Endoscopic submucosal dissection or piecemeal endoscopic mucosal resection for large superficial colorectal lesions: A cost effectiveness study

SCHEER, S; Wallenhorst, Thimotée; Albouys, Jérémie; Olivier, Raphaël; Dahan, Martin; Pauliat, Emmanuelle; Leclerc, E.; Denost, Quentin; Christou, Niki; Brischoux, Sonia; Lepetit, Hugo; Gschwind, Guillaume; Legros, Romain; Pioche, Mathieu; Geyl, Sophie; Jacques, Jérémie

doi:10.1016/j.clinre.2022.101969

Cited by 9 publications

(3 citation statements)

References 47 publications

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“…Moreover, a recent analysis of cost-effectiveness indicates that opting for an en-bloc resection strategy may turn out to be more cost-effective than a piecemeal resection strategy for rectal lesions, as it could reduce the number of patients requiring additional endoscopic procedures (either therapeutic or surveillance) or further radical rectal surgery [64]. The same results were consistent with another cost-effectiveness study in which it was concluded that the removal of lesions in the rectum ESD for all LSTs larger than 20 mm is more cost-effective than pEMR or selective ESD [65].…”

Section: En-bloc Resection-is It Really Necessary?supporting

confidence: 70%

Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review

Moreira

Cardoso

Macedo

et al. 2023

JCM

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Endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and transanal minimally invasive surgery (TAMIS) are modern techniques that now play a crucial role in the treatment of colorectal lesions. ESD is a minimally invasive endoscopic procedure that allows for the resection of lesions of any size in a single piece, with clear advantages regarding oncological outcomes and recurrences. However, it is a complex technique, requiring high endoscopic skills, expertise, and specialized training, with higher rates of adverse events expected compared with EMR. EMR is another endoscopic technique used to remove superficial gastrointestinal tumors, particularly those that are limited to the mucosal layer. It is a faster and more accessible procedure, with fewer adverse events, although it only allows for an en-bloc resection of lesions measuring 15–20 mm. TAMIS is a minimally invasive surgical technique used to remove rectal tumors, involving the insertion of a single-port device through the anus, allowing for a better visualization and removal of the tumor with minimal disruption. This article reviews the current applications and evidence regarding these techniques, in search for the most adequate treatment for the removal of lesions in the rectum and anorectal junction, as these locations possess distinct characteristics that demand a more specific approach.

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Section: En-bloc Resection-is It Really Necessary?supporting

confidence: 70%

Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review

Moreira

Cardoso

Macedo

et al. 2023

JCM

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“…[ 9 ]. EMR also exhibits higher rates of local recurrence compared to ESD [ 10 ] and recent cost analyses indicate that ESD is more cost-effective due to reduced need for surveillance colonoscopies [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Traction-Assisted Endoscopic Submucosal Dissection of a Gastric Subepithelial Tumor: A Case Report

Sekra,

Yozu

2024

Cureus

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Endoscopic submucosal dissection (ESD) is considered curative for patients with early gastrointestinal cancers. However, it is a technically challenging procedure that can be time-consuming and associated with complications such as bleeding and perforation. Traction devices and techniques have been developed to mitigate these risks and reduce procedure times. Most traction devices are unavailable in New Zealand, and traction techniques have not been widely utilized due to the precision required for successful outcomes. We report the first case of traction-assisted ESD performed in New Zealand for a gastric submucosal tumor. The procedure was successfully performed using the clip with rubber band traction technique. The lesion was resected en bloc, and histology confirmed an R0, curative resection. There were no complications, and the total procedure time was 54 minutes. In conclusion, traction techniques can be effectively employed for ESD in lesions with difficult submucosal access. They contribute to safer dissections and reduced procedure times.

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“…Endoscopic submucosal dissection (ESD) is a safe and effective technique to achieve R0 resection of superficial colorectal neoplasia, regardless of its size, and is associated with few recurrences [1][2][3][4]. Endoscopic mucosal resection (EMR) is still the usual technique to remove superficial colonic tumors in Western countries, despite a lower rate of effectiveness and a higher rate of recurrence (6 %-31 % of all patients) compared with ESD [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study

Yzet,

Le Baleur,

Albouys

et al. 2023

Endoscopy

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Introduction Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions. Methods All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins. Results 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20–30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30–40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations. Conclusion ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.

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Endoscopic submucosal dissection or piecemeal endoscopic mucosal resection for large superficial colorectal lesions: A cost effectiveness study

Cited by 9 publications

References 47 publications

Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review

Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection, and Transanal Minimally Invasive Surgery for the Management of Rectal and Anorectal Lesions: A Narrative Review

Traction-Assisted Endoscopic Submucosal Dissection of a Gastric Subepithelial Tumor: A Case Report

Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study

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