Submucosal endoscopy – a novel approach to en bloc endoscopic mucosal resection

Background: 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. Summary: Endoscopic treatment is now regarded as first-line therapy for benign lesions. Key Message: Endoscopic resection of dysplastic lesions or early stages of cancer is recommended. A plethora of different techniques can be used dependent on the lesions.

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Higher rate of en bloc resection with underwater than conventional endoscopic mucosal resection: A meta-analysis

Digestive and Liver Disease ◽

10.1016/j.dld.2021.05.001 ◽

2021 ◽

Author(s):

Georgios Tziatzios ◽

Paraskevas Gkolfakis ◽

Konstantinos Triantafyllou ◽

Lorenzo Fuccio ◽

Antonio Facciorusso ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Meta Analysis ◽

En Bloc Resection ◽

Bloc Resection ◽

En Bloc ◽

Mucosal Resection

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Anchoring the snare tip is a feasible endoscopic mucosal resection method for small rectal neuroendocrine tumors

Scientific Reports ◽

10.1038/s41598-021-92462-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jeongseok Kim ◽

Jisup Kim ◽

Eun Hye Oh ◽

Nam Seok Ham ◽

Sung Wook Hwang ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Neuroendocrine Tumors ◽

Similar Efficacy ◽

En Bloc Resection ◽

Lesion Size ◽

Bloc Resection ◽

En Bloc ◽

Delayed Bleeding ◽

Mucosal Resection ◽

The Mean

AbstractSmall rectal neuroendocrine tumors (NETs) can be treated using cap-assisted endoscopic mucosal resection (EMR-C), which requires additional effort to apply a dedicated cap and snare. We aimed to evaluate the feasibility of a simpler modified endoscopic mucosal resection (EMR) technique, so-called anchored snare-tip EMR (ASEMR), for the treatment of small rectal NETs, comparing it with EMR-C. We retrospectively evaluated 45 ASEMR and 41 EMR-C procedures attempted on small suspected or established rectal NETs between July 2015 and May 2020. The mean (SD) lesion size was 5.4 (2.2) mm and 5.2 (1.7) mm in the ASEMR and EMR-C groups, respectively (p = 0.558). The en bloc resection rates of suspected or established rectal NETs were 95.6% (43/45) and 100%, respectively (p = 0.271). The rates of histologic complete resection of rectal NETs were 94.1% (32/34) and 88.2% (30/34), respectively (p = 0.673). The mean procedure time was significantly shorter in the ASEMR group than in the EMR-C group (3.12 [1.97] vs. 4.13 [1.59] min, p = 0.024). Delayed bleeding occurred in 6.7% (3/45) and 2.4% (1/41) of patients, respectively (p = 0.618). In conclusion, ASEMR was less time-consuming than EMR-C, and showed similar efficacy and safety profiles. ASEMR is a feasible treatment option for small rectal NETs.

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Endoscopic resection outcomes and predictors of failed en bloc endoscopic mucosal resection of colorectal polyps ≤ 20 mm among advanced endoscopy trainees

Endoscopy International Open ◽

10.1055/a-1578-1965 ◽

2021 ◽

Vol 09 (11) ◽

pp. E1820-E1826

Author(s):

William W. King ◽

Peter V. Draganov ◽

Andrew Y. Wang ◽

Dushant Uppal ◽

Amir Rumman ◽

...

Keyword(s):

Multivariate Analysis ◽

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Lesion Size ◽

Bloc Resection ◽

Colorectal Polyps ◽

Polyp Size ◽

En Bloc ◽

Mucosal Resection ◽

Piecemeal Resection

Abstract Background and study aims En bloc endoscopic mucosal resection (EMR) is preferred over piecemeal resection for polyps ≤ 20 mm. Data on colorectal EMR training are limited. We aimed to evaluate the en bloc EMR rate of polyps ≤ 20 mm among advanced endoscopy trainees and to identify predictors of failed en bloc EMR. Methods This was a multicenter prospective study evaluating trainee performance in EMR during advanced endoscopy fellowship. A logistic regression model was used to identify the number of procedures and lesion cut-off size associated with an en bloc EMR rate of ≥ 80 %. Multivariate analysis was performed to identify predictors of failed en bloc EMR. Results Six trainees from six centers performed 189 colorectal EMRs, of which 104 (55 %) were for polyps ≤ 20 mm. Of these, 57.7 % (60/104) were resected en bloc. Trainees with ≥ 30 EMRs (OR 6.80; 95 % CI: 2.80–16.50; P = 0.00001) and lesions ≤ 17 mm (OR 4.56;95 CI:1.23–16.88; P = 0.02) were more likely to be associated with an en bloc EMR rate of ≥ 80 %. Independent predictors of failed en bloc EMR on multivariate analysis included: larger polyp size (OR:6.83;95 % CI:2.55–18.4; P = 0.0001), right colon location (OR:7.15; 95 % CI:1.31–38.9; P = 0.02), increased procedural difficulty (OR 2.99; 95 % CI:1.13–7.91; P = 0.03), and having performed < 30 EMRs (OR: 4.87; 95 %CI: 1.05–22.61; P = 0.04). Conclusions In this pilot study, we demonstrated that a relatively low proportion of trainees achieved en bloc EMR for polyps ≤ 20 mm and identified procedure volume and lesion size thresholds for successful en bloc EMR and independent predictors for failed en bloc resection. These preliminary results support the need for future efforts to define EMR procedure competence thresholds during training.

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Risk factors for colon adenomas recurrence after endoscopic mucosal resection

Koloproktologia ◽

10.33878/2073-7556-2021-20-1-10-16 ◽

2021 ◽

Vol 20 (1) ◽

pp. 10-16

Author(s):

Yu. E. Vaganov ◽

V. V. Veselov ◽

A. A. Likutov ◽

E. A. Khomyakov ◽

S. V. Chernyshov ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Mucosal Resection ◽

Disease Recurrence ◽

Morbidity Rate ◽

Severe Dysplasia ◽

En Bloc ◽

Mucosal Resection ◽

Colon Adenomas ◽

Independent Risk Factors ◽

Mucosal Fold

Aim: to identify risk factors for neoplasms recurrence removed by endoscopic mucosal resection (EMR).Patients and methods: the single-center retrospective observational study included 207 patients with 260 benign colon neoplasms. There were 95 (45.9%) males and 112 (54.1%) females. The median age of the patients was 67 (27-80) years. The results obtained were assessed using following criteria: morbidity rate, complication type, hospital stay, tumor site, number of neoplasms in colon, lateral growth, fragmentation rate, technical difficulties (mucosal fold convergence)during surgery, grade of dysplasia, recurrence rate.Results: intraoperative fragmentation of the neoplasms during mucosectomy occurred in 48/260 (18.5%) cases. Postoperative complications within the period of up to 30 days occurred in 13/207 (6.3%) patients. The most frequent 9 (4.2%) postoperative complication arising after mucosectomy was post-polypectomy syndrome. Another 4 (2.0%) patients produced bleeding after the surgery, which required repeated endoscopic procedure. No mortality occurred. The tumor size exceeding 25 mm (Exp (B) = 0.179; 95% CI = 0.05-0.7; p = 0.014), severe dysplasia (Exp (B) = 0.113; 95% CI = 0.03-0.4; p = 0.001) and fold convergence (Exp (B) = 0.2; 95% CI = 0.07-0.7; p = 0.015) are independent risk factors for disease recurrence.Conclusion: mucosectomy is indicated for colon adenomas if its size does not exceed 25 mm and can be removed en bloc.

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Efficacy of precutting endoscopic mucosal resection with full or partial circumferential incision using a snare tip for difficult colorectal lesions

Endoscopy ◽

10.1055/a-0956-6879 ◽

2019 ◽

Vol 51 (09) ◽

pp. 871-876 ◽

Cited By ~ 4

Author(s):

Naohisa Yoshida ◽

Ken Inoue ◽

Osamu Dohi ◽

Ritsu Yasuda ◽

Ryohei Hirose ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Complete Resection ◽

Benign Lesions ◽

Resection Rate ◽

En Bloc ◽

Mucosal Resection ◽

Therapeutic Outcomes ◽

Mucosal Incision

Abstract Background We analyzed the efficacy of precutting endoscopic mucosal resection (EMR), which is a method of making a full or partial circumferential mucosal incision around a tumor with a snare tip for en bloc resection. Methods We reviewed cases from 2011 to 2018 in which precutting EMR (n = 167) and standard EMR (n = 557) were performed for lesions of 10 – 30 mm. Precutting EMR was indicated for benign lesions of 20 – 30 mm or lesions of < 20 mm for which standard EMR was difficult. Through propensity score matching of the two groups, the therapeutic outcomes for 35 lesions of ≥ 20 mm and 98 lesions of < 20 mm in each group were analyzed. Results In the two sizes of lesion, there were significant differences between the precutting and standard groups in the en bloc resection rate (≥ 20 mm 88.6 % vs. 48.5 %, P < 0.001; < 20 mm 98.0 % vs. 85.7 %, P = 0.004) and the histological complete resection rate (≥ 20 mm 71.4 % vs. 42.9 %, P = 0.02; < 20 mm 87.8 % vs. 67.3 %, P < 0.001). Conclusion Precutting EMR enabled high en bloc resection rates in cases involving difficult lesions.

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