Submucosal Injection Solution for Endoscopic Resection in Gastrointestinal Tract: A Traditional and Network Meta-Analysis

Objective. To explore and define the current optimal submucosal injection solution used in ESD and EMR for gastrointestinal tract neoplasms in terms of clinical outcomes and other aspects.Methods. PubMed, Cochrane Library, Embase, and clinical trials register center were searched with terms of “endoscopic resection” and “submucosal injection solution” to identify relevant randomized controlled trials (RCTs). Both direct comparison using traditional meta-analysis method and indirect comparison using network meta-analysis method were performed.Results. A total of 11 RCTs with 1152 patients were included. Meta-analysis showed that, compared with normal saline, other submucosal injection solutions induced a significant increase in terms ofen blocresection rate(I2=0%, OR = 2.11, 95% CI (1.36, 3.26), andP= 0.008)and complete resection rate(I2=0%, OR = 2.14, 95% CI (1.41, 3.24), andP= 0.0003); and there was no significant difference in the incidence of total complications(I2=0%, OR = 0.87, 95% CI (0.59, 1.29), andP= 0.49).Conclusions. Other newly developed submucosal injection solutions significantly increaseden blocresection rate and complete resection rate and decreased bleeding rate and finical cost of endoscopic resection in gastrointestinal tract, while current evidence did not find the difference between them, which need to be explored by further studies.

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ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis

Endoscopy International Open ◽

10.1055/a-0579-9050 ◽

2018 ◽

Vol 06 (08) ◽

pp. E998-E1007 ◽

Cited By ~ 6

Author(s):

Enrique Pérez-Cuadrado-Robles ◽

Lucille Quénéhervé ◽

Walter Margos ◽

Tom G. Moreels ◽

Ralph Yeung ◽

...

Keyword(s):

Systematic Review ◽

Local Recurrence ◽

Meta Analysis ◽

Random Effect ◽

Complete Resection ◽

Cochrane Library ◽

Resection Rate ◽

En Bloc ◽

Delayed Bleeding ◽

The Impact

Abstract Background and study aims Endoscopic submucosal dissection (ESD) has been developed as an option for treatment of esophageal, gastric and colorectal lesions. However, there is no consensus on the role of ESD in duodenal tumors. Methods This systematic review and meta-analysis compared ESD and endoscopic mucosal resection (EMR) in sporadic non-ampullary superficial duodenal tumors (NASDTs), including local experience. We conducted a search in PubMed, Scopus and the Cochrane library up to August 2017 to identify studies that compared both techniques reporting at least one main outcome (en-bloc/complete resection, local recurrence). Pooled outcomes were calculated under fixed and random-effect models. Subgroup analyses were conducted. Results A total of 753 patients presenting with 784 NASDTs (242 ESD, 542 EMR) in 14 studies were included. Tumor size (MD: 5.88, [CI95 %: 2.15, 9.62], P = 0.002, I2 = 79 %) and procedure time (MD: 65.65, [CI95 %: 40.39, 90.92], P < 0.00001, I2 = 88 %) were greater in the ESD group. En-bloc resection rate was significantly higher in Asian studies (OR: 2.16 [CI95 %: 1.15, 4.08], P = 0.02, I2: 46 %). ESD provided a higher complete resection rate (OR: 1.63 [I95 %: 1.06, 2.50], P = 0.03, I2: 59 %), but there was no risk difference in the risk of local recurrence (RD: – 0.03 [CI95 %: – 0.07, 0.01], P = 0.15, I2: 0 %) or delayed bleeding. ESD was associated with an increased number of intraoperative perforations [RD: 0.12 (CI95 %: 0.04, 0.20), P = 0.002, I2: 56 %] and emergency surgery for delayed perforations. The inclusion of eligible studies was limited to retrospective series with inequalities in comparative groups. Conclusions Duodenal ESD for NASDTs may achieve higher en-bloc and complete resections at the expense of a greater perforation rate compared to EMR. The impact on local recurrence remains uncertain.

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Analysis of factors associated with local recurrence after endoscopic resection of gastric epithelial dysplasia

10.21203/rs.2.13763/v3 ◽

2020 ◽

Author(s):

Min Kyung Back ◽

Hee Seok Moon ◽

In Sun Kwon ◽

Jae Ho Park ◽

Ju Seok Kim ◽

...

Keyword(s):

Local Recurrence ◽

Recurrence Rate ◽

Endoscopic Resection ◽

Local Recurrence Rate ◽

Complete Resection ◽

Epithelial Dysplasia ◽

Resection Rate ◽

Factors Associated ◽

Complete Resection Rate ◽

Increased Risk

Abstract Background: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are widely used techniques for the treatment of gastric epithelial dysplasia. Previous studies have compared the clinical outcome of endoscopic resection for early gastric cancer, but few studies have focused on gastric dysplasia alone. This study aimed to evaluate the long-term prognosis following endoscopic procedures for gastric epithelial dysplasia, investigate differences in local recurrence rates according to the treatment modality, and identify risk factors associated with local recurrence. Methods: In this retrospective study, local recurrence rates and risk factors associated with local recurrence were compared between 599 patients who underwent EMR and 306 who underwent ESD for gastric epithelial dysplasia from January 2011 to December 2015.Results: The en bloc resection rate (32.2% vs. 100%, p<0.001) and complete resection rate (94.8% vs. 99.0%, p=0.003) were significantly lower in the EMR group than in the ESD group. The local recurrence rate was significantly lower in the ESD group (1.3%) than in the EMR group (4.2%; p=0.026). There was a significantly increased risk of local recurrence, regardless of lesion location or histologic grade, in patients with lesions >2 cm (p=0.002) or red in color (p=0.03). The ESD group had a significantly lower local recurrence rate, with a higher complete resection rate, than that in the EMR group (p<0.05). In the case of recurrence after endoscopic resection, most of the recurred lesions were removed through additional endoscopic procedures; there was no difference between the two groups ( p=0.153).Conclusions: The complete resection rate was significantly higher, and the local recurrence rate was significantly lower, in patients with gastric epithelial dysplasia treated with ESD. Therefore, ESD should be considered the preferred treatment in patients with lesions >2 cm or showing redness due to an increased risk of local recurrence and EMR may be possible for low-grade dysplasia that is less than 2 cm without surface changes such as redness, depression and nodularity.

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High complete resection rate for pre-lift and cold biopsy of diminutive colorectal polyps

Endoscopy International Open ◽

10.1055/s-0043-121874 ◽

2018 ◽

Vol 06 (02) ◽

pp. E173-E178 ◽

Cited By ~ 2

Author(s):

Sam O’Connor ◽

Trevor Brooklyn ◽

Paul Dunckley ◽

Roland Valori ◽

Ruth Carr ◽

...

Keyword(s):

Screening Program ◽

Final Analysis ◽

Colorectal Polyps ◽

Complete Resection ◽

Histopathological Analysis ◽

Complication Rates ◽

Biopsy Forceps ◽

Resection Rate ◽

En Bloc ◽

Complete Resection Rate

Abstract Background and study aims The majority of polyps removed at colonoscopy are diminutive (≤ 5 mm) to small (< 10 mm) and there are few guidelines for the best way for these polyps to be removed. We aimed to assess the feasibility and effectiveness of cold biopsy forceps polypectomy with pre-lift (CBPP) for polyps ≤ 7 mm. Our aims were to assess completeness of histological resection of this technique, to identify factors contributing to this and assess secondary considerations such as timing, retrieval and complication rates. Patients and methods We conducted a prospective cohort study on consecutive patients receiving a colonoscopy at Cheltenham General Hospital, as part of the National Bowel Cancer Screening Program (BCSP) in England. The study included only polyps that were judged as ≤ 7 mm by the colonoscopist. A small sub-mucosal pre-lift injection was administered prior to removal of the polyp using cold biopsy forceps. One or more biopsies were taken until the polyp was confidently assessed visually as being completely removed by the colonoscopist. The entire polypectomy site was then removed en bloc by endomucosal resection (EMR) with a margin of at least 1 to 2 mm around defect. This was sent for histopathological analysis to assess completeness of resection. Polypectomy timing, tissue retrieval, number of bites required for visual resection and complications were recorded at the time of the procedure. Results Sixty-four patients were recruited and consented. Of them, 42 patients had a total of 60 polyps resected. Three patients had inflammatory polyps and were excluded from the study, leaving 57/60 polyps for final analysis. Seventeen were hyperplastic and 40 adenomatous polyps. Retrieval was complete for all 57 polyps and there were no complications both during or post- polypectomy. The complete resection rate (CRR) was 86 %. The technique was more effective in smaller polyps with 91.7 % of diminutive polyps (≤ 5 mm) completely excised. Conclusions CBPP is a safe and highly effective technique for polyps < 5 mm with a high complete resection and retrieval rate. The time taken for the procedure is significantly greater than cold forceps alone, or cold snare as seen in other studies.

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Endoscopic Resection for Small Rectal Neuroendocrine Tumors: Comparison of Endoscopic Submucosal Resection with Band Ligation and Endoscopic Submucosal Dissection

Gastroenterology Research and Practice ◽

10.1155/2016/6198927 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Byoung Wook Bang ◽

Jin Seok Park ◽

Hyung Kil Kim ◽

Yong Woon Shin ◽

Kye Sook Kwon ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Endoscopic Resection ◽

Complete Resection ◽

Procedure Time ◽

Resection Rate ◽

Band Ligation ◽

Endoscopic Submucosal Resection ◽

Submucosal Dissection ◽

Complete Resection Rate ◽

Submucosal Resection

Background and Aims. There is no consensus so far regarding the optimal endoscopic method for treatment of small rectal neuroendocrine tumor (NET). The aim of this study was to compare treatment efficacy, safety, and procedure time between endoscopic submucosal resection with band ligation (ESMR-L) and endoscopic submucosal dissection (ESD).Methods. We conducted a prospective study of patients who visited Inha University Hospital for endoscopic resection of rectal NET (≦10 mm). Pathological complete resection rate, procedure time, and complications were evaluated.Results. A total of 77 patients were treated by ESMR-L (n=53) or ESD (n=24). En bloc resection was achieved in all patients. A significantly higher pathological complete resection rate was observed in the ESMR-L group (53/53, 100%) than in the ESD group (13/24, 54.2%) (P=0.000). The procedure time of ESD (17.9±9.1 min) was significantly longer compared to that of ESMR-L (5.3±2.8 min) (P=0.000).Conclusions. Considering the clinical efficacy, technical difficulty, and procedure time, the ESMR-L method should be considered as the first-line therapy for the small rectal NET (≤10 mm). ESD should be left as a second-line treatment for the fibrotic lesion which could not be removed using the ESMR-L method.

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Comparison of different endoscopic resection techniques for submucosal tumors originating from muscularis propria at the esophagogastric junction

BMC Gastroenterology ◽

10.1186/s12876-019-1099-5 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Hong-wei Xu ◽

Qi Zhao ◽

Shu-xia Yu ◽

Ying Jiang ◽

Jing-hua Hao ◽

...

Keyword(s):

Endoscopic Resection ◽

Tumor Recurrence ◽

Esophagogastric Junction ◽

Muscularis Propria ◽

Operation Time ◽

Complete Resection ◽

Resection Rate ◽

Submucosal Tunneling Endoscopic Resection ◽

Submucosal Tumors ◽

Complete Resection Rate

Abstract Background To compare the outcomes of submucosal tunneling endoscopic resection (STER) and submucosal excavation (ESE) for the treatment of submucosal tumors (SMTs) arising from the muscularis propria (MP) at the esophagogastric junction (EGJ). Methods A retrospective analysis of patients with SMTs at EGJ who underwent STER and ESE from October 2011 to October 2017 was performed. The outcomes evaluated were operation time, complete resection rate, adverse events, and tumor recurrence. Results Ninety patients were included in this study. Complete resection rates in the STER group were higher than those of the ESE group (100 vs. 92%, p < 0.05). For tumors ≤15 mm, both techniques achieved 100% complete resection rate; but for tumors > 15 mm, complete resection rate was higher in the STER group than the ESE group (100% vs. 77.8%, p < 0.05). Subgroup analyses revealed that the operation time of STER for in cardiac-gastric group was longer than that for ESE (145.14 ± 42.43 min vs. 70.32 ± 39.84 min, p < 0.05). The air leakage symptoms were more frequent in STER group (90.9% vs. 50.0%, p < 0.05). No tumor recurrence occurred in both the STER and ESE groups. Conclusions For SMTs ≤15 mm, both STER and ESE have similar satisfactory therapeutic outcomes. However, in the cardiac-gastric subgroup, STER had a longer operative time compared to the ESE procedure. For SMTs > 15 mm, STER is the preferred choice due to its higher complete resection rate.

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Endoscopic Submucosal Dissection vs Endoscopic Mucosal Resection for Colorectal Polyps. A Meta-Analysis

10.21203/rs.3.rs-139442/v1 ◽

2021 ◽

Author(s):

Xiong Chang Lim ◽

Kameswara Rishi Yeshayahu Nistala ◽

Cheng Han Ng ◽

Snow Yunni Lin ◽

Darren Jun Hao Tan ◽

...

Keyword(s):

Subgroup Analysis ◽

Meta Analysis ◽

Bleeding Risk ◽

Colorectal Polyps ◽

Complete Resection ◽

Resection Rate ◽

En Bloc ◽

Margin Involvement ◽

Additional Surgery ◽

The World

Abstract Background: This extensive meta-analysis sought to compare the surgical, histological, and oncological outcomes between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in the treatment of colorectal polyps, with subgroup analysis comparing the efficacy of ESD and EMR between Japan and the rest of the world. Methods: Embase and Medline databases were searched from inception to October 2020 in accordance with PRISMA guidelines for studies comparing en bloc, complete resection, margin involvement, resection time, need for additional surgery, complications, and recurrence rate of ESD with EMR. Results: 281,344 colorectal polyps from 21 studies were included. When compared to EMR, the pooled analysis revealed ESD was associated with higher en bloc and complete resection rate, and lower lateral margin involvement and recurrence. ESD led to increased procedural time, need for additional surgery, and perforation risk. No significant difference in bleeding risk was found between the two groups. Meta-regression analysis suggested only right colonic polyps correlated with an increased perforation risk in ESD. Confounders including polyp size and invasion depth did not significantly influence the en bloc and complete resection rate, bleeding risk and recurrence. In subgroup analysis, Japan performed better than the rest of the world in both ESD and EMR with perforation risk of 4% and 0.0002%, respectively, as compared to perforation risk of 8% and 1%, respectively, in reports coming from rest of the world.Conclusions: This meta-analysis demonstrated increased safety and efficacy of ESD and EMR done in Japan as compared with the rest of the world.

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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.

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Long-Term Clinical Efficacy and Perioperative Safety of Endoscopic Submucosal Dissection versus Endoscopic Mucosal Resection for Early Gastric Cancer: An Updated Meta-Analysis

BioMed Research International ◽

10.1155/2018/3152346 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 2

Author(s):

Yajie Zhao ◽

Chengfeng Wang

Keyword(s):

Gastric Cancer ◽

Local Recurrence Rate ◽

Operative Time ◽

Postoperative Bleeding ◽

En Bloc Resection ◽

Bloc Resection ◽

Complete Resection ◽

Resection Rate ◽

En Bloc ◽

Prolonged Operative Time

Background. To systematically evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) versus endoscopic mucosal resection (EMR) for early gastric cancer (EGC). Methods. We searched the databases of PubMed, Web of Science, EMBASE, and the Cochrane Library from January 2000 to April 2017 and included studies that compared the outcomes of ESD with EMR for EGC. These eligible studies that met the inclusion criteria were screened out and were assessed by two independent investigators. Result. In total, 18 retrospective cohort studies were eligible for analysis. Our results indicated that ESD is more beneficial than EMR in increasing the complete resection rate and en bloc resection rate and decreasing the local recurrence rate. However, ESD prolonged operative time and increased incidence of gastric perforation than EMR. No differences were found in postoperative bleeding rate between the two approaches. Conclusion. Compared with EMR, ESD offers higher complete resection rate, higher en bloc resection rate, and lower local recurrence rate but has prolonged operative time and increased incidence of gastric perfusion. There is no statistical difference in the rate of postoperative bleeding between the two groups. However, the above conclusion needs further verification by well-designed, randomized trials with larger samples and long follow-up periods.

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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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