Endoscopic submucosal dissection of colonic lesions: first 50 cases at a local institution

Tai, Yee Shyn; Chia, C. K.; Tan, Kok‐Yang

doi:10.11622/smedj.2019130

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Procedure time in the literature is variable, certainly as a function of lesion size. Our median procedure time of 62.5 min was within the range of what has been described in the literature, whereas our median lesion diameter of 4.00 cm and area of 10.05 cm 2 were larger than several other study populations 19,23–27 . Resections were efficient with a median efficiency of 6.86 min/cm 2 , although this metric is not widely reported.…”

Section: Discussionsupporting

confidence: 67%

“…Our median procedure time of 62.5 min was within the range of what has been described in the literature, whereas our median lesion diameter of 4.00 cm and area of 10.05 cm 2 were larger than several other study populations. 19,[23][24][25][26][27] Resections were efficient with a median efficiency of 6.86 min/cm 2 , although this metric is not widely reported. Complication rates were low, with a low incidence of perforation (microperforation in 0.9%) and bleeding (delayed bleed in 0.9%).…”

Section: Discussionmentioning

confidence: 95%

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Endoscopic submucosal dissection and JNET classification for colorectal neoplasia: A North American academic center experience

Ahmed,

Bechara

2023

DEN Open

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ObjectivesEndoscopic submucosal dissection (ESD) enables minimally invasive resection of superficial gastrointestinal neoplasms en bloc regardless of size. The Japan narrow band imaging expert team (JNET) classification utilizes optical magnification and narrow band imaging (NBI) to predict pathology. In North America, ESD is far from ubiquitous, and regional outcomes are not widely described. To date there are no North American studies describing the application and yield of the JNET classification as applied in the practice of ESD.MethodsA retrospective, single‐center, cohort analysis was performed on a prospectively maintained database of ESD procedures. Between July 2016 and February 2023, all consecutive patients treated with ESD for colorectal lesions were identified and stratified by lesion location, JNET, NBI International Colorectal Endoscopic, lateral spreading tumors, and Paris classifications. Univariate analysis was used for clinicopathological data. p < 0.05 was considered statistically significant.ResultsA total of 112 patients were identified. One lesion, a lipoma, was excluded. Overall, 49.5% (55/111) of lesions were colonic and 50.5% (56/111) rectal. Most lesions were lateral spreading tumors (60.4%, 67/111). Overall, 96.4% (107/111) ESDs were successfully completed, 98.1% (105/107) en bloc, and 87.9% (94/107) R0. Adverse events occurred in 1.8% (2/111) of procedures. The median diameter was 4.0 cm and resected in a median time of 62.0 min. Overall, 70.1% (47/67) lesions were upstaged from pre‐ESD biopsy. JNET 2B showed 80.2% (95% CI 71.5–87.1) accuracy for high‐grade dysplasia or sm1. All JNET type 3 were ≥sm2 (p < 0.001).ConclusionsESD permits safe and effective resection of superficial colorectal neoplasms. JNET classification was more accurate than pre‐resection biopsy at predicting histology in this series.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 95%

Endoscopic submucosal dissection and JNET classification for colorectal neoplasia: A North American academic center experience

Ahmed,

Bechara

2023

DEN Open

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“…According to a single-center study in Japan, the mean ESD time was 46.4 minutes for 1199 lesions [17]. A study conducted by a Singapore group showed a mean time of 80.9 minutes with a median lesion size of 19.3 mm, showing that larger lesions require longer procedure times [27]. A study by a Korean group revealed a median time of 53.7 minutes for ESD, with a median lesion size of 21.1 mm [28].…”

Section: The Efficiency Of Esdmentioning

confidence: 99%

Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern Taiwan

Yao²,

Li³

et al. 2022

PLoS ONE

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Background and aims Endoscopic submucosal dissection (ESD) as an advanced endoscopic procedure can be considered for the removal of colorectal lesions with high suspicion of limited submucosal invasion or cannot be optimally removed by snare-based techniques. We aimed to analyze the clinical outcomes of ESD for colorectal neoplasms in our hospital. Methods We retrospectively enrolled 230 patients with 244 colorectal neoplasms who received ESD procedures from April 2012 to October 2020 at Kaohsiung Chang Gung Memorial Hospital. Clinicopathological data were collected by chart review. We also recorded ESD-related complications and clinical outcomes. Results The average age was 64 years old, with a mean follow-up time of 22.59 months. There was a loss of follow-up in 34 lesions. Most lesions were lateral spreading tumors of the non-granular type. The average ESD time was 51.9 minutes. Nine cases (3.7%) had procedure-related complications, including two intra-procedure perforations (0.8%) and seven delayed bleeding (2.9%) without procedure-related mortality. 241 lesions (98.8%) achieved en-bloc resection, while 207 lesions (84.8%) achieved R0 resection. Most lesions were tubulo-(villous) adenoma. Malignancy included 35 adenocarcinomas and 5 neuroendocrine tumors. No local recurrence was developed during follow-up. Multivariate analysis for long ESD time revealed significance in size ≥ 10 cm2 and endoscopist’s experience < 3 years. Pre-ESD endoscopic ultrasound revealed good prediction in discrimination of mucosal (sensitivity: 0.90) and submucosal lesion (specificity: 0.67). Conclusions ESD for colorectal neoplasms is an effective and safe technique. Size ≥ 10 cm2 and endoscopist’s experience < 3 years were significantly associated with long procedure time. Pre-ESD EUS provided a good prediction for colorectal neoplasms in invasion depth.

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“…Tiing Leong Ang, FRCPEd, FAMS I n this issue of the Singapore Medical Journal, Koay et al (1) examined the role of narrow-band imaging (NBI), an image-enhanced endoscopy (IEE) technique, for the diagnosis of duodenal villous atrophy, while Li et al (2) and Tai et al (3) reported the early Singapore experience with colorectal endoscopic submucosal dissection (ESD). The aim of IEE as an adjunct to standard white light endoscopy is to improve endoscopic detection, characterisation and diagnosis of mucosal lesions.…”

Section: Gastrointestinal Neoplasiamentioning

confidence: 99%

Optimising endoscopic management of early gastrointestinal neoplasia

Ang

2019

smedj

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I n this issue of the Singapore Medical Journal, Koay et al (1) examined the role of narrow-band imaging (NBI), an image-enhanced endoscopy (IEE) technique, for the diagnosis of duodenal villous atrophy, while Li et al (2) and Tai et al (3) reported the early Singapore experience with colorectal endoscopic submucosal dissection (ESD). The aim of IEE as an adjunct to standard white light endoscopy is to improve endoscopic detection, characterisation and diagnosis of mucosal lesions. This would facilitate subsequent management strategies, including endoscopic resection or surgery. It is thus appropriate to take the opportunity to briefly examine the crucial issue of optimising endoscopic management of early gastrointestinal (GI) neoplasia. This would encompass preprocedural preparation, intraprocedural diagnosis, endoscopic treatment and post-resection follow-up options guided by histopathological findings.Endoscopy is the gold standard test for examining GI mucosa. However, to improve diagnostic yield, the mucosal surface must be clean and not obscured by mucus, fluids or other solid debris. Hence, adequate fasting, appropriate use of mucolytics and anti-foaming agents (for upper endoscopy), and good bowel preparation (for colonoscopy) are crucial. Quality endoscopic examinations are characterised by careful, deliberate and meticulous techniques. Surrogate markers of a quality examination include diagnostic procedure time, cleanliness of mucosal surface, completeness of examination, quality of captured endoscopic images and adenoma detection rates. IEE techniques are an important adjunct to white light endoscopy to improve lesion detection, characterisation and diagnosis. This may be achieved using dye spray chromoendoscopy such as the absorptive dye, Lugol's iodine, for detection of dysplastic oesophageal squamous lesions and the contrast dye, indigo carmine, which is used to highlight mildly elevated or mildly depressed mucosal lesions in the stomach and colon -or by equipment-based optical techniques. The latter techniques include NBI and blue light imaging, which focus on mucosal surface details and can be combined with optical magnification to characterise a detected lesion to determine whether it is neoplastic; if the lesion is neoplastic, the likelihood of deep submucosal involvement and feasibility of curative endoscopic resection are examined.Endoscopic classification systems based on these narrow-bandwidth imaging features have been established for the oesophagus, stomach and colon to guide treatment decisions. These include the intrapapillary capillary loop classification system for oesophageal squamous neoplasia, (4) the BING (Barrett's International NBI Group) classification system for Barrett's oesophagus, (5) the VS (vessel plus surface) classification system for early gastric cancer (6) and the NBI and JNET (Japan NBI Expert Team) classification systems for colorectal neoplasia. (7) It is important for an endoscopist to correctly describe the morphology of a detected lesion using the Paris morphol...

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Endoscopic submucosal dissection of colonic lesions: first 50 cases at a local institution

Cited by 4 publications

References 22 publications

Endoscopic submucosal dissection and JNET classification for colorectal neoplasia: A North American academic center experience

Endoscopic submucosal dissection and JNET classification for colorectal neoplasia: A North American academic center experience

Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern Taiwan

Optimising endoscopic management of early gastrointestinal neoplasia

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