scholarly journals Hybrid endoscopic mucosal resection and full-thickness resection for large colonic polyps harboring a small focus of invasive cancer: a case series

2021 ◽  
Vol 09 (11) ◽  
pp. E1686-E1691
Author(s):  
Jamie S. Chua ◽  
Hao Dang ◽  
Liselotte W. Zwager ◽  
Nik Dekkers ◽  
James C. H. Hardwick ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Case Series ◽  
Colonic Polyps ◽  
Full Thickness ◽  
Surveillance Colonoscopy ◽  
Noninvasive Treatment ◽  
Mucosal Resection ◽  
Endoscopic Full Thickness Resection ◽  
Small Focus

AbstractEndoscopic 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.

scholarly journals Asymptomatic free gas post Endoscopic Mucosal Resection (EMR) - Is surgical intervention always necessary?

2020 ◽  
pp. 19-26
Author(s):  
Shafquat Zaman ◽  
Hayaka Amada ◽  
Pratik Bhattachayra ◽  
Stephen Stonelake ◽  
Mark Goldstein ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Surgical Intervention ◽  
Bowel Perforation ◽  
Case Series ◽  
Colonic Polyps ◽  
Cost Effective ◽  
Direct Result ◽  
Free Gas ◽  
Mucosal Resection ◽  
Emergency Surgical Intervention

Background& Objectives Endoscopic mucosal resection (EMR) is an efficient, cost-effective and minimally-invasive mode of treatment of colonic polyps. Colonic perforation post EMR is one of the potential complications associated with this procedure. Some patients may present with asymptomatic free gas on imaging and therefore not necessarily require intervention. Methods We present a case series of patients undergoing EMR who were found to have intra-abdominal free gas or ‘bowel perforation’ on imaging post procedure. They were all asymptomatic and did not warrant emergency surgical intervention. In addition, we aim to provide a review of the existing literature on ‘bowel perforation’ post EMR and discuss its management. Results & Conclusion Through this case series we highlight the importance of assessing patients clinically and not treating the radiological findings alone. Clinicians must be aware of the possibility of patients with asymptomatic free gas post EMR as a direct result of the injectate during the procedure or due to the passage of air or CO2 from the distended colon. As the popularity of this procedure increases, it is crucial that clinicians, surgeons and endoscopists are all aware of its associated complications.

scholarly journals Risk factors associated with adenoma recurrence following cold snare endoscopic mucosal resection of polyps ≥ 20 mm: a retrospective chart review

2021 ◽  
Vol 09 (06) ◽  
pp. E867-E873
Author(s):  
Suraj Suresh ◽  
Jinyu Zhang ◽  
Abdelwahab Ahmed ◽  
Mouhanna Abu Ghanimeh ◽  
Ahmed Elbanna ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endoscopic Mucosal Resection ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Surveillance Colonoscopy ◽  
Factors Associated ◽  
Adenoma Recurrence ◽  
Mucosal Resection ◽  
Risk Factors For Recurrence

Abstract Background and study aims Cold snare endoscopic mucosal resection (EMR) is being increasingly utilized for non-pedunculated polyps ≥ 20 mm due to adverse events associated with use of cautery. Larger studies evaluating adenoma recurrence rate (ARR) and risk factors for recurrence following cold snare EMR of large polyps are lacking. The aim of this study was to define ARR for polyps ≥ 20 mm removed by cold snare EMR and to identify risk factors for recurrence. Patients and methods A retrospective chart review of colon cold snare EMR procedures performed between January 2015 and July 2019 at a tertiary care medical center was performed. During this period, 310 non-pedunculated polyps ≥ 20 mm were excised using cold snare EMR with follow-up surveillance colonoscopy. Patient demographic data as well as polyp characteristics at the time of index and surveillance colonoscopy were collected and analyzed. Results A total of 108 of 310 polyps (34.8 %) demonstrated adenoma recurrence at follow-up colonoscopy. Patients with a higher ARR were older (P = 0.008), had endoscopic clips placed at index procedure (P = 0.017), and were more likely to be Asian and African American (P = 0.02). ARR was higher in larger polyps (P < 0.001), tubulovillous adenomas (P < 0.001), and polyps with high-grade dysplasia (P = 0.003). Conclusions Although cold snare EMR remains a feasible alternative to hot snare polypectomy for resection of non-pedunculated polyps ≥ 20 mm, endoscopists must also carefully consider factors associated with increased ARR when utilizing this technique.

Current Endoscopic Resection Techniques for Gastrointestinal Lesions: Endoscopic Mucosal Resection, Submucosal Dissection, and Full-Thickness Resection

2021 ◽  
pp. 1-14
Author(s):  
Arthur Hoffman ◽  
Raja Atreya ◽  
Timo Rath ◽  
Markus Ferdinand Neurath
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
Complication Rates ◽  
Full Thickness ◽  
National Guidelines ◽  
En Bloc ◽  
Early Stages ◽  
Mucosal Resection ◽  
Submucosal Dissection ◽  
Gastrointestinal Lesions

<b><i>Background:</i></b> Endoscopic resection of dysplastic lesions in early stages of cancer reduces mortality rates and is recommended by many national guidelines throughout the world. Snare polypectomy and endoscopic mucosal resection (EMR) are established techniques of polyp removal. The advantages of these methods are their relatively short procedure times and acceptable complication rates. The latter include delayed bleeding in 0.9% and a perforation risk of 0.4–1.3%, depending on the size and location of the resected lesion. EMR is a recent modification of endoscopic resection. A limited number of studies suggest that larger lesions can be removed en bloc with low complication rates and short procedure times. Novel techniques such as endoscopic submucosal dissection (ESD) are used to enhance en bloc resection rates for larger, flat, or sessile lesions. Endoscopic full-thickness resection (EFTR) is employed for non-lifting lesions or those not easily amenable to resection. Procedures such as ESD or EFTR are emerging standards for lesions inaccessible to EMR techniques. <b><i>Summary:</i></b> Endoscopic treatment is now regarded as first-line therapy for benign lesions. <b><i>Key Message:</i></b> Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.

scholarly journals Clinical and financial impacts of introducing an endoscopic mucosal resection service for treatment of patients with large colonic polyps into a regional tertiary hospital

2019 ◽  
Vol 07 (11) ◽  
pp. E1386-E1392
Author(s):  
Thomas Worland ◽  
Oliver Cronin ◽  
Benjamin Harrison ◽  
Linda Alexander ◽  
Nik Ding ◽  
...  
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Surgical Procedures ◽  
Colonic Polyps ◽  
Tertiary Hospital ◽  
Safe Alternative ◽  
Intention To Treat ◽  
Mucosal Resection ◽  
Regional Center ◽  
Financial Benefits ◽  
Number Of Patients

Abstract Background and study aims Endoscopic mucosal resection (EMR) of large sessile or laterally spreading colonic lesions is a safe alternative to surgery. We assessed reductions in Surgical Resection (SR) rates and associated clinical and financial benefits following the introduction of an EMR service to a large regional center. Patients and methods Ongoing prospective intention-to-treat analysis of EMR was undertaken from time of service inception in 2009 to 2017. Retrospective data for SR of large sessile/laterally spreading colonic lesions were collected for the period 4 years before commencement of the EMR service (2005 – 2008) and 9 years after its introduction (2009 – 2017). Results From 2005 to 2008, 32 surgical procedures were performed for non-malignant colonic neoplasia (50 % male, median age 68 years, median Length of Stay (LoS) 10 days). Following the introduction of the EMR service, there was a 56 % reduction in the number of patients referred for surgery (32 surgical procedures, 47 % male, median age 70 years, median LoS 8.5 days). During this period, EMR was successfully performed in 183 patients with 216 lesions resected (60 % male, median age 68 years, median LoS 1 day). Compared to the SR group, the EMR cohort had a lower peri-procedural complication rate (7.7 % vs 54.7 %, P < 0.0001), and shorter average LoS (1 vs 9 days, P < 0.0001). A cost saving of AUD $ 19 543.5 was seen per lesion removed with EMR compared to SR. Conclusions The introduction of a dedicated EMR service into a large regional center as an alternative to SR can lead to a substantial decrease in unnecessary surgery with subsequent clinical and financial benefits.

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