Complete Resection of Colorectal Adenomas: What Are the Important Factors in Fellow Training?

Choi, Ji Min; Lee, Changhyun; Park, Jeong Hwan; Oh, Hyeon Jeong; Hwang, Sung Wook; Chun, Jaeyoung; Koh, Seong‐Joon; Im, Jong Pil; Kim, Ji Won; Kim, Sang Woo; Kim, Byeong Gwan; Lee, Kook Lae

doi:10.1007/s10620-014-3500-0

Cited by 14 publications

(10 citation statements)

References 28 publications

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“…The resection margin was classified as negative, positive, or uncheckable. 21 Negative referred to the presence of space between the resected margin and the CRC; positive referred to the presence of CRC abutted to the resected margin; and uncheckable was used when the resected margin was blurred by electrical damage or tangential cutting of the specimen. CRC with a positive margin was further classified into positive in the lateral margin, positive in the deep margin, or positive in both the lateral and deep margin.…”

Section: Methodsmentioning

confidence: 99%

Characteristics and outcomes of endoscopically resected colorectal cancers that arose from sessile serrated adenomas and traditional serrated adenomas

et al. 2016

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Background/AimsThe efficacy and safety of endoscopic resection of colorectal cancer derived from sessile serrated adenomas or traditional serrated adenomas are still unknown. The aims of this study were to verify the characteristics and outcomes of endoscopically resected early colorectal cancers developed from serrated polyps.MethodsAmong patients who received endoscopic resection of early colorectal cancers from 2008 to 2011, cancers with documented pre-existing lesions were included. They were classified as adenoma, sessile serrated adenoma, or traditional serrated adenoma according to the baseline lesions. Clinical characteristics, pathologic diagnosis, and outcomes were reviewed.ResultsOverall, 208 colorectal cancers detected from 198 patients were included: 198 with adenoma, five with sessile serrated adenoma, and five with traditional serrated adenoma. The sessile serrated adenoma group had a higher prevalence of high-grade dysplasia (40.0% vs. 25.8%, P<0.001) than the adenoma group. During follow-up, local recurrence did not occur after endoscopic resection of early colorectal cancers developed from serrated polyps. In contrast, two cases of metachronous recurrence were detected within a short follow-up period.ConclusionsCautious observation and early endoscopic resection are recommended when colorectal cancer from serrated polyp is suspected. Colorectal cancers from serrated polyp can be treated successfully with endoscopy.

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Section: Methodsmentioning

confidence: 99%

Characteristics and outcomes of endoscopically resected colorectal cancers that arose from sessile serrated adenomas and traditional serrated adenomas

et al. 2016

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“…Choi et al . demonstrated that complete resection margins of trainee endoscopists reached the standards of their expert group after 300 EMR procedures, increasing from 37.4% after the first 100 EMRs to 57.6% after 300 procedures.…”

Section: Resultsmentioning

confidence: 96%

“…The summary characteristics of the three EMR learning curve studies [13][14][15] are outlined in Table 3. All studies evaluated real-world procedural outcomes with a total of 2778 EMRs.…”

Section: Colorectal Emrmentioning

confidence: 99%

Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy

et al. 2020

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Aim The performance of therapeutic procedures in lower gastrointestinal endoscopy (LGI) can be challenging and carries an increased risk of adverse events. There is increasing demand for the training of endoscopists in these procedures, but limited guidelines exist concerning procedural competency. The aim of this study was to assess the learning curves for LGI polypectomy, colorectal endoscopic mucosal resection (EMR) and colorectal endoscopic submucosal dissection (ESD). Method A systematic review of electronic databases between 1946 and September 2019 was performed. Citations were included if they reported learning curve data. Outcome measures that defined the success of procedural competency were also recorded. Results A total of 34 out of 598 studies met the inclusion criteria of which 28 were related to ESD, three to polypectomy and three to EMR. Outcome measures for polypectomy competency (en bloc resection, delayed bleeding and independent polypectomy rate) were achieved after completion of between 250 and 400 polypectomies and after 300 colonoscopies. EMR outcome measures, including complete resection and recurrence, were achieved variably between 50 and 300 procedures. Outcome measures for ESD included efficiency (resection rates and procedural speed) and safety (adverse events). En bloc resection rates of over 80% and R0 resection rates of over 70% were achieved at 20-40 cases and procedural speed increased after 30 ESD cases. Competency in safety metrics was variably achieved at 20-200 cases. Conclusion There is a paucity of data on learning curves in LGI polypectomy, EMR and ESD. Despite limited evidence, we have identified relevant outcome measures and threshold numbers for the most common LGI polyp resection techniques for potential inclusion in training programmes/credentialing guidelines.

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“…However, the lesion size was important in the expert group. [ 18 ] Although the procedure types were no randomly distributed among endoscopists in the present study, all endoscopists experienced therapeutic endoscopic procedure more than 3 years (each endoscopist performs more than 100 cases endoscopic submucosal dissection, annually). And, the tumor sizes were less than 10 mm in diameter.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic resection for small esophageal submucosa tumor

et al. 2017

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Because an esophageal submucosa tumor (SMT) may be malignant despite its small size, a safe endoscopic resection method is needed in some small SMTs. Conventional endoscopic mucosal resection (EMR) may be simple, but incomplete pathologic resection margin status is common. We aimed to investigate the clinical outcomes of 2 kinds of EMR techniques (conventional EMR and EMR with band ligation device) and to evaluate the factors associated with incomplete pathologic resection.We evaluated the medical records of 36 patients. All lesions were esophageal SMTs located in the submucosa or muscularis mucosa less than 10 mm in size by endoscopic ultrasound (EUS). The clinical outcomes based on the endoscopic procedures and factors associated with incomplete pathologic resection were evaluated.The mean tumor size was 6.6 ± 4.1 mm. The overall en bloc and complete resection rates were 100% and 80.6%, respectively. No procedure-related complications, such as perforation and bleeding, were found. Univariate analysis showed that complete resection rates were higher in granular cell tumors than in leiomyomas (82.8% vs 17.2%, P = .029), tumors located in the submucosa layer than in the muscularis mucosa (96.6% vs 3.4%, P = .003), and in EMR with band ligation device than in conventional EMR (82.8% vs 17.2%, P < .001). Multivariate analysis showed that conventional EMR was the only significant factor associated with incomplete resection (OR, 35.594; 95% CI, 2.042–520.329; P = .014)EMR with a band ligation device is an effective and safe treatment method for small esophageal SMT.

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Complete Resection of Colorectal Adenomas: What Are the Important Factors in Fellow Training?

Abstract: In the fellow-treated group, the level of procedure experience was closely associated with the polypectomy outcomes. Meticulous attention is critical to ensure the completeness of polypectomies performed by trainee endoscopists during the training program.

Cited by 14 publications

References 28 publications

Characteristics and outcomes of endoscopically resected colorectal cancers that arose from sessile serrated adenomas and traditional serrated adenomas

Characteristics and outcomes of endoscopically resected colorectal cancers that arose from sessile serrated adenomas and traditional serrated adenomas

Systematic literature review of learning curves for colorectal polyp resection techniques in lower gastrointestinal endoscopy

Endoscopic resection for small esophageal submucosa tumor

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