Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon

Ahlenstiel, Golo; Hourigan, Luke F.; Brown, Gregor J.; Zanati, Simon; Williams, Stephen J.; Singh, Rajvinder; Moss, Alan; Sonson, Rebecca; Bourke, Michael J.

doi:10.1016/j.gie.2014.04.015

Cited by 169 publications

(116 citation statements)

References 32 publications

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“…Wide-fi eld endoscopic mucosal resection (WF-EMR) is established as the fi rst-line treatment for large sessile and laterally spreading colorectal lesions (LSL) owing to its effi cacy, safety and economic benefi ts over surgery (1)(2)(3). Clinically signifi cant post-WF-EMR bleeding (CSPEB) is the most frequent EMR-related adverse event.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Bahin

Rasouli

Byth

et al. 2016

American Journal of Gastroenterology

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Section: Introductionmentioning

confidence: 99%

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Bahin

Rasouli

Byth

et al. 2016

American Journal of Gastroenterology

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“…4-6 Although surgery prevents the risk of recurrence of these lesions, it exposes patients to substantial risks, including mortality and morbidity. 7 …”

Section: Introductionmentioning

confidence: 99%

Outcome of EMR as an alternative to surgery in patients with complex colon polyps

Raju

Lum

Ross

et al. 2016

Gastrointestinal Endoscopy

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Background and Aims Patients with complex colon polyps were traditionally referred for surgery to avoid adverse events associated with endoscopic resection. Recent advances in endoscopic imaging as well endoscopic hemostasis and clip closure allow for the use of endoscopic mucosal resection (EMR) as an alternative to surgery for such lesions. To determine the outcome of treatment of complex colon polyps with EMR as an alternative to surgery, we conducted a retrospective observational study. Methods Two hundred three patients with complex colon polyps referred to an EMR center as an alternative to surgery. Patients underwent a protocol driven EMR.. The primary endpoint was the complete resection rate. Secondary endpoints were safety, residual adenoma rate, and incidence of missed synchronous polyps. Results EMR was performed in 155 patients and was deferred in 48 patients who were referred to surgery. EMR specimens revealed benign polyps in 149 and cancer in 6 patients. EMR adverse events occurred in seven patients, requiring hospitalization in five of them. None of the patients died of their adverse events. Surveillance colonoscopy at 4-6 months after resection of a benign lesion in 137 patients revealed residual adenoma at the scar site in 6 patients and additional synchronous precancerous lesions in 117 patients that were not removed by the referring endoscopist. None underwent surgery for failure of EMR. The overall precancerous lesion burden was 2.83 per patient, the adenoma burden was 2.13 per patient, and the serrated polyp burden was 0.69 per patient. Conclusions EMR can be used instead of surgery for complex colon polyps in 75 percent of patients with few adverse events and few residual adenomas at resection sites. In addition, careful repeat examination of the entire colon for synchronous lesions overlooked by the referring endoscopist is required for the majority of patients.

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“…The advent of laparoscopic surgery has resulted in improvements in patient length of stay, with equivalent adverse event rates and outcomes to open surgery . Despite this, surgery has higher rates of adverse events than endoscopic procedures, is associated with longer hospitalization and may not be appropriate for patients with significant comorbidities or the very elderly because of the mortality risk . Surgery for rectosigmoid lesions may necessitate low abdomino‐perineal resection which can result in long‐term disability as a result of sacral nerve disruption resulting in bladder and bowel dysfunction along with anal sphincter damage .…”

Section: Advanced Lesionsmentioning

confidence: 99%

Endoscopic resection of colorectal lesions: The narrowing divide between East and West

Burgess

Bourke

2015

Digestive Endoscopy

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Colonic polypectomy is an effective way of reducing colon cancer mortality. Multiple techniques now exist for the resection of polyps, and the endoscopist must decide on the appropriate resection approach for individual patients and lesions. This decision should maximize efficacy, safety and cost-effectiveness and provide optimal oncological outcomes while minimizing unnecessary surgical treatment. Advances in endoscopic imaging technology are improving the accuracy of endoscopic diagnosis and allowing more precise risk assessment of colonic lesions. Resection technique can be tailored to the endoscopic findings. Diminutive (≤5 mm) and small polyps (≤9 mm) are best resected primarily by snare techniques. Cold snare polypectomy has proven safety, but efficacy and technique require further study. There is variation in techniques used for polyps 6-20 mm in size and incomplete resection rates for conventional polypectomy may be considerable. Endoscopic mucosal resection (EMR) is well established, safe and effective for lesions without submucosal invasion (SMI); however, recurrence is a key limitation. Endoscopic submucosal dissection (ESD) is well established in the East; however, it is resource intensive and its role in lesions with a low risk of SMI is questionable. ESD in the West remains incompletely defined and is associated with high adverse event rates, but it is becoming increasingly available and successful as experience grows. Emerging full-thickness resection technologies are still in their infancy and remain experimental as a result of the absence of reliable closure devices and techniques. Patient-focused outcomes should guide technique selection.

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Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon

Cited by 169 publications

References 32 publications

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score

Outcome of EMR as an alternative to surgery in patients with complex colon polyps

Endoscopic resection of colorectal lesions: The narrowing divide between East and West

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