Endoscopic submucosal dissection for rectal tumors

Onozato, Yoshikuni; Kakizaki, Satoru; Ishihara, Hideaki; Iizuka, Haruhisa; Sohara, Naondo; Okamura, Shinichi; Mori, Masataka; Itoh, Hideaki

doi:10.1055/s-2007-966237

Cited by 85 publications

(49 citation statements)

References 9 publications

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“…We were unable to clarify these doubts because we received no reply to our request from the respective study authors. In all, 21 studies met the inclusion criteria for a total of 2,077 patients: 11 ESD series [11][12][13][14][15][16][17][18][19][20][21] totaling 536 patients, and 10 TEM series [2,[22][23][24][25][26][27][28][29][30], totaling 1,541 patients. …”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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Background For almost 30 years, transanal endoscopic microsurgery (TEM) has been the mainstay treatment for large rectal lesions. With the advent of endoscopic submucosal dissection (ESD), flexible endoscopy has aimed at en bloc R0 resection of superficial lesions of the digestive tract. This systematic review and meta-analysis compared the safety and effectiveness of ESD and fullthickness rectal wall excision by TEM in the treatment of large nonpedunculated rectal lesions preoperatively assessed as noninvasive. Methods A systematic review of the literature published between 1984 and 2010 was conducted (Registration no. CRD42012001882). Data were integrated with those from the original databases requested from the study authors when needed. Pooled estimates of the proportions of patients with en bloc R0 resection, complications, recurrence, and need for further treatment in the ESD and TEM series were compared using random-effects single-arm meta-analysis. Results This review included 11 ESD and 10 TEM series (2,077 patients). The en bloc resection rate was 87.8 % (95 % confidence interval [CI] 84.3-90.6) for the ESD patients versus 98.7 % (95 % CI 97.4-99.3 %) for the TEM patients (P < 0.001). The R0 resection rate was 74.6 % (95 % CI 70.4-78.4 %) for the ESD patients versus 88.5 % (95 % CI 85.9-90.6 %) for the TEM patients (P < 0.001). The postoperative complications rate was 8.0 % (95 %, CI 5.4-11.8 %) for the ESD patients versus 8.4 % (95 % CI 5.2-13.4 %) for the TEM patients (P = 0.874). The recurrence rate was 2.6 % (95 % CI 1.3-5.2 %) for the ESD patients versus 5.2 % (95 % CI 4.0-6.9 %) for the TEM patients (P < 0.001). Nevertheless, the rate for the overall need of further abdominal treatment, defined as any type of surgery performed through an abdominal access, including both complications and pathology indications, was 8.4 % (95 % CI 4.9-13.9 %) for the ESD patients versus 1.8 % (95 % CI 0.8-3.7 %) for the TEM patients (P < 0.001). ConclusionsThe ESD procedure appears to be a safe technique, but TEM achieves a higher R0 resection rate when performed in full-thickness fashion, significantly reducing the need for further abdominal treatment. Keywords Rectal adenoma Transanal endoscopic microsurgery Endoscopic submucosal dissection Systematic review Meta-analysis For nearly 30 years, transanal endoscopic microsurgery (TEM) has been the optimal mainstay treatment for large rectal lesions. Initially conceived for treating benign lesions, its indications were extended to early rectal cancer treatment when Hermanek and Gall [1] assessed criteria to determine lesions at "low risk" for recurrence. One increasingly recognized advantage of the technique versus standard transanal surgery is the high rate of en bloc resection with disease-free margins, which is strictly related to the risk of recurrence [2]. With the advent of endoscopic submucosal dissection (ESD) about 10 years ago, flexible endoscopy permitted a surgical-like technique for en bloc resection of superficial lesions of the digestive trac...

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

et al. 2013

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“…(1/40) Colorectum Fujishiro [31] 2007 ESD-Flex knife 91.5 1.8 (183/200) (2/111) Saito [40] 2007 ESD several knives 84 0.5 (168/200) (1/180) Tanaka [41] 2007 ESD several knives 80 0 (56/70) (0/62) Tamegai [42] 2007 ESD-Hook knife 98.6 11 (33/42) (4/36) Onozato [43] 2007 ESD-Flex knife 77 0 (27/35) (0/23)…”

Section: Stomachmentioning

confidence: 99%

“…The ESD technique is still not a treatment at ease, and further refinements of the technique is required to popularize ESD as a safe and reliable, less invasive treatment for patients with GI neoplasms. [33] 2002 EMRSH 70 4 0 Ishigooka [34] 2004 s-ERHSE 34 0 12 Oda [35] 2005 ESD-IT knife 1 033 6 4 Kakushima [32] 2006 ESD-Flex knife 383 3.4 3.9 Imagawa [36] 2006 ESD-Flex knife 159 0 6.1 Oyama [37] 2006 ESD-Hook knife 111 -1 Onozato [38] 2006 ESD-Flex knife 171 7.6 3.5 Hirasaki [39] 2007 ESD-IT knife 112 4 1 Esophagus Oyama [8] 2005 ESD-Hook knife 102 -0 Fujishiro [11] 2006 ESD-Flex knife 58 0 6.9 Colorectum Fujishiro [31] 2007 ESD-Flex knife 200 1 6 Saito [40] 2007 ESD-several knives 200 2 5 Tanaka [41] 2007 ESD-several knives 70 1.4 10 Tamegai [42] 2007 ESD-Hook knife 74 -1.4 Hurlstone [50] 2007 ESD-Flex knife 42 12 2.4 Onozato [43] 2007 ESD-Flex knife 35 0 2.9…”

Section: Future Perspectivesmentioning

confidence: 99%

Endoscopic submucosal dissection for gastrointestinal neoplasms

Kakushima¹,

Fujishiro²

2008

WJG

160

131

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Endoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy for superficial gastrointestinal neoplasms. Three steps characterize it: injecting fluid into the submucosa to elevate the lesion, cutting the surrounding mucosa of the lesion, and dissecting the submucosa beneath the lesion. The ESD technique has rapidly permeated in Japan for treatment of early gastric cancer, due to its excellent results of enbloc resection compared to endoscopic mucosal resection (EMR). Although there is still room for improvement to lessen its technical difficulty, ESD has recently been applied to esophageal and colorectal neoplasms. Favorable short-term results have been reported, but the application of ESD should be well considered by three aspects: (1) the possibility of nodal metastases of the lesion, (2) technical difficulty such as location, ulceration and operator's skill, and (3) organ characteristics.

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“…Theoretically, rectal carcinoid tumors less than 1 cm in diameter and a depth of invasion limited to the submucosal layer can be curatively treated by endoscopic resection [1][2][3][4] . Conventional snare polypectomy or endoscopic mucosal resection often results in incomplete resection of rectal carcinoid tumors and the need for additional surgery that sometimes requires a stoma [4][5][6] . Endoscopic submucosal dissection (ESD) has been reported to improve the rate of successful en bloc resection in early stage rectal tumors [6] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

Akahoshi¹,

Motomura²,

Kubokawa³

et al. 2009

WJG

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Endoscopic submucosal dissection (ESD) with a knife is a technically demanding procedure associated with a high complication rate. The shortcomings of this method are the inability to fix the knife to the target lesion, and compression of the lesion. These can lead to major complications such as perforation and bleeding. To reduce the risk of complications related to ESD, we developed a new grasping type scissors forceps (GSF), which can grasp and incise the targeted tissue using electrosurgical current. Colonoscopy on a 55-year-old woman revealed a 10-mm rectal submucosal nodule. The histological diagnosis of the specimen obtained by biopsy was carcinoid tumor. Endoscopic ultrasonography demonstrated a hypoechoic solid tumor limited to the submucosa without lymph node involvement. It was safely and accurately resected without unexpected incision by ESD using a GSF. No delayed hemorrhage or perforation occurred. Histological examination confirmed the carcinoid tumor was completely excised with negative resection margin.

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Endoscopic submucosal dissection for rectal tumors

Cited by 85 publications

References 9 publications

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions

Endoscopic submucosal dissection for gastrointestinal neoplasms

Endoscopic submucosal dissection of a rectal carcinoid tumor using grasping type scissors forceps

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