalışmada tamamlanmamış endoskopik mukozal rezeksiyon sonrasında endoskopik submukozal diseksiyon uyguladığımız kolorektal lateral yayılımlı tümörlü hastaların sonuçlarını analiz ettik.
Gereç ve Yöntem: Şubat 2019- Nisan 2021 tarihleri arasında endoskopik mukozal rezeksiyon tamamlanmamış kolorektal lateral yayılımlı tümörlerde endoskopik submukozal diseksiyon uygulanan 8 hasta çalışmaya dahil edildi. Primer sonlanım noktası olarak endoskopik submukozal diseksiyon ile en bloc, R0 ve küratif rezeksiyon oranlarına bakıldı.
Bulgular: Tüm hastalarda endoskopik submukozal diseksiyon başarı ile tamamlandı. Ortalama tümör çapı 61,5 mm (35-100 mm) idi. En bloc, R0 ve küratif rezeksiyon oranları sırayla %100, %87,5 ve %87,5’du. Uygulama esnasında perforasyon bir (%12,5) hastada görüldü ve klip uygulanarak tedavi edildi. Gecikmiş kanama bir (%12,5) hastada izlendi ve endoluminal hemostaz sağlandı. Histopatolojik incelemede lateral yayılımlı tümörlerin dördünde (%50,0) submukozal invazyon izlendi. Derin submukozal invazyon nedeniyle bir hastada endoskopik submukozal diseksiyon sonrasında cerrahi rezeksiyon uygulandı.
Sonuç: Endoskopik mukozal rezeksiyon tamamlanmamış kolorektal lateral yayılımlı tümörlerde endoskopik submukozal diseksiyon etkili ve oldukça güvenilir bir yöntemdir.
Keywords
Başarısız endoskopik mukozal rezeksiyon endoskopik submukozal diseksiyon lateral yayılımlı tümör
References
- Moss A, Williams SJ, Hourigan LF, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut. 2015; 64 (1): 57-65.
- Tanaka H, Oka S, Tanaka S, et al. Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: Large multicenter 10‐year study. Digestive Endoscopy. 2021; 33 (4): 608-15.
- Rahmi G, Tanaka S, Ohara Y, et al. Efficacy of endoscopic submucosal dissection for residual or recurrent superficial colorectal tumors after endoscopic mucosal resection. Journal of Digestive Diseases. 2015; 16 (1): 14-21.
- Kuroki Y, Hoteya S, Mitani T, et al. Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. Journal of Gastroenterology and Hepatology. 2010; 25 (11): 1747-53.
- Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digestive Endoscopy. 2015; 27 (4): 417-34.
- Hayashi N, Tanaka S, Hewett DG, et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the Narrow-Band Imaging International Colorectal Endoscopic (NICE) classification. Gastrointestinal Endoscopy. 2013; 78 (4): 625-32.
- Makino T, Kanmura S, Sasaki F, et al. Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography. Endoscopy International Open. 2015; 03 (04): 363-7.
- Sakamoto H, Hayashi Y, Miura Y, et al. Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endoscopy International Open. 2017; 05 (02): 123-9.
- Suzuki Y, Tanuma T, Nojima M, et al. Comparison of dissection speed during colorectal ESD between the novel Multiloop (M-loop) traction method and ESD methods without traction. Endoscopy International Open. 2020; 08 (07): 840-7.
- Kim ER, Chang DK. Management of Complications of Colorectal Submucosal Dissection. Clinical Endoscopy. 2019; 52 (2): 114-9.
- Tominaga K, Fujinuma S, Endo T, Saida Y, Takahashi K, Maetani I. Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias. World Journal of Gastroenterology. 2009; 15 (19): 2351-6.
- Hashiguchi Y, Muro K, Saito Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. International Journal of Clinical Oncology. 2020; 25 (1): 1-42.
- Tseng M-Y, Lin J-C, Huang T-Y, et al. Endoscopic Submucosal Dissection for Early Colorectal Neoplasms: Clinical Experience in a Tertiary Medical Center in Taiwan. Gastroenterology Research and Practice. 2013:891565.1-7.
- Ma MX, Bourke MJ. Endoscopic submucosal dissection in the West: Current status and future directions. Digestive Endoscopy. 2018; 30 (3). 310-20.
- Kuroha M, Shiga H, Kanazawa Y, et al. Factors Associated with Fibrosis during Colorectal Endoscopic Submucosal Dissection: Does Pretreatment Biopsy Potentially Elicit Submucosal Fibrosis and Affect Endoscopic Submucosal Dissection Outcomes? Digestion. 2021; 102 (4): 590-8.
- Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015; 47 (09): 829-54.
- Rutter MD, Chattree A, Barbour JA, et al. British Society of Gastroenterology/Association of Coloproctologists of Great Britain and Ireland guidelines for the management of large non-pedunculated colorectal polyps. Gut. 2015; 64 (12): 1847-73
- Kobayashi N, Saito Y, Sano Y, et al. Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth? Endoscopy. 2007; 39 (08): 701-5.
- Han KS, Sohn DK, Choi DH, et al. Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointestinal Endoscopy. 2008; 67 (1): 97-102.
- Kaosombatwattana U, Yamamura T, Limsrivilai J, et al. Preoperative endoscopic predictors of severe submucosal fibrosis in colorectal tumors undergoing endoscopic submucosal dissection. Endoscopy International Open. 2019; 07 (04): 421-30.
- Harada H, Nakahara R, Murakami D, et al. Saline-pocket endoscopic submucosal dissection for superficial colorectal neoplasms: a randomized controlled trial (with video). Gastrointestinal Endoscopy. 2019; 90 (2): 278-87.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 13, 2022 |
| Submission Date | August 14, 2021 |
| Published in Issue | Year 2022 |