Polypoid nodule scar after gastric endoscopic submucosal dissection: results from a multicenter study

Abstract Background and study aims A post-endoscopic submucosal dissection (ESD) scar is expected to look homogeneous, however, some patients develop benign polypoid nodule scar (PNS). Incidence of PNS is unknown, yet these scars have direct clinical implications because they may render evaluation of post-ESD neoplastic recurrence difficult. Therefore, we reviewed the clinical experience of 5 ESD referral centers and evaluated their PNS incidence and clinical management. Patients and methods This was a retrospective multicenter case series enrolling patients that underwent R0, curative gastric ESD from 2003 to 2015 in 5 academic centers. PNS was defined as ESD site nodularity with hyperplastic or regenerative tissue histology. Results A total of 2275 patients underwent gastric ESD with endoscopy control and 28 patients (18 men/10 women) developed PNS for overall incidence of 1.2 %. Incidence of PNS ranged from 0.15 % to 11.4 % between centers. All patients that developed PNS had primary neoplastic lesions located in the distal stomach. Considering only lesions situated in the antrum (n = 912), incidence of PNS was 3.1 %. After mean follow-up of 43 months (range 6 – 192), no malignant recurrence in the PNS has been identified. In five patients (17.8 %) PNS disappeared after a mean of 18 months. Conclusion PNS occurs exclusively after ESD in the distal stomach in approximately 3.1 % of patients. Although PNS appearance can be concerning, no malignant recurrence was observed after curative R0 resection. Therefore, PNS should be viewed as a benign alteration that does not require any type of intervention, other than endoscopic surveillance.

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Endoscopic Submucosal Dissection of Gastric Neoplastic Lesions: An Italian, Multicenter Study

Journal of Clinical Medicine ◽

10.3390/jcm9030737 ◽

2020 ◽

Vol 9 (3) ◽

pp. 737

Author(s):

Raffaele Manta ◽

Giuseppe Galloro ◽

Francesco Pugliese ◽

Stefano Angeletti ◽

Angelo Caruso ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

En Bloc Resection ◽

Bloc Resection ◽

R0 Resection ◽

Gastric Lesions ◽

En Bloc ◽

Submucosal Dissection ◽

Neoplastic Lesions ◽

One Year

Endoscopic submucosal dissection (ESD) allows removing neoplastic lesions on gastric mucosa, including early gastric cancer (EGC) and dysplasia. Data on ESD from Western countries are still scanty. We report results of ESD procedures performed in Italy. Data of consecutive patients who underwent ESD for gastric neoplastic removal were analyzed. The en bloc resection rate and the R0 resection rates for all neoplastic lesions were calculated, as well as the curative rate (i.e., no need for surgical treatment) for EGC. The incidence of complications, the one-month mortality, and the recurrence rate at one-year follow-up were computed. A total of 296 patients with 299 gastric lesions (80 EGC) were treated. The en bloc resection was successful for 292 (97.6%) and the R0 was achieved in 266 (89%) out of all lesions. In the EGC group, the ESD was eventually curative in 72.5% (58/80) following procedure. A complication occurred in 30 (10.1%) patients. Endoscopic treatment was successful in all 3 perforations, whereas it failed in 2 out of 27 bleeding patients who were treated with radiological embolization (1 case) or surgery (1 case). No procedure-related deaths at one-month follow-up were observed. Lesion recurrence occurred in 16 (6.2%) patients (6 EGC and 10 dysplasia). In conclusion, the rate of both en bloc and R0 gastric lesions removal was very high in Italy. However, the curative rate for EGC needs to be improved. Complications were acceptably low and amenable at endoscopy.

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Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series

Endoscopy International Open ◽

10.1055/a-0848-8048 ◽

2019 ◽

Vol 07 (05) ◽

pp. E664-E671 ◽

Cited By ~ 3

Author(s):

Victoria Jimenez-Garcia ◽

Masayoshi Yamada ◽

Hiroaki Ikematsu ◽

Hiroyuki Takamaru ◽

Seiichiro Abe ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Case Series ◽

Clinicopathological Characteristics ◽

R0 Resection ◽

Incomplete Resection ◽

Colorectal Tumors ◽

Resection Rate ◽

Retrospective Case ◽

En Bloc ◽

Submucosal Dissection

Abstract Background and study aims Surgery is the standard treatment for colon tumors associated with diverticulum. Use of endoscopic submucosal dissection (ESD) to treat such tumors is controversial. The aim of this study was to assess the safety and feasibility of ESD in treating superficial colorectal tumors situated near or involving diverticulum. Patients and methods Consecutive patients from two referral centers who had colorectal tumors near or involving diverticulum treated by ESD were retrospectively studied. Clinicopathological characteristics and clinical outcomes were analyzed. Results Of the 12 patients studied, six had tumors near diverticulum and six had tumors involving diverticulum. The overall en-bloc R0 resection rate, median tumor size and procedure time were 67 %, 26.5 mm (range, 15 – 80 mm) and 110 minutes (range, 50 – 220 minutes), respectively. For tumors near diverticulum group, the en-bloc R0 resection rate was 100 % and no adverse events (AEs) or residual/recurrent tumors were observed. In contrast, for intradiverticular tumors group, the en-bloc R0 resection rate was low at 33 %, and one AE (perforation) was observed. The diverticula were ≥ 6 mm in diameter in the patients with incomplete resection. However, all but one diverticulum was unrecognized before ESD. Two residual tumors were detected at the 12-month surveillance and one required surgery. Conclusions This case series indicates that ESD is safe and feasible for treating colorectal tumors near a diverticulum and might be feasible for tumors involving a diverticulum smaller than 6 mm. Selection for smaller diverticulum size may contribute to higher en-bloc R0 resection rates.

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P656 Clinical implications of endoscopic submucosal dissection in management of patients with ulcerative colitis-associated dysplasia

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.784 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S540-S541

Author(s):

T Sakurai ◽

R Nezu ◽

A Okada ◽

Y Komeda ◽

T Nagai ◽

...

Keyword(s):

Ulcerative Colitis ◽

Endoscopic Submucosal Dissection ◽

Tp53 Mutation ◽

Magnifying Endoscopy ◽

Clinical Implications ◽

Low Grade ◽

Submucosal Dissection ◽

Metachronous Colorectal Cancer ◽

Gene Mutation Analysis

Abstract Background Colectomy has been recommended for patients presenting ulcerative colitis (UC)-associated dysplasia because of the risk of metachronous recurrence. However, it has been recently proposed that endoscopic submucosal dissection (ESD) of dysplasia, combined with subsequent surveillance, may contribute to avoiding colectomy. This study assessed clinical implications of ESD in UC-associated dysplasia. Methods We investigated 30 lesions (27 patients) of UC-associated dysplasia/cancer treated with ESD and surgery (15 ESD and 16 surgery) including a patient who underwent surgery following ESD. Among them, paraffin-embedded tissues of 15 lesions (6 cancers, 7 high-grade dysplasia: HGDs, 2 low-grade dysplasia: LGDs) and 11 surrounding mucosae were available and gene mutation analysis was performed. Indications for ESD were determined according to the criteria applied for sporadic colorectal neoplasms that are based on magnifying endoscopy. Results The median follow-up duration was 40 months. Three out of 27 patients (11%) developed metastasis. Although no serious complications, local recurrence, or metastasis occurred in 13 patients undergoing ESD, one out of them (7.7%) had metachronous colorectal cancer 3 years after ESD in the rectum, where TP53 mutation and diffuse p53 staining was found at non-dysplastic mucosae. Based on magnifying endoscopy, we underestimated the invasion depth in two cases: in a case of deeply submucosal invasive mucinous cancer, endoscopic ultrasonography exhibited thickening of the submucosal layer exclusively at the lesion. Conclusion The proposed indication for ESD in UC-associated dysplasia is that a lesion is well-demarcated and surrounding mucosa is not actively inflamed and does not exhibit diffuse p53 staining. ESD would contribute to advances in the management of UC-associated dysplasia.

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Endoscopic submucosal dissection for rectal neoplastic lesions: experience from a European center.

Archives of Medical Science ◽

10.5114/aoms/144292 ◽

2021 ◽

Author(s):

Michał Spychalski ◽

Marcin Włodarczyk ◽

Jakub Włodarczyk ◽

Igor Dąbrowski ◽

Piotr Bednarski ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Case Series ◽

En Bloc Resection ◽

Bloc Resection ◽

R0 Resection ◽

Safe Procedure ◽

Rectal Tumors ◽

En Bloc ◽

Submucosal Dissection ◽

Case Series Study

IntroductionNowadays, various endoscopic resections including polypectomy, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD) are well known first-line approaches for early neoplastic rectal tumors.Material and methodsIn this case series study, we analyzed 320 ESD procedures performed in a high-volume colorectal center in Poland, Europe. The aim of this study was to retrospectively evaluate ESD procedure in cases of rectal carcinoma performed by a single trained operator in a referral center provided with endoscopy.ResultsOverall, en bloc resection was observed in 92.5% of patients (296/320). The en bloc resection rate was at a similar level in those lesions with involved anal sphincters versus tumors without involvement (93.85% vs. 92.16%; p=0.644). R0 resection was noted in 89.4% of patients (286/320). The overall curative ESD rate was 85.94% (n=275). The curative ESD rate in the invasive cancer group reached 52.6% (n=20). We observed ESD-related adverse events, such as bleeding and perforation, in 3.4 % of patients (n=11).ConclusionsWe have demonstrated that ESD in rectal tumors is an efficient and safe procedure with a high curative rate, even in difficult lesions. Anal sphincter localization and recurrent character of the lesion have no impact on the final outcomes. The ESD approach should have been considered for all rectal tumors, especially those lesions suspected of superficial mucosal invasion, as it can serve as a staging method and may have been curative for adenomas and cancers limited to mucosa.

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Feasibility of endoscopic submucosal dissection of lesions at anastomosis site post-colorectal surgery: a case series

Endoscopy International Open ◽

10.1055/a-0903-2403 ◽

2019 ◽

Vol 07 (08) ◽

pp. E949-E954 ◽

Cited By ~ 1

Author(s):

Chonlada Krutsri ◽

Takashi Toyonaga ◽

Tsukasa Ishida ◽

Namiko Hoshi ◽

Shinichi Baba ◽

...

Keyword(s):

Colorectal Surgery ◽

Endoscopic Submucosal Dissection ◽

Case Series ◽

Resected Specimen ◽

Surveillance Colonoscopy ◽

Benign Lesions ◽

Invasive Treatment ◽

Submucosal Dissection ◽

Anastomosis Site ◽

Neoplastic Lesions

Abstract Background and study aims Patients who have undergone colorectal surgery for resection of cancer and benign lesions are at risk for recurrent, residual, or metachronous lesions at the anastomosis site. Surgical resection of such lesions is difficult because of adhesions, and a stoma may be required as there are risks for leakage after resection. The feasibility and safety of endoscopic submucosal dissection (ESD) for these lesions remain unknown. Therefore, this case series aimed to examine the feasibility and safety of ESD by evaluating the clinical outcomes. Patients and methods We retrospectively investigated five patients who underwent ESD by a single expert for superficial neoplastic lesions at the anastomosis site after previous colorectal surgery. Results R0 resections were achieved for all lesions. Mean procedure time was 160.6 minutes. Mean dimensions of the resected specimen and tumor were 52.4 mm and 31.8mm, respectively. None of the patients had complications or recurrence after surveillance colonoscopy 1-year post-resection. Conclusions In an expert’s hands, ESD at the anastomosis site might be feasible minimally invasive treatment for superficial neoplastic lesions.

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OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) DURING LIVE ENDOSCOPY EVENTS – A 12- YEAR FOLLOW-UP

10.1055/s-0039-1681382 ◽

2019 ◽

Author(s):

A Ebigbo ◽

S Freund ◽

A Probst ◽

C Römmele ◽

S Gölder ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Submucosal Dissection

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Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions

Endoscopy International Open ◽

10.1055/a-1268-7353 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1832-E1839

Author(s):

Yuichiro Kuroki ◽

Toshiyuki Endo ◽

Kenta Iwahashi ◽

Naoki Miyao ◽

Reika Suzuki ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Postoperative Bleeding ◽

En Bloc Resection ◽

Tumor Location ◽

Proximal Colon ◽

R0 Resection ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Serrated Lesions

Abstract Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm2/h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.

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Advanced Colon Cancer after Curative Resection of Intramucosal Adenocarcinoma with Endoscopic Submucosal Dissection

Case Reports in Gastroenterology ◽

10.1159/000516314 ◽

2021 ◽

pp. 603-609

Author(s):

Akiko Sasaki ◽

Chikamasa Ichita ◽

Chihiro Sumida ◽

Karen Kimura ◽

Takashi Nishino ◽

...

Keyword(s):

Elderly Patients ◽

Endoscopic Submucosal Dissection ◽

Advanced Cancer ◽

Curative Resection ◽

Submucosal Tumor ◽

R0 Resection ◽

Surveillance Colonoscopy ◽

Epithelial Tumor ◽

Submucosal Dissection ◽

Intramucosal Adenocarcinoma

Endoscopic resection, particularly endoscopic submucosal dissection (ESD), for colorectal cancers enables a precise pathological diagnosis and safe R0 resection. The recurrence rate after ESD is generally extremely low, with annual surveillance colonoscopy recommended. However, surveillance may not be considered for super-elderly patients owing to their condition. This is a case report of an 85-year-old man in whom curative resection was achieved for an intramucosal adenocarcinoma with ESD. The patient presented with a hypoechoic mass located in his lower right abdomen, diagnosed via surveillance abdominal ultrasound. He had undergone curative ESD for intramucosal cecal cancer 2 years prior. Colonoscopy revealed a type 2 epithelial tumor at the proximal aspect of the ESD scar. Ileocolic resection with lymph node dissection was performed. An epithelial tumor and well-differentiated adenocarcinoma but not a submucosal tumor was detected in the mucosal layer. The lesion was diagnosed not as a local recurrence after ESD but as a newly emerged original advanced cancer. After ESD for colorectal cancer, a newly developed advanced cancer may occur at the site of the ESD scar in a shorter term than usual. Surveillance colonoscopy after ESD is necessary even for super-elderly patients.

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Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile

GE Portuguese Journal of Gastroenterology ◽

10.1159/000514797 ◽

2021 ◽

pp. 1-9

Author(s):

João Santos-Antunes ◽

Margarida Marques ◽

Rui Morais ◽

Fátima Carneiro ◽

Guilherme Macedo

Keyword(s):

Endoscopic Submucosal Dissection ◽

Safety Profile ◽

En Bloc Resection ◽

R0 Resection ◽

Hybrid Technique ◽

Resection Rate ◽

En Bloc ◽

Delayed Bleeding ◽

Submucosal Dissection ◽

Gastrointestinal Lesions

Introduction: Endoscopic submucosal dissection (ESD) is a well-established endoscopic technique for the treatment of gastrointestinal lesions. Colorectal ESD outcomes are less reported in the Western literature, and Portuguese data are still very scarce. Our aim was to describe our experience on colorectal ESD regarding its outcomes and safety profile. Methods: We conducted a retrospective evaluation of recorded data on ESDs performed between 2015 and 2020. Only ESDs performed on epithelial neoplastic lesions were selected for further analysis. Results: Of a total of 167 colorectal ESDs, 153 were included. Technical success was achieved in 147 procedures (96%). The lesions were located in the colon (n = 24) and rectum (n = 123). The en bloc resection rate was 92% and 97%, the R0 resection rate was 83% and 82%, and the curative resection rate was 79% and 78% for the colon and the rectum, respectively. The need for a hybrid technique was the only risk factor for piecemeal or R1 resection. We report a perforation rate of 3.4% and a 4.1% rate of delayed bleeding; all the adverse events were manageable endoscopically, without the need of blood transfusions or surgery. Most of the lesions were laterally spreading tumours of the granular mixed type (70%), and 20% of the lesions were malignant (12% submucosal and 8% intramucosal cancer). Conclusion: Our series on colorectal ESD reports a very good efficacy and safety profile. This technique can be applied by endoscopists experienced in ESD.

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Feasibility of a modified search, coagulation, and clipping method with and without the use of polyglycolic acid sheets and fibrin glue for preventing delayed bleeding after gastric endoscopic submucosal dissection

BMC Gastroenterology ◽

10.1186/s12876-020-01539-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Satoshi Abiko ◽

Soichiro Oda ◽

Akimitsu Meno ◽

Akane Shido ◽

Sonoe Yoshida ◽

...

Keyword(s):

High Risk ◽

Endoscopic Submucosal Dissection ◽

Median Time ◽

Fibrin Glue ◽

Polyglycolic Acid ◽

Low Risk ◽

R0 Resection ◽

Antithrombotic Agents ◽

Delayed Bleeding ◽

Submucosal Dissection

Abstract Background Methods have been developed for preventing delayed bleeding (DB) after gastric endoscopic submucosal dissection (GESD). However, none of the methods can completely prevent DB. We hypothesized that DB could be prevented by a modified search, coagulation, and clipping (MSCC) method for patients at low risk for DB and by combining the use of polyglycolic acid sheets and fibrin glue with the MSCC method (PMSCC method) for patients at high risk for DB (antibleeding [ABI] strategy). This study assessed the technical feasibility of this novel strategy. Method We investigated 123 lesions in 121 consecutive patients who underwent GESD in Kushiro Rosai Hospital between April 2018 and January 2020. The decision for continuation or cessation of antithrombotic agents was based on the Guidelines for Gastroenterological Endoscopy in Patients Undergoing Antithrombotic Treatment. Results Oral antithrombotic agents were administered to 28 patients (22.8%). The en bloc R0 resection rate was 98.4%. The MSCC method and the PMSCC method for preventing DB were performed in 114 and 9 lesions, respectively. The median time of the MSCC method was 16 min, and the median speed (the resection area divided by the time of method used) was 3.6 cm2/10 min. The median time of the PMSCC method was 59 min, and the median speed was 1.3 cm2/10 min. The only delayed procedural adverse event was DB in 1 (0.8%) of the 123 lesions. Conclusions The ABI strategy is feasible for preventing DB both in patients at low risk and in those at high risk for DB after GESD, whereas the PMSCC method may be necessary for reduction of time.

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