A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video)

Saito, Yutaka; Uraoka, Toshio; Yamaguchi, Yoshihiro; Hotta, Kinichi; Sakamoto, Naoto; Ikematsu, Hiroaki; Fukuzawa, Masakatsu; Kobayashi, Nozomu; Nasu, Junichirou; Michida, Tomoki; Yoshida, Shigeaki; Ikehara, Hisatomo; Otake, Yosuke; Nakajima, Takeshi; Matsuda, Takahisa; Saito, Daizo

doi:10.1016/j.gie.2010.08.004

Cited by 721 publications

(637 citation statements)

References 33 publications

Supporting

Mentioning

575

Contrasting

Unclassified

Order By: Relevance

“…We were unable to clarify these doubts because we received no reply to our request from the respective study authors. In all, 21 studies met the inclusion criteria for a total of 2,077 patients: 11 ESD series [11][12][13][14][15][16][17][18][19][20][21] totaling 536 patients, and 10 TEM series [2,[22][23][24][25][26][27][28][29][30], totaling 1,541 patients. …”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

Self Cite

View full text Add to dashboard Cite

Background For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and fullthickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. Methods A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. Results This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). ConclusionsThe ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment. Keywords Rectal adenoma Transanal endoscopic microsurgery Endoscopic submucosal dissection Systematic review Meta-analysis For nearly 30 years, transanal endoscopic microsurgery (TEM) has been the optimal mainstay treatment for large rectal lesions. Initially conceived for treating benign lesions, its indications were extended to early rectal cancer treatment when Hermanek and Gall [1] assessed criteria to determine lesions at "low risk" for recurrence. One increasingly recognized advantage of the technique versus standard transanal surgery is the high rate of en bloc resection with disease-free margins, which is strictly related to the risk of recurrence [2]. With the advent of endoscopic submucosal dissection (ESD) about 10 years ago, flexible endoscopy permitted a surgical-like technique for en bloc resection of superficial lesions of the digestive trac...

show abstract

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…Perforation and bleeding are the most common complications for EMR and ESD which are more frequent than with standard polypectomy [15]. The size of lesion, location, histology, the type of device used, and operator experience are the factors that affects complication rates [15,[107][108][109].…”

Section: Advanced Techniques For Colonoscopic Tissue Removalmentioning

confidence: 99%

“…Perforation may occur in 0-5% and 5-10% in EMR and ESD respectively which is usually recognized during the procedure and managed endoscopically, although delayed perforation has been reported in 0.4% [15,[107][108][109][110][111].…”

Section: Advanced Techniques For Colonoscopic Tissue Removalmentioning

confidence: 99%

Complications of Colonoscopy

Waye

Aisenberg

Rubin

2013

Practical Colonoscopy

View full text Add to dashboard Cite

“…The introduction of endscopic submucosal dissection (ESD) has enabled the en bloc resection of large lesions, lesions with scar formation, and lesions formed on intestinal folds, which could not be resected en bloc by the conventional endoscopic mucosal resection (EMR) technique [1,2]. The en bloc resection of a lesion with a negative margin has significant clinicopathological benefits, such as eliminating the risk of residual or recurrent tumors and enabling an accurate pathological diagnosis.…”

Section: Introductionmentioning

confidence: 99%