Endoscopic submucosal dissection for colorectal polyps: outcome determining factors

Chow, Chi Woo Samuel; Fung, Tak Lit Derek; Chan, Pak Tat; Kwok, Kam Hung

doi:10.1007/s00464-022-09672-2

Cited by 12 publications

(8 citation statements)

References 39 publications

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“…Previous studies reported 80% to 97.3% en bloc resection rates after ESD. [28][29][30] Our en bloc resection rate after ESD was 74%. This difference can be explained by our institution being a referral center and most of our patients having previous interventions.…”

Section: Discussionmentioning

confidence: 75%

Predictors of En Bloc, R0 Resection and Post-Procedural Complications Following Advanced Endoscopic Resections for Colorectal Neoplasms: Results of 1213 Procedures

Gorgun,

Yilmaz,

Ozgur

et al. 2024

Diseases of the Colon &Amp; Rectum

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BACKGROUND: Advanced endoscopic resection techniques are used for treatment of colorectal neoplasms that are not amenable for conventional colonoscopic resection. Literature regarding the predictors of the outcomes of advanced endoscopic resections, especially from a colorectal surgical unit, is limited. OBJECTIVE: To determine the predictors of short- and long-term outcomes following advanced endoscopic resections. DESIGN: Retrospective case series. SETTINGS: Tertiary care center. PATIENTS: Patients who underwent advanced endoscopic resections for colorectal neoplasms from November 2011 to August 2022. INTERVENTION: Endoscopic mucosal resection, endoscopic submucosal dissection, hybrid endoscopic submucosal dissection, combined endoscopic laparoscopic surgery. MAIN OUTCOME MEASURES: Predictors of en bloc and R0 resection, bleeding, perforation was determined using univariable and multivariable logistic regression models. Cox regression models were used to determine the predictors of tumor recurrence. RESULTS: A total of 1213 colorectal lesions from 1047 patients were resected [median age 66 (58-72) years, 484 (46.2%) female, median body mass index 28.6 (24.8-32.6) kg/m 2]. Most neoplasms were in the proximal colon (898, 74%). Median lesion size was 30 (IQR: 20-40, range: 0-120) mm. 911 (75.1%) lesions had previous interventions. Most common Paris and Kudo classifications were 0-IIa flat elevation (444, 36.6%) and IIIs (301, 24.8%), respectively. En bloc and R0 resection rates were 56.6% and 54.3%, respectively. Smaller lesions, rectal location, and procedure type (endoscopic submucosal dissection) were associated with significantly higher en bloc and R0 resection rates. Bleeding and perforation rates were 5% and 6.6%, respectively. Increased age [1.06 (1.03-1.09), p < 0.0001] was a predictor for bleeding. Lesion size [1.02 (1.00-1.03), p = 0.03] was a predictor for perforation. Tumor recurrence rate was 6.6%. En bloc [HR 1.41 (95% CI 1.05-1.93), p = 0.02] and R0 resection [HR 1.49 (95% CI 1.11-2.06), p = 0.008] were associated with decreased recurrence risk. LIMITATIONS: Single center, retrospective study. CONCLUSIONS: Outcomes of advanced endoscopic resections can be predicted by patient and lesion-related characteristics. See Video Abstract

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Section: Discussionmentioning

confidence: 75%

Predictors of En Bloc, R0 Resection and Post-Procedural Complications Following Advanced Endoscopic Resections for Colorectal Neoplasms: Results of 1213 Procedures

Gorgun,

Yilmaz,

Ozgur

et al. 2024

Diseases of the Colon &Amp; Rectum

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“…ESD has an important role in en bloc removal sessile polyp & lateral spreading mucosal lesions. ESD in the colon has been widely used for laterally spreading tumors larger than 20 mm in diameter 9 .…”

Section: Editorialmentioning

confidence: 99%

Colonic Polyp and Treatment Options

Alam

2024

J. Bangladesh Coll. Phys.

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“…Intraprocedural bleeding, defined as blood oozing or spurting during C-ESD, was reported in 1.8% (4/220) of cases. 3 …”

Section: Intraprocedural Complicationsmentioning

confidence: 99%

Management of complications related to colorectal endoscopic submucosal dissection

Gweon

Yang

2023

Clin Endosc

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Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

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Endoscopic submucosal dissection for colorectal polyps: outcome determining factors

Cited by 12 publications

References 39 publications

Predictors of En Bloc, R0 Resection and Post-Procedural Complications Following Advanced Endoscopic Resections for Colorectal Neoplasms: Results of 1213 Procedures

Predictors of En Bloc, R0 Resection and Post-Procedural Complications Following Advanced Endoscopic Resections for Colorectal Neoplasms: Results of 1213 Procedures

Colonic Polyp and Treatment Options

Management of complications related to colorectal endoscopic submucosal dissection

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