Endoscopic Submucosal Dissection for Visible Dysplasia Treatment in Ulcerative Colitis Patients: Cases Series and Systematic Review of Literature

Abstract Background and Aims Ulcerative colitis [UC] patients are at an increased risk of developing colorectal cancer due to chronic inflammation. Endoscopic submucosal dissection [ESD] allows removal of non-invasive neoplastic lesions in the colon, but few data are available on its efficacy in UC patients. Methods Data from consecutive UC patients diagnosed with visible dysplastic lesions in the colon who underwent ESD were evaluated. The en bloc removal, R0 resection and complication rates were calculated. Local recurrence and metachronous lesions during follow-up were identified. A systematic review of the literature with pooled data analysis was performed. Results A total of 53 UC patients [age: 65 years; range 30–74; M/F: 31/22] underwent ESD. The en bloc resection rate was 100%, and the R0 resection rate was 96.2%. Bleeding occurred in seven [13.2%] patients, and perforation in three [5.6%] cases, all treated at endoscopy. No recurrence was observed, but two metachronous lesions were detected. Data from six other studies [three Asian and three European] were available. By pooling data, en bloc resection was successful in 88.4% (95% confidence interval [CI] = 83.5–92) of 216 lesions and in 91.8% [95% CI = 87.3–94.8] of 208 patients. R0 resection was achieved in 169 ESDs, equivalent to a 78.2% [95% CI = 72.3–83.2] rate for lesions and 81.3% [95% CI = 75.4–86] rate for patients. No difference between European and Asian series was noted. Conclusions This pooled data analysis indicated that ESD is a suitable tool for safely and properly removing non-invasive neoplastic lesions on colonic mucosa of selected UC patients.

Download Full-text

High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

Endoscopy International Open ◽

10.1055/a-0965-8531 ◽

2019 ◽

Vol 07 (09) ◽

pp. E1166-E1174 ◽

Cited By ~ 9

Author(s):

Jérémie Jacques ◽

Aurélie Charissoux ◽

Pierre Bordillon ◽

Romain Legros ◽

Jérôme Rivory ◽

...

Keyword(s):

Case Series ◽

Rubber Band ◽

En Bloc Resection ◽

Bloc Resection ◽

Point Of View ◽

University Hospital ◽

Control Group ◽

R0 Resection ◽

Resection Rate ◽

En Bloc

Abstract Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.

Download Full-text

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

Endoscopy ◽

10.1055/a-1234-8918 ◽

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.

Download Full-text

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.

Download Full-text

Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type

Endoscopy International Open ◽

10.1055/s-0042-122778 ◽

2017 ◽

Vol 05 (02) ◽

pp. E123-E129 ◽

Cited By ~ 38

Author(s):

Hirotsugu Sakamoto ◽

Yoshikazu Hayashi ◽

Yoshimasa Miura ◽

Satoshi Shinozaki ◽

Haruo Takahashi ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

En Bloc Resection ◽

Bloc Resection ◽

R0 Resection ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Novel Strategy ◽

Laterally Spreading Tumors ◽

Severe Fibrosis

Abstract Background and study aims The pocket-creation method (PCM) is a novel strategy for endoscopic submucosal dissection (ESD). The aim of this study is to determine the efficacy of the PCM for colorectal laterally spreading tumors, non-granular type (LST-NG). Patients and methods The records of 126 consecutive patients with colorectal LST-NG who underwent ESD between April 2012 and July 2015 were retrospectively reviewed. Patients were divided into PCM (n = 73) and conventional method (CM) (n = 53) groups. Results The en bloc resection rate in the PCM group was significantly higher than in the CM group (100 % [73/73] vs. 92 % [49/53], P = 0.03). The en bloc resection rate with severe fibrosis was higher in the PCM group than in the CM group (100 % [3/3] vs. 60 % [3/5]). The R0 resection rate for the two groups was not statistically significantly different (93 % [68/73] vs. 91 % [48/53], P = 0.74). The perforation rate in the PCM group was lower than in the CM group although not statistically significantly less (0 % 0/73 vs. 4 % 2/53, P = 0.18). For lesions resected en bloc, dissection speed for the PCM group was significantly faster than for the CM group (median [IQR], 19 [13 –24] vs. 14 [10 – 22] mm2/min, P = 0.03). Conclusion ESD using PCM achieves a reliable and safe resection of colorectal LST-NG.

Download Full-text

A89 IMPLEMENTING ENDOSCOPIC SUBMUCOSAL DISSECTION IN A WESTERN CANADIAN SETTING: OUTCOMES, LEARNING CURVE AND LOGISTICAL CONSIDERATIONS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.088 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 103-104

Author(s):

R Trasolini ◽

B Zhao ◽

D Chahal ◽

E Lam

Keyword(s):

Gastric Cancer ◽

British Columbia ◽

Endoscopic Submucosal Dissection ◽

En Bloc Resection ◽

Bloc Resection ◽

R0 Resection ◽

Resection Rate ◽

Surgical Time ◽

En Bloc ◽

Canadian Setting

Abstract Background Endoscopic submucosal dissection (ESD) is an advanced resection technique for large gastrointestinal lesions. ESD was developed in Japan and is popular in countries with gastric cancer screening and a high incidence of gastric cancer. ESD has benefits over endoscopic mucosal resection (EMR) such as increased complete resection, en bloc resection and lower recurrence. However, ESD is a longer procedure and is difficult to master in countries with low incidence of early gastric neoplasia which is the ideal anatomic location for learning. There is increasing interest in using ESD techniques including hybrid ESD/EMR in western centers. Barriers include procedure time, perforation risk and challenges accumulating sufficient experience. Aims To present our experience implementing an ESD program in British Columbia including outcomes and logistical considerations of interest. Methods All ESD procedures since implementation of the program in May 2015 to July 2019 were included. Descriptive statistics and performance indicators over time are reported. All procedures were performed by a staff endoscopist after specialized training. Procedures were performed at two hospitals in British Columbia. Cases were referred from endoscopists and were assessed with dedicated endoscopy with or without endoscopic ultrasound prior to booking ESD. Results 40 procedures were performed, though only one procedure was performed in the first year (Mean age 70, 67.5% male). ASA class ranged from 1–4 (mean 2.08). 22 lesions were gastric, 13 were rectal, with the remainder throughout the colon. Mean lesion size was 25mm in maximum dimension (interquartile range 15-30mm). 18 procedures were performed under general anesthesia and the remainder using procedural sedation. Total surgical time ranged from 22 to 398 minutes. Mean surgical time was 104 minutes, or 126 minutes including anesthesia. 50% of procedures were performed using hybrid ESD/EMR technique. R0 resection rate across all cases was 68% (60% for hybrid procedures, 80% for strict ESD). En bloc resection rate was 60%. Recurrence rate was 10%. Complication rate was 7.5% all were post-procedure bleeds requiring hospitalization. No perforations occurred. 3 patients required surgery for incomplete resection or invasive cancer on pathology, 3 required repeat endoscopic resection. Surgical time per cm of lesion improved significantly from the first 10 cases to the last 10 (time per cm resected 75 min to 32 min p<0.006). Conclusions ESD is an effective therapy for GI neoplasia. ESD is feasible in a Canadian setting. Hybrid techniques tend to be faster though at the expense of R0 resection. Patient centered outcomes in this sample are favorable and comparable to large ESD series. Monitoring of ESD quality is critical for comparison with standard of care as experience with ESD in Canada grows. Funding Agencies None

Download Full-text

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

Endoscopy ◽

10.1055/a-1266-1855 ◽

2020 ◽

Author(s):

Thomas R. McCarty ◽

Ahmad Najdat Bazarbashi ◽

Christopher C. Thompson ◽

Hiroyuki Aihara

Keyword(s):

Systematic Review ◽

Endoscopic Submucosal Dissection ◽

Meta Analysis ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Subgroup Analyses ◽

Procedure Duration

Abstract Background Hybrid endoscopic submucosal dissection (ESD) is increasingly utilized to overcome the complexity of conventional ESD. This systematic review and meta-analysis evaluated the efficacy and safety of hybrid ESD for treatment of colorectal lesions. Methods Search strategies were developed in accordance with PRISMA guidelines. Pooled proportions were calculated with rates estimated using random effects models. Measured outcomes included en bloc resection, procedure-associated complications, recurrence, and need for surgery. Subgroup analyses were performed to compare effectiveness of conventional versus hybrid ESD. Results 16 studies (751 patients) were included with a mean (standard deviation [SD]) lesion size of 27.96 (10.55) mm. En bloc resection rate was 81.63 % (95 % confidence interval [CI] 72.07 – 88.44; I2 = 80.89). Complications, recurrences, and need for surgery occurred in 7.74 % (95 %CI 4.78 – 12.31; I2 = 65.84), 4.52 % (95 %CI 1.40 – 13.65; I2 = 76.81), and 3.64 % (95 %CI 1.76 – 7.37; I2 = 15.52), respectively. Mean procedure duration was 48.83 (22.37) minutes. On subgroup analyses comparing outcomes for conventional (n = 1703) versus hybrid ESD (n = 497), procedure duration was significantly shorter for hybrid ESD (mean difference 18.45 minutes; P = 0.003), with lower complication rates (P = 0.04); however, hybrid ESD had lower en bloc resection rates (P < 0.001). There was no difference in rates of recurrence or surgery (P > 0.05). Conclusion While hybrid ESD was safe and effective for removal of colorectal lesions, with shorter procedure duration, fewer complications, and no difference in recurrence versus conventional ESD, hybrid ESD was associated with a lower en bloc resection rate.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.192 ◽

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

Download Full-text

Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

Journal of Clinical Medicine ◽

10.3390/jcm10112511 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2511

Author(s):

Yoshitsugu Misumi ◽

Kouichi Nonaka

Keyword(s):

Endoscopic Submucosal Dissection ◽

Endoscopic Mucosal Resection ◽

Endoscopic Resection ◽

En Bloc Resection ◽

Bloc Resection ◽

Resection Rate ◽

En Bloc ◽

Educational Methods ◽

Submucosal Dissection ◽

Management Of Complications

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.

Download Full-text