Combining eastern and western practices for safe and effective endoscopic resection of large complex colorectal lesions

Emmanuel, Andrew; Gulati, Shraddha; Burt, Margaret; Hayee, Bu’Hussain; Haji, Amyn

doi:10.1097/meg.0000000000001086

Cited by 15 publications

(20 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These 19 fulltext articles were scrutinized in detail and another four were excluded. Two single institution studies were excluded due to obvious overlap with subsequent studies from the same institute [19,20]. The latest published or the one with highest numbers of colorectal ESD cases were included herein.…”

Section: Literature Searchmentioning

confidence: 99%

European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety

2019

View full text Add to dashboard Cite

Background: Endoscopic submucosal dissection (ESD) is an advanced method allowing en bloc resection of large and complex lesions in colon and rectum. Herein, the European experience of colorectal ESD was systematically reviewed in the medical literature to determine the clinical efficacy and safety of colorectal ESD in Europe. Material and methods: A systematic search of PubMed for full-text studies including more than 20 cases of colorectal ESD emanating from European centres was performed. Data were independently extracted by two authors using predefined data fields, including efficacy and safety. Results: We included 15 studies containing a total of 1404 colorectal ESD cases (41% in the colon) performed between 2007 and 2018. Lesion size was 40 mm (range 24-59 mm) and procedure time was 102 min (range 48-176 min). En bloc resection rate was 83% (range 67-93%) and R0 resection rate was 70% (range 35-91%). Perforation rate was 7% (range 0-19%) and bleeding rate was 5% (range 0-12%). The percentage of ESD cases undergoing emergency surgery was 2% (range 0-6%). Additional elective surgery was performed in 3% of all cases due to histopathological findings showing deep submucosal invasion or more advanced cancer. The recurrence rate was 4% (range 0-12%) after a median follow-up time of 12 months (range 3-24 months). Conclusions: This review shows that ESD is effective and safe for treating large and complex colorectal lesions in Europe although there is room for improvement. Thus, it is important to develop standardized and high-quality educational programs in colorectal ESD in Europe. ARTICLE HISTORY

show abstract

Section: Literature Searchmentioning

confidence: 99%

European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety

2019

View full text Add to dashboard Cite

show abstract

“…We generally use APC as adjunctive therapy after complete resection of visible adenoma, following a similar rational to those using snare tip soft coagulation after complete adenoma removal [16]. The lower recurrence in our study could also be explained by our treatment strategy, a pragmatic combination of eastern and western practices of assessment and resection which we have previously reported [17]. ESD techniques were used significantly more frequently in the resection of lesions after failed attempts at resection which, along with the routine examination of the post-resection defect with magnification, may help to ensure complete removal of visible adenoma.…”

Section: Discussionmentioning

confidence: 56%

“…Our approach to assessment and resection has been previously described [17,18]. Procedures were generally performed using conscious sedation and analgesia with intravenous midazolam and fentanyl administered by the endoscopist, and patients were discharged home on the day of the procedure.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of endoscopic resection of large colorectal lesions subjected to prior failed resection or substantial manipulation

Emmanuel

Gulati

Burt

et al. 2019

Int J Colorectal Dis

Self Cite

View full text Add to dashboard Cite

Purpose Injudicious attempts at resection and extensive sampling of large colorectal adenomas prior to referral for endoscopic resection (ER) are common. This has deleterious effects, but little is known about the outcomes following ER. We retrospectively analysed the outcomes of ER of large adenomas previously subjected to substantial manipulation. Method ER of large (≥ 2 cm) colorectal adenomas were grouped according to level of manipulation: prior attempted resection, heavy manipulation (≥ six biopsies or tattoo under lesion) or minimal manipulation (< six biopsies). Outcomes were compared between groups. Independent predictors of outcomes were identified using multiple logistic regression. Results Five hundred forty-two lesions (mean size 53.7 mm) were included. Two hundred sixty-five (49%) had been subjected to prior attempted resection or heavy manipulation, 151 (28%) to minimal manipulation, and 126 (23%) were not previously manipulated. ESD techniques were used more frequently than EMR after substantial manipulation. There were no differences in initial success of ER (99%, 98%, 98%, p = 0.71). Prior attempted resection was independently associated with recurrence (OR 2.2, 95% CI 1.1-4.5, p = 0.03) and negatively associated with en bloc resection (OR 0.29, 95% CI 0.1-0.7, p = 0.004). Regardless of level of prior manipulation, there were no differences in sustained endoscopic cure with > 95% of patients overall free from recurrence and avoiding surgery at last follow-up. Conclusion There is a substantial burden of injudicious lesion manipulation before referral, which makes recurrence more likely and en bloc resection less likely. However, with appropriate expertise, sustained successful endoscopic treatment is achievable for the vast majority of patients treated in a specialist unit.

show abstract

“…Our approach to assessment and resection has been previously described [8,9]. Procedures were generally performed using conscious sedation and analgesia with intravenous midazolam and fentanyl administered by the endoscopist and patients were discharged home on the day of the procedure.…”

Section: Methodsmentioning

confidence: 99%

Endoscopic resection of colorectal circumferential and near-circumferential laterally spreading lesions: outcomes and risk of stenosis

Emmanuel

Ghosh

Lapa

et al. 2019

Int J Colorectal Dis

Self Cite

View full text Add to dashboard Cite

Purpose Almost any colorectal superficial neoplastic lesion can be treated by endoscopic resection (ER) but very little is known about outcomes of ER leaving circumferential or near-circumferential mucosal defects. We report the outcomes of ER leaving ≥ 75% circumferential mucosal defects performed in a western expert centre. Methods Five hundred eighty-seven ERs of large colorectal lesions ≥ 20 mm were grouped according to the extent of the mucosal defect and comparisons made between those with < 75% and ≥ 75% defects. Independent predictors of stenosis were identified. Results Forty-seven patients had ER leaving ≥ 75% circumference defect, most located at or distal to the rectosigmoid, with ≥ 90% defects in 5 and 100% in 11. There were no significant colonic muscle injuries in patients with ≥ 75% defect and no differences in post-procedure bleeding (OR 1.6, 95% CI 0.2-13.7, p = 0.64) between patients with ≥ 75% and < 75% defects. Stenosis developed in 9 patients. ≥ 90% circumference defect was the only independent risk factor for stenosis (OR 286, p < 0.001). Three of 4 patients with asymptomatic stenosis had successful expectant management. The remainder were treated with dilatation. Recurrence was more likely in those with ≥ 75% defect (OR 7.9, 95% CI 3.8-16.4, p < 0.001) but was managed with further ER in all but 2 cases. Conclusion ER of colorectal lesions resulting in defects ≥ 75% of the luminal circumference is challenging but safe and effective when performed in an expert centre. The only independent predictor of stenosis is ≥ 90% circumference defect but some patients improve with expectant management; therefore, pre-emptive intervention may not be warranted.

show abstract

Combining eastern and western practices for safe and effective endoscopic resection of large complex colorectal lesions

Cited by 15 publications

References 26 publications

European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety

European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety

Outcomes of endoscopic resection of large colorectal lesions subjected to prior failed resection or substantial manipulation

Endoscopic resection of colorectal circumferential and near-circumferential laterally spreading lesions: outcomes and risk of stenosis

Contact Info

Product

Resources

About