Current practices in endoscopic submucosal dissection for colorectal neoplasms: a survey of indications among Korean endoscopists

Kim, Tae Jun; Kim, Eun Ran; Hong, Sung Noh; Kim, Young‐Ho; Chang, Dong Kyung

doi:10.5217/ir.2017.15.2.228

Cited by 17 publications

(14 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,7,8 Additionally, even if endoscopic resection of a local lesion is successful, surgical resection must still be considered to minimize the possibility of cancer recurrence and metastasis when histopathological risk factors associated with cancer recurrence in the lymph nodes are detected in the endoscopic resection specimen. High-resolution endoscopy, image-enhanced endoscopy, chromoscopy, magnification endoscopy, endoscopic ultrasound, and computed tomography (CT) are used in making the clinical decision of whether to perform endoscopic resections, [9][10][11][12][13][14][15] and models have been developed that can predict patients with high likelihoods of lymph node metastasis. 1,7,8,16,17 Evidence-based guidelines published from other countries help clinicians with decision-making regarding the examination and treatment of gastrointestinal cancers.…”

Section: Introductionmentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

View full text Add to dashboard Cite

Although surgery was the standard treatment for early gastrointestinal cancers, endoscopic resection is now a standard treatment for early gastrointestinal cancers without regional lymph node metastasis. High-definition white light endoscopy, chromoendoscopy, and image-enhanced endoscopy such as narrow band imaging are performed to assess the edge and depth of early gastrointestinal cancers for delineation of resection boundaries and prediction of the possibility of lymph node metastasis before the decision of endoscopic resection. Endoscopic mucosal resection and/or endoscopic submucosal dissection can be performed to remove early gastrointestinal cancers completely by en bloc fashion. Histopathological evaluation should be carefully made to investigate the presence of risk factors for lymph node metastasis such as depth of cancer invasion and lymphovascular invasion. Additional treatment such as radical surgery with regional lymphadenectomy should be considered if the endoscopically resected specimen shows risk factors for lymph node metastasis. This is the first Korean clinical practice guideline for endoscopic resection of early gastrointestinal cancer. This guideline was developed by using mainly de novo methods and encompasses endoscopic management of superficial esophageal squamous cell carcinoma, early gastric cancer, and early colorectal cancer. This guideline will be revised as new data on early gastrointestinal cancer are collected.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

et al. 2020

View full text Add to dashboard Cite

show abstract

“…However, in cases of non‐polypoid dysplasia, dysplasia with submucosal fibrosis, or large (≥ 20 mm) dysplasia, endoscopic mucosal resection may result in a piecemeal resection. Meanwhile, endoscopic submucosal dissection (ESD) is now widely used in Korea and Japan, mainly to resect large, flat, sporadic colorectal epithelial neoplasms, such as adenomas and early cancers. Experts have recommended ESD as one of the therapeutic options for ulcerative colitis (UC)‐associated dysplasia .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of ulcerative colitis‐associated dysplasia patients referred for potential endoscopic submucosal dissection

Yang

Kim

Song

et al. 2019

J of Gastro and Hepatol

View full text Add to dashboard Cite

Background and Aim The feasibility of endoscopic submucosal dissection (ESD) as a treatment option for dysplasia in ulcerative colitis (UC) has been reported, but the associated therapeutic decision‐making and clinical outcomes have not been extensively investigated. Methods We retrospectively reviewed 25 UC patients who were referred for potential ESD of non‐polypoid or sessile dysplasia. We analyzed the treatment decisions and the ESD and colectomy outcomes for this patient group. Results All lesions were located at the colitic segments. The median UC duration was 13.4 years. A colectomy was recommended for 10 patients because of ulceration with indistinct borders (one patient), non‐ulceration with indistinct borders (two patients), and non‐lifting signs (seven patients). The remaining 15 patients underwent ESD. The en bloc and R0 resection rates were 93.3% and 80%, respectively. The median hospitalization periods were 1 (range, 1–2) day after ESD and 7 (range, 5–30) days after colectomy. No procedure‐related complications occurred after ESD, but early and late postoperative complications occurred in two (22.2%) and six (66.7%) of the colectomized patients, respectively. Fourteen ESD cases were followed endoscopically for a median period of 24.7 (range, 5.2–64.8) months. Local recurrence occurred in 2 (14.3%) patients, and metachronous recurrence was identified in two separate patients (14.3%). Conclusions Endoscopic submucosal dissection is a feasible endoscopic treatment option for UC‐associated dysplasia showing noninvasive pit or vascular patterns, no surface ulceration, distinct borders, and appropriate lifting after submucosal injection. Meticulous endoscopic surveillance is essential to monitor for local or metachronous recurrence of dysplasia after ESD.

show abstract

“…However, the proportion of ESD was highest in this type of lesions among the Korean endoscopists, reflecting the regulation and medical reimbursement system for colorectal ESD in Korea. 20,21 ESD was the most preferred resection method for malignant-looking nonpedunculated polyps ≥20 mm by the overall respondents. However, when shown photos of nonpedunculated polyps ≥20 mm, most respondents selected ESD regardless of the assessment for submucosal invasion.…”

Section: Discussionmentioning

confidence: 96%

Colonoscopic Polypectomy Preferences of Asian Endoscopists: Results of a Survey-Based Study

et al. 2021

View full text Add to dashboard Cite

Background/Aims: The clinical practice pattern of polypectomy is not well-investigated in Asian countries. We aimed to survey Asian endoscopists about their preferred polypectomy techniques for given conditions and images of polyps. Methods: A survey was performed using questionnaires composed of two parts: a scenario-based questionnaire using scenarios of polyps, which were adopted from the European Society of Gastrointestinal Endoscopy guidelines, and an image-based questionnaire using provided endoscopic images of polyps. Results: A total of 154 endoscopists participated in this survey. The most preferred resection techniques for diminutive (≤5 mm), small (6-9 mm), and benign-looking intermediate (10-19 mm) nonpedunculated polyps were cold forceps polypectomy, hot snare polypectomy, and endoscopic mucosal resection (EMR), respectively, in both the scenarioand image-based questionnaires. For benign-looking large (≥20 mm) nonpedunculated polyps, EMR and endoscopic submucosal dissection (ESD) were preferred in the scenarioand image-based surveys, respectively. In case of malignant nonpedunculated polyps, EMR and ESD were preferred for intermediate-sized and large lesions, respectively, according to the scenario-based survey. However, ESD was preferred in both intermediate-sized and large malignant nonpedunculated polyps according to the image-based survey. Trainee endoscopists, endoscopists working in referral centers, and endoscopists in the colorectal cancer-prevalent countries were independently associated with preference of cold snare polypectomy for removing small polyps. Conclusions: The polypectomy practice patterns of Asian endoscopists vary, and cold snare polypectomy was not the most preferred resection method for polyps <10 mm in size, in contrast to recent guidelines.

show abstract

Current practices in endoscopic submucosal dissection for colorectal neoplasms: a survey of indications among Korean endoscopists

Cited by 17 publications

References 27 publications

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Clinical Practice Guideline for Endoscopic Resection of Early Gastrointestinal Cancer

Outcomes of ulcerative colitis‐associated dysplasia patients referred for potential endoscopic submucosal dissection

Colonoscopic Polypectomy Preferences of Asian Endoscopists: Results of a Survey-Based Study

Contact Info

Product

Resources

About