Endoscopic Submucosal Dissection of Early Cancers, Flat Adenomas, and Submucosal Tumors in the Gastrointestinal Tract

Probst, Andreas; Golger, Daniela; Arnholdt, H.; Messmann, Helmut

doi:10.1016/j.cgh.2008.09.005

Cited by 97 publications

(72 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thus, in cases in which the available endoscopic techniques such as EUS do not provide a definitive diagnosis, ESD offers a reliable alternative, allowing definitive treatment of SMTs and GISTs. In case of tumors limited to submucosal or with a minimum invasion of the proper muscle layer and in absence of deep central ulceration, endoscopic treatment can be considered after careful evaluation of each single patient [25][26][27]. Our experience is, however, limited to a few patients and our findings remain to be confirmed in a larger series.…”

Section: Discussioncontrasting

confidence: 40%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

View full text Add to dashboard Cite

Background A submucosal tumor (SMT) of the stomach, which is an occasional finding during routine upper gastrointestinal endoscopy, may pose diagnostic and therapeutic challenges. Methods To assess whether endoscopic submucosal dissection (ESD) is a feasible approach to definitively cure SMTs, the authors performed a retrospective cohort study with two endoscopic italian centers.Results The study consisted of 20 patients with SMTs who underwent ESD. The patients underwent ESD and were followed up by endoscopy. We analyzed complete resection rate, frequency of complications, and survival. The overall rate of R0 resection was 90 % (18/20), with two endoscopic failures, one for a submucosal tumor and one for a neoplasm deeply infiltrating the proper muscle layer. The median procedure time was 119.1 min (range 40-240 min). The median size of the resected specimens was 29 mm (range 15-60 mm). Perforation occurred in 3 patients; all were treated conservatively. There were no cases of severe bleeding. Based on histopathological findings, 6 cases of ectopic pancreas, 1 of ectopic spleen, 3 of leiomyoma, and 10 of gastrointestinal stromal tumor (GIST) were diagnosed. Complete resection was obtained in all GIST cases. Among the 10 GIST cases treated by ESD, no death occurred: the 5-year disease-specific survival rate was 100 %. Conclusions The high success rate of 90 % and the low incidence of complications should indicate ESD is the correct diagnostic and definitive treatment in selected patients.

show abstract

Section: Discussioncontrasting

confidence: 40%

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

et al. 2012

View full text Add to dashboard Cite

show abstract

“…ESD has also been used to treat large colorectal adenomas, with recurrence rates of 0-9 % and complication rates of only 0-9 % [11,22,23]. However, compared to conventional EMR, the ESD technique is technically challenging and time consuming and requires a steep learning curve [11,24]. As a result, ESD has not gained wide acceptance in Western countries to date.…”

Section: Discussionmentioning

confidence: 99%

“…ESD has recently gained more support, mainly because of good clinical results in the treatment of esophageal and gastric neoplasms as reported in Japanese centers [21]. ESD has also been used to treat large colorectal adenomas, with recurrence rates of 0-9 % and complication rates of only 0-9 % [11,22,23]. However, compared to conventional EMR, the ESD technique is technically challenging and time consuming and requires a steep learning curve [11,24].…”

Section: Discussionmentioning

confidence: 99%

“…However, for large sessile lesions, endoscopic mucosal resection (EMR) techniques may be inadequate to achieve a documented en bloc resection, and piecemeal resection has been reported to have a recurrence rate as high as 11.2 % [7]. On the other hand, endoscopic submucosal dissection (ESD) still remains a technical challenge without clear advantages compared to EMR in terms of achieving R0 resections [8][9][10][11]. Therefore, transanal surgery is mostly indicated.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

et al. 2012

View full text Add to dashboard Cite

Background Transanal endoscopic microsurgery (TEM) has revolutionized the technique and outcome of transanal surgery, becoming the standard of treatment for large sessile rectal adenomas. Nevertheless, only a few studies have evaluated the risk factors for local recurrence in order to recommend a "tailored" approach. The aim of this study was to identify predictor variables for recurrence after TEM to treat rectal adenoma. Methods This study is a retrospective analysis of a prospective database of patients treated for large sessile rectal adenomas by TEM at our institution, with a minimum follow-up of 12 months. Age, gender, tumor diameter, distance from the anal verge, degree of dysplasia, histology, and margin involvement were investigated. Results Between January 1993 and July 2010, 293 patients with a rectal adenoma ≥3 cm underwent TEM. Postoperative morbidity rate was 7.2 % (21/293) and there was no 30-day mortality. Over a median follow-up period of 110 (range = 12-216) months, 13 patients (5.6 %) were diagnosed with local recurrence. The median time to recurrence was 10 (range = 4-33) months, with 76.9 % of recurrences detected within 12 months after TEM. At univariate analysis, tumor diameter (p = 0.007), and positive margins (p < 0.001) were shown to be significant risk factors, while multivariate analysis indicated the presence of positive margins as the only independent predictor of recurrence (p = 0.003). Conclusions TEM provides excellent oncological outcomes in the treatment of large sessile benign rectal lesions, assuring a minimal risk of resection margin infiltration at pathology examination, which represents the only risk factor for recurrence. Keywords Transanal endoscopic microsurgery Rectal adenoma Recurrence Risk factors Rectal cancer is a common disease in Western countries, with increased incidence in the elderly, males, and obese people [1,2]. Dysplasia precedes the occurrence of invasive rectal cancer [3,4]. Endoscopic detection and removal of rectal adenomas prevents the development of rectal cancer, significantly contributing to the "cure" of the disease [5,6]. Complete resection of the precancerous lesion is mandatory to prevent recurrence. However, for large sessile lesions, endoscopic mucosal resection (EMR) techniques may be inadequate to achieve a documented en bloc resection, and piecemeal resection has been reported to have a recurrence rate as high as 11.2 % [7]. On the other hand, endoscopic submucosal dissection (ESD) still remains a technical challenge without clear advantages compared to EMR in terms of achieving R0 resections [8][9][10][11]. Therefore, transanal surgery is mostly indicated.

show abstract

“…For example, previous research reported that repetitive cancer screening increases the likelihood of detecting EGC; however, we applied the same gastric cancer stage distribution in the screening arms. In reality, some cases of EGC can be treated via endoscopic mucosal resection, which would result in lower costs and a higher quality of life (Probst et al, 2009). The costs of treatment according to cancer stage were assumed to be similar without considering whether screening was performed.…”

mentioning

confidence: 99%

Comparing Endoscopy and Upper Gastrointestinal X-ray for Gastric Cancer Screening in South Korea: A Cost-utility Analysis

Chang

Park

Chung

et al. 2012

Asian Pacific Journal of Cancer Prevention

View full text Add to dashboard Cite

Background: There are limited data evaluating the cost-effectiveness of gastric cancer screening using endoscopy or upper gastrointestinal x-ray in the general population. Objective: To evaluate the costeffectiveness of population-based screening for gastric cancer in South Korea by decision analysis. Methods: A time-dependent Markov model for gastric cancer was constructed for healthy adults 30 years of age and older, and a deterministic sensitivity analysis was performed. Cost-utility analysis with multiple strategies was conducted to compare the costs and effects of 13 different screening alternatives with respect to the following eligibility criteria: age at the beginning of screening, screening interval, and screening method. The main outcome measurement was the incremental cost-effectiveness ratio. Results: The results revealed that annual endoscopic screening from ages 50-80 was the most cost-effective for the male population. In the females, biennial endoscopy screening from ages 50-80 was calculated as the most cost-effective strategy among the 12 screening alternatives. The most cost-effective screening strategy may be adjustable according to the screening costs and the distribution of cancer stage at screening. The limitation was that effectiveness data were obtained from published sources. Conclusions: Using the threshold of $19,162 per quality-adjusted life year on the basis of the Korean gross domestic product (2008), as suggested by the World Health Organization, endoscopic gastric cancer screening starting at the age of 50 years was highly cost-effective in the Korean population. The national recommendation for gastric cancer screening should consider the starting age of screening, the screening interval, and the screening modality.

show abstract

Endoscopic Submucosal Dissection of Early Cancers, Flat Adenomas, and Submucosal Tumors in the Gastrointestinal Tract

Cited by 97 publications

References 18 publications

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Endoscopic submucosal dissection in the treatment of gastric submucosal tumors: results from a retrospective cohort study

Recurrence after transanal endoscopic microsurgery for large rectal adenomas

Comparing Endoscopy and Upper Gastrointestinal X-ray for Gastric Cancer Screening in South Korea: A Cost-utility Analysis

Contact Info

Product

Resources

About