Endoscopic mucosal resection and conventional polypectomy in colon adenomas

2021 ◽  
Vol 20 (2) ◽  
pp. 29-34
Author(s):  
Yu. E. Vaganov ◽  
E. A. Khomyakov ◽  
A. B. Serebry ◽  
E. U. Abdulzhalieva
Keyword(s):  
Endoscopic Mucosal Resection ◽  
Postoperative Morbidity ◽  
Complete Resection ◽  
Long Term Results ◽  
Colon Neoplasms ◽  
Mucosal Resection ◽  
Endoscopic Excision ◽  
Colon Adenomas ◽  
Postoperative Scar

Aim: to compare the early and long-term results of endoscopic mucosal resection (EMR) and conventional polypectomy for benign epithelial colon neoplasmsPatients and methods: the retrospective study included 344 patients with histologically verified adenomas of the size of up to 40 mm in the colon, who underwent EMR or conventional polypectomy. Mucosectomy (EMR) was performed in 207 patients, while conventional polypectomy was performed in 137.Results: there were no significant differences in the postoperative morbidity rates between the methods (OR = 1.8; 95% CI = 0.7–4.8, p = 0.3). Fragmentation significantly more often occurred in the group of conventional polypectomy (OR = 3.5; 95% CI = 2.3–5.5, p = 0.001, especially when the size of the neoplasm was over 1 cm (OR = 3.1; 95% CI = 1.1–8.9 = 0.037). Recurrence occurred in 19/173 (10.9%) in 12 (8.3%) patients of the EMR group. In the polypectomy group, recurrence developed in 22 (23.1%) patients, in 24/108 (22.2%) cases at the site of the postoperative scar. It was found that the adenoma recurrence in the area of endoscopic excision occurs significantly more often after conventional polypectomy (OR = 2.3; 95% CI = 1.2–4.4; p = 0.016).Conclusion: EMR and conventional polypectomy both are the safe methods with low morbidity rates. However, the EMR is the preferred method of endoscopic excision for adenomas larger than 1 cm due to the fact that it allows for deeper and more complete resection of the tissue than conventional polypectomy.

scholarly journals Risk factors for colon adenomas recurrence after endoscopic mucosal resection

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.

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

Endoscopy ◽  
2019 ◽  
Vol 51 (09) ◽  
pp. 871-876 ◽  
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.

scholarly journals Results of surgical treatment of carcinoma of papilla of Vater

Medicina ◽  
2006 ◽  
Vol 43 (6) ◽  
pp. 455 ◽  
Author(s):  
Giedrius Barauskas ◽  
Antanas Gulbinas ◽  
Juozas Pundzius
Keyword(s):  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Long Term Results ◽  
Papilla Of Vater ◽  
Term Survival ◽  
Retrospective Design ◽  
Significant Difference ◽  
Survival Pattern ◽  
Better Than

Adenocarcinoma is the most common malignant tumor of the ampulla, but in general, it is still rare. Therefore, these tumors are difficult to study, and most reports are of retrospective design. To evaluate immediate postoperative and long-term results, we have collected data prospectively in a specially created database on 21 consecutive patients with adenocarcinoma of the papilla of Vater, operated on at the Department of Surgery, Kaunas University of Medicine Hospital. All patients have undergone classical or pylorus-preserving pancreatoduodenectomy. Postoperative mortality was 4.8% and overall morbidity – 28.6%. Pancreas-associated morbidity was 14.3% in the series. Actuarial 3-year survival among our patients was 89%. Stage I–II patients with T1–T2 and/or N negative tumors had significantly better 3-year survival when compared with stage III–IV patients, T3–T4 and/or N positive tumors. Patients with highly or moderately differentiated tumors (G1, G2) survived better than patients with poor cell differentiation (G3), though significant difference was not achieved. Results are satisfactory in terms of overall postoperative morbidity and mortality. Long-term survival pattern concerning T, N, and G status corresponds with other reports in literature, while the 3-year survival results are promising and speaks in favor of our surgical strategy.

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