scholarly journals Comparison of underwater and conventional endoscopic mucosal resection for removing sessile colorectal polyps: a propensity-score matched cohort study

2019 ◽  
Vol 07 (11) ◽  
pp. E1528-E1536 ◽  
Author(s):  
Hsu-Chih Chien ◽  
Noriya Uedo ◽  
Ping-Hsin Hsieh
Keyword(s):  
Cohort Study ◽  
Muscle Layer ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Matched Pairs ◽  
Procedure Time ◽  
Resection Rate ◽  
En Bloc ◽  
Delayed Bleeding

Abstract Background and study aims Endoscopic mucosal resection (EMR) is a standard method for removing sessile colorectal polyps ≥ 10 mm. Recently, underwater EMR (UEMR) has been introduced as a potential alternative. However, the effectiveness and safety of UEMR compared with conventional EMR is un clear. Patients and methods In this 1:1 propensity score (PS) matched retrospective cohort study, we compared the en bloc resection rates, procedure time, intraprocedural and delayed bleeding rates, and incidence of muscle layer injury. We also performed subgroup analyses by sizes of polyps (< 20 mm and ≥ 20 mm). Results Among 350 polyps in 315 patients from August 2012 to November 2017, we identified 121 PS-matched pairs. Mean polyp size was 16.8 mm. With similar en bloc resection rates (EMR: 82.6 % vs. UEMR: 87.6 %, rate difference: 5.0, 95 % confidence interval [95 % CI]: – 4 to 13.9 %), UEMR demonstrated a shorter resection time (10.8 min vs. 8.6 min, difference: – 2.2 min, 95 % CI: – 4.1 to – 0.3 min) and a lower intraprocedural bleeding rate (15.7 % vs. 5.8 %, rate difference: – 9.9 %, 95 % CI: – 17.6 to – 2.2 %). Incidence of delayed bleeding and muscle layer injury were low in both groups. For polyps < 20 mm, effectiveness and safety outcomes were similar in both groups. For polyps ≥ 20 mm (42 PS-matched pairs), the UEMR group has a comparable en bloc resection rate with shorter procedure time and superior safety outcomes Conclusions UEMR achieved an en bloc resection rate comparable to conventional EMR with less intraprocedural bleeding and a shorter procedure time.

ID: 3518501 EN-BLOC RESECTION RATE OF COLORECTAL POLYPS ≤ 20 MM IS LOW AMONG ADVANCED ENDOSCOPY TRAINEES

2021 ◽  
Vol 93 (6) ◽  
pp. AB70
Author(s):  
William W. King ◽  
Peter V. Draganov ◽  
Andrew Y. Wang ◽  
Dushant Uppal ◽  
Nikhil A. Kumta ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Resection Rate ◽  
En Bloc

scholarly journals Underwater versus conventional endoscopic mucosal resection for small size non-pedunculated colorectal polyps: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhixin Zhang ◽  
Yonghong Xia ◽  
Hongyao Cui ◽  
Xin Yuan ◽  
Chunnian Wang ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Efficacy And Safety ◽  
Resection Rate ◽  
En Bloc ◽  
Randomized Controlled ◽  
Mucosal Resection ◽  
Group 1

Abstract Background Underwater endoscopic mucosal resection (UEMR) is a recently developed technique and can be performed during water-aided or ordinary colonoscopy for the treatment of colorectal polyps. The objective of this clinical trial was to evaluate the efficacy and safety of UEMR in comparison with conventional endoscopic mucosal resection (CEMR) of small non-pedunculated colorectal polyps. Methods Patients with small size, non-pedunculated colorectal polyps (4–9 mm in size) who underwent colonoscopic polypectomy were enrolled in this multicenter randomized controlled clinical trial. The patients were randomly allocated to two groups, an UEMR group and a CEMR group. Efficacy and safety were compared between groups. Results In the intention-to-treat (ITT) analysis, the complete resection rate was 83.1% (59/71) in the UEMR group and 87.3% (62/71) in the CEMR group. The en-bloc resection rate was 94.4% (67/71) in the UEMR group and 91.5% (65/71) in the CEMR group (difference 2.9%; 90% CI − 4.2 to 9.9%), showed noninferiority (noninferiority margin − 5.7% < − 4.2%). No significant difference in procedure time (81 s vs. 72 s, P = 0.183) was observed. Early bleeding was observed in 1.4% of patients in the CEMR group (1/71) and 1.4% of patients in the UEMR group (1/71). None of the patients in the UEMR group complained of postprocedural bloody stool, whereas two patients in the CEMR group (2/64) reported this adverse event. Conclusion Our results indicate that UEMR is safer and just as effective as CEMR in En-bloc resection for the treatment of small colorectal polyps as such, UEMR is recommended as an alternative approach to excising small and non-pedunculated colorectal adenomatous polyps. Trial registration Clinical Trials.gov, NCT03833492. Retrospectively registered on February 7, 2019.

The efficacy and safety of underwater endoscopic mucosal resection for ≥10-mm colorectal polyps: systematic review and meta-analysis

Endoscopy ◽  
2020 ◽  
Author(s):  
De-feng Li ◽  
Ming-Guang Lai ◽  
Mei-feng Yang ◽  
Zhi-yuan Zou ◽  
Jing Xu ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Complete Resection ◽  
R0 Resection ◽  
Efficacy And Safety ◽  
Resection Rate ◽  
En Bloc ◽  
Mucosal Resection

Abstract Background Underwater endoscopic mucosal resection (UEMR) is a promising strategy for nonpedunculated colorectal polyp removal. However, the efficacy and safety of the technique for the treatment of ≥ 10-mm colorectal polyps remain unclear. We aimed to comprehensively assess the efficacy and safety of UEMR for polyps sized 10–19 mm and ≥ 20 mm. Methods PubMed, EMBASE, and the Cochrane Library databases were searched for relevant articles from January 2012 to November 2019. Primary outcomes were the rates of adverse events and residual polyps. Secondary outcomes were the complete resection, en bloc resection, and R0 resection rates. Results 18 articles including 1142 polyps from 1093 patients met our inclusion criteria. The overall adverse event and residual polyp rates were slightly lower for UEMR when removing colorectal polyps of 10–19 mm vs. ≥ 20 mm (3.5 % vs. 4.3 % and 1.2 % vs. 2.6 %, respectively). The UEMR-related complete resection rate was slightly higher for colorectal polyps of 10–19 mm vs. ≥ 20 mm (97.9 % vs. 92.0 %). However, the en bloc and R0 resection rates were dramatically higher for UEMR removal of polyps of 10–19 mm vs. ≥ 20 mm (83.4 % vs. 36.1 % and 73.0 % vs. 40.0 %, respectively). In addition, univariate meta-regression revealed that polyp size was an independent predictor for complete resection rate (P = 0.03) and en bloc resection (P = 0.01). Conclusions UEMR was an effective and safe technique for the removal of ≥ 10-mm nonpedunculated colorectal polyps. However, UEMR exhibited low en bloc and R0 resection rates for the treatment of ≥ 20-mm polyps.

scholarly journals The introduction of colorectal endoscopic submucosal hydrodissection at a Western Center: results and learning curve

2019 ◽  
Author(s):  
Felipe Ramos-Zabala ◽  
Adolfo Parra-Blanco ◽  
Sabina Beg ◽  
Marian García-Mayor ◽  
Ana Domínguez-Pino ◽  
...  
Keyword(s):  
Learning Curve ◽  
Conversion Rate ◽  
Curative Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Incomplete Resection ◽  
Resection Rate ◽  
En Bloc ◽  
The Impact

Abstract Background Colorectal endoscopic submucosal dissection (CR-ESD) is an evolving technique in Western countries. The use of hydrodissection has been established as an effective technique for safe resection. However, it is unknown if the adoption of this technique can help a novice perform ESD safely without prior experience or formal tutorial. Here we aimed to determine the results of the introduction of endoscopic submucosal hydrodissection for the treatment of complex colorectal polyps and establish the learning curve for this technique, at a European tertiary hospital. Methods This study included data from 80 consecutive CR-ESDs performed for complex colorectal polyps, by a single endoscopist within a structured training program. The main outcome was en bloc resection rate, while secondary outcomes included complications (perforation and bleeding), knife en bloc (KEB) resection rate, knife-snare en bloc resection rate, conversion rate to endoscopic piecemeal mucosal resection (EPMR), complete resection rate, curative resection rate. To explore the impact of experience, procedures were divided into 4 groups of 20 each, with outcomes measures compared between these. Results The overall en bloc resection rate was 75%. KEB resection was obtained in 15%, 25%, 50%, and 80% cases in the consecutive periods (period 1 vs 4, p<0.001; periods 1, 2 and 3 vs 4, p<0.001). Conversion rate to EPMR was obtained in 40%, 25%, 25% and 5% respectively (period 1,2 and 3 vs 4; p=0.031). Curative resection was achieved in 55%, 75%, 70% and 95% respectively (p=0.037). Series results were 75% R0 resection, 23.7% conversion to EPMR, and 1.2% incomplete resection. Complications included perforations (7.5%) and bleeding (3.75%), there was no significant difference in the 4 periods of training. Multivariate analysis revealed factors more likely to result in non-en bloc versus en bloc resection were polyp size > 35 mm [70% vs. 23.4%; OR 13.2 (95% CI: 1.7-100.9); p=0. 013], severe fibrosis [40% vs. 11.7%; OR 10.2 (95% CI: 1.2-86.3); p= 0.033] and non-use of CO2 [65% vs. 30%; OR 0.09 (95% CI: 0.01-0.53); p= 0.008]. Conclusions CR-ESD by hydrodissection can be implemented in a western centre and offers safe and effective treatment for complex polyps.

scholarly journals Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis

2020 ◽  
Vol 08 (12) ◽  
pp. E1884-E1894
Author(s):  
Rajat Garg ◽  
Amandeep Singh ◽  
Babu P. Mohan ◽  
Gautam Mankaney ◽  
Miguel Regueiro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Mucosal Resection ◽  
Meta Analysis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Incomplete Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Mucosal Resection

Abstract Background and study aims Underwater endoscopic mucosal resection (UEMR) for colorectal polyps has been reported to have good outcomes in recent studies. We conducted a systematic review and meta-analysis comparing the effectiveness and safety of UEMR to conventional EMR (CEMR). Methods A comprehensive search of multiple databases (through May 2020) was performed to identify studies that reported outcome of UEMR and CEMR for colorectal lesions. Outcomes assessed included incomplete resection, rate of recurrence, en bloc resection, adverse events (AEs) for UEMR and CEMR. Results A total of 1,651 patients with 1,704 polyps were included from nine studies. There was a significantly lower rate of incomplete resection (odds ratio [OR]: 0.19 (95 % confidence interval (CI), 0.05–0.78, P = 0.02) and polyp recurrence (OR: 0.41, 95 % CI, 0.24–0.72, P = 0.002) after UEMR. Compared to CEMR, rates overall complications (relative risk [RR]: 0.66 (95 % CI, 0.48–0.90) (P = 0.008), and intra-procedural bleeding (RR: 0.59, 95 % CI, 0.41–0.84, P = 0.004) were significantly lower with UEMR. The recurrence rate was also lower for large non-pedunculated polyps ≥ 10 mm (OR 0.24, 95 % CI, 0.10–0.57, P = 0.001) and ≥ 20 mm (OR 0.14, 95 % CI, 0.02–0.72, P = 0.01). The rates of en bloc resection, delayed bleeding, perforation and post-polypectomy syndrome were similar in both groups (P > 0.05). Conclusions In this systematic review and meta-analysis, we found that UEMR is more effective and safer than CEMR with lower rates of recurrence and AEs. UEMR use should be encouraged over CEMR.

scholarly journals Usefulness of epinephrine-added injection solution to reduce procedure time for gastric endoscopic submucosal dissection

2020 ◽  
Vol 08 (08) ◽  
pp. E1044-E1051
Author(s):  
Shuntaro Inoue ◽  
Noriya Uedo ◽  
Takahiro Tabuchi ◽  
Kentaro Nakagawa ◽  
Masayasu Ohmori ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Type ◽  
Procedure Time ◽  
Injection Solution ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Significant Difference

Abstract Background and study aims Epinephrine-added submucosal injection solution is used to facilitate hemostasis of non-variceal upper gastrointestinal bleeding and to prevent delayed bleeding of large pedunculated colorectal lesions. However, its benefit in gastric endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is unclear. The effectiveness of epinephrine-added injection solution for outcomes of gastric ESD was examined using propensity score matching analysis. Patients and methods A total of 1,599 patients with solitary EGC (83 with non-epinephrine-added solution and 1,516 with epinephrine-added solution) between 2011 and 2018 were enrolled. Propensity scores were calculated to balance the distribution of baseline characteristics: age, sex, tumor location, specimen size, presence of ulcer scar, tumor depth, histological tumor type, and operators’ experience, and 1:3 matching was performed. En bloc resection rate, mean procedure time, delayed bleeding rate, and perforation rate were compared between the non-epinephrine (n = 79) and epinephrine (n = 237) groups. Results Mean procedure time was significantly shorter in the epinephrine group than in the non-epinephrine group (60 vs. 78 min, P < 0.001). No significant difference was found in the rate of en bloc resection (both 99 %), incidence of delayed bleeding (both 6 %), or perforation (0 vs. 0.8 %) between the two groups. In multiple linear regression analysis, use of epinephrine-added solution was independently associated with short procedure time (P < 0.001) after adjustment for other covariates. Conclusion The results suggest that epinephrine-added injection solution is useful for reduction of gastric ESD procedure time, warranting validation in a randomized controlled trial.

scholarly journals The efficacy of the pocket-creation method for cases with severe fibrosis in colorectal endoscopic submucosal dissection

2018 ◽  
Vol 06 (08) ◽  
pp. E975-E983 ◽  
Author(s):  
Naohisa Yoshida ◽  
Yuji Naito ◽  
Ritsu Yasuda ◽  
Takaaki Murakami ◽  
Ryohei Hirose ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Procedure Time ◽  
Resection Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Intramucosal Cancer ◽  
Colorectal Endoscopic Submucosal Dissection ◽  
Severe Fibrosis

Abstract Background and study aims Severe fibrosis poses a challenge in colorectal endoscopic submucosal dissection (ESD). Recently, the pocket-creation method (PCM) has been developed for overcoming various difficulties of ESD. A specific tapered hood is used for adequate traction in the PCM, and endoscopic operability becomes stable in the pocket. In this study, we investigated the efficacy of the PCM in ESD for cases with severe fibrosis. Patients and methods We retrospectively reviewed 1000 consecutive colorectal ESD cases (April 2006 to January 2017). Since 2016, the PCM was performed in 58 cases. The indications for ESD included (1) tumors ≥ 20 mm in size diagnosed as intramucosal cancer or high-grade dysplasia and part of T1a cancer using magnifying endoscopic examinations and (2) tumors that appeared impossible to resect with endoscopic mucosal resection because of suspected fibrosis. We identified 120 cases with severe fibrosis and compared them to cases without severe fibrosis. Additionally, the 120 severe fibrosis cases were divided into the PCM and non-PCM groups. En bloc resection, procedure time, discontinuation, and complications were analyzed between these 2 groups. Results Among all 1000 ESDs, severe fibrosis and discontinuation rates were 12.0 % (120 cases) and 1.8 % (18 cases), respectively. Regarding the comparison between cases with severe fibrosis and with no severe fibrosis, there were significant differences about en bloc resection rate (78.3 % vs. 95.7 %, P < 0.001), discontinuance rate (12.5 % vs. 0.3 %, P < 0.001), and perforation rate (8.3 % vs. 2.6 %, P = 0.001). Among the 120 cases with severe fibrosis, 21 and 99 cases were in the PCM and non-PCM groups, respectively. The PCM group had a higher en bloc resection rate (95.2 vs. 74.7, P =  0.03), a shorter mean procedure time (min) (79.6 ± 26.5 vs. 118.8 ± 71.0, P = 0.001), and no cases of discontinuation. An analysis of the interobserver agreement for the diagnosis of severe fibrosis among the 3 endoscopists showed kappa values of > 0.6. Conclusions In cases with severe fibrosis, the PCM with ESD improved en bloc resection rates and shortened the procedure time compared to the conventional non-PCM method. Additionally, the PCM reduced the discontinuation rate.

FACTORS ASSOCIATED WITH COMPLETE CLIP CLOSURE AFTER ENDOSCOPIC MUCOSAL RESECTION OF LARGE COLORECTAL POLYPS.

Endoscopy ◽  
2020 ◽  
Author(s):  
Oswaldo Ortiz ◽  
Douglas K. Rex ◽  
Grimm Ian ◽  
Matthew Moyer ◽  
Muhammad K Hasan ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Factors Associated ◽  
Mucosal Resection ◽  
Mucosal Defect ◽  
Large Colorectal Polyps ◽  
Clip Closure

Background. Delayed bleeding is a common adverse event following endoscopic mucosal resection (EMR) of large colorectal polyps. Prophylactic clip closure of the mucosal defect after EMR of ≥20 mm non-pedunculated polyps reduces the incidence of severe delayed bleeding, especially in proximal polyps. Aim: Evaluate factors associated with complete prophylactic clip closure of the mucosal defect after EMR of large polyps. Methods: This is a post-hoc analysis of the CLIP STUDY (NCT01936948). All patients randomized to the clip group were included. Main outcome was complete clip closure of the mucosal resection defect. The defect was considered completely closed when there was no remaining visible mucosal defect and clips were <1cm apart. Factors associated with complete closure were evaluated in multivariable analysis. Results: 458 patients (age 65, 58% men) with 494 large polyps were included. Complete clip closure of the resection defect was achieved for 338 polyps (68.4%) and was not complete for 156 (31.6%). Factors associated with complete closure in adjusted analysis were smaller polyp size (OR 1.06 for every mm decrease [1.02-1.08]), good access (OR 3.58 [1.94-9.59]), complete submucosal lifting (OR 2.28 [1.36-3.90]), en bloc resection (OR 5.75 [1.48-22.39]), and serrated histology (OR 2.74 [1.35-5.56]). Conclusions: Complete clip closure was not achieved for almost 1 out of 3 resected large non-pedunculated polyps. While stable access and en bloc resection facilitate clip closure, most factors associated with clip closure are not modifiable and highlight the need for alternative closure options and preventative bleeding measures.

scholarly journals Gastric ESD may be useful as accurate staging and decision of future therapeutic strategy

2017 ◽  
Vol 05 (02) ◽  
pp. E90-E95 ◽  
Author(s):  
Ai Fujimoto ◽  
Osamu Goto ◽  
Toshihiro Nishizawa ◽  
Yasutoshi Ochiai ◽  
Joichiro Horii ◽  
...  
Keyword(s):  
Adverse Events ◽  
Treatment Outcomes ◽  
Preoperative Diagnosis ◽  
Therapeutic Strategy ◽  
Average Length ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Procedure Time ◽  
En Bloc ◽  
Delayed Bleeding

Abstract Background and study aims We sometimes perform gastric endoscopic submucosal dissection (ESD) for total pathologic diagnosis when preoperative diagnosis is difficult. In the present study we analyzed the treatment outcomes and adverse events of diagnostic ESD for early gastric cancer (EGC). Patients and methods We conducted a retrospective analysis of 18 consecutive cases of EGC in 18 patients with a suspected out-of-indication diagnosis who underwent diagnostic ESD, between June 2010 and November 2014. The following parameters were examined: the average length of the longer axis of the lesion; the procedure time; the rates of en bloc resection (ER), complete en bloc resection (CER), and curative resection (CR) as treatment outcomes; and the rates of perforation, delayed bleeding, aspiration pneumonia, disease-related death, and emergency surgery as adverse events. Results The treatment outcomes were as follows: average length of the longer axis of the lesion, 27.4 ± 10.0 mm; procedure time, 87.0 ± 43.1 minutes; ER rate, 18/18 (100.0 %); CER rate, 13/18 (72.2 %); CR rate, 4/18 (22.2 %). CR rate was achieved 37.5 % for the lesions which preoperative diagnosis was more than 30 mm (> 30 mm) in diameter differentiated type with mucosal layer/submucosal layer 1 invasion and ulceration positive. The adverse events (AEs) were perforation in 1 of 18 (5.5 %) patients and delayed bleeding in 1 of 18 (5.5 %). There were no other AEs. Conclusions Diagnostic ESD may be acceptable for future therapeutic strategy when we unconfirmed the pre ESD diagnosis because of lower rate of adverse events and high rate of ER.

scholarly journals Pedunculated colorectal polyps with heads ≤ 1 cm in diameter can be resected using cold snare polypectomy

2021 ◽  
Vol 84 (3) ◽  
Author(s):  
T Kudo ◽  
A Horiuchi ◽  
I Horiuchi ◽  
M Kajiyama ◽  
A Morita ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Total Procedure Time ◽  
Cold Snare Polypectomy ◽  
Immediate Bleeding ◽  
Total Procedure ◽  
Snare Polypectomy

Background and study aims : Cold snare polypectomy (CSP) is not recommended for the resection of pedunculated colorectal polyp. The aim of this study was to examine the adequacy of CSP compared to hot snare polypectomy (HSP) for the complete resection of pedunculated polyps with heads ≤ 1 cm in diameter. Patients and methods : This was a retrospective study of a cohort of consecutive outpatients who had resection of pedunculated polyps with heads 6-10 mm in diameter using either dedicated CSP or HSP from 2014 through 2019. The primary outcome measure was occurrence of delayed bleeding. Secondary outcome measures included total procedure time, en bloc resection rate, immediate bleeding, and number of clips used. Results : 415 patients with 444 eligible polyps were enrolled; the CSP group (363 patients; 386 polyps) and HSP group (52 patients; 58 polyps). Patient characteristics, polyp characteristics and en bloc resection rate were similar between groups. The mean total procedure time and mean number (range) of hemostatic clips/patient used were significantly lower with CSP than with HSP (18± 8 min vs. 25± 9 min, P<0.001; 1.1 ± 0.6 (1-3) vs.3.1 ± 1.6 (1-5), respectively, P<0.001). Delayed bleeding occurred significantly less frequently in the CSP, 0% (0/363 vs.3.8% (2/52) in the HSP group (P<0.001), although immediate bleeding was significantly higher in CSP than HSP (84% (325/386) vs. 12% (7/58), P<0.001). Conclusion : Pedunculated colorectal polyps with heads ≤ 1 cm can be removed using CSP, which has several advantages over HSP.

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