Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors

Sato, Koichiro; Ito, Sayo; Kitagawa, Tomoyuki; Kato, Mitsuru; Tominaga, Kenji; Suzuki, Takeshi; Maetani, Iruru

doi:10.1007/s00464-014-3558-y

Cited by 105 publications

(89 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Similar to our results, a previous study has reported that the presence of fibrosis was associated with difficult procedures and low complete resection rates during colorectal ESD 1215. When the degree of fibrosis was assessed, F2 fibrosis was associated with this outcome 12.…”

Section: Discussionsupporting

confidence: 91%

The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection?

Kim

Han

et al. 2016

Intest Res

View full text Add to dashboard Cite

Background/AimsEndoscopic submucosal dissection (ESD) allows removal of colorectal epithelial neoplasms en bloc regardless of size. Colorectal ESD is a difficult procedure because of technical difficulties and risks of complications. This study aimed to assess the relationship between ESD outcome and degree of submucosal fibrosis.MethodsPatients with colorectal tumors undergoing ESD and their medical records were reviewed retrospectively. The degree of submucosal fibrosis was classified into three types. The relationship between ESD outcome and degree of submucosal fibrosis was analyzed.ResultsESD was performed in 158 patients. Thirty-eight cases of F0 (no) fibrosis (24.1%) and 46 cases of F2 (severe) fibrosis (29.1%) were observed. Complete resection was achieved for 138 lesions (87.3%). Multivariate analysis demonstrated that submucosal invasion of tumor and histology of carcinoma were independent risk factors for F2 fibrosis. Severe fibrosis was an independent risk factor for incomplete resection.ConclusionsSevere fibrosis is an important factor related to incomplete resection during colorectal ESD. In cases of severe fibrosis, the rate of complete resection was low even when ESD was performed by an experienced operator. Evaluation of submucosal fibrosis may be helpful to predict the submucosal invasion of tumors and technical difficulties in ESD.

show abstract

Section: Discussionsupporting

confidence: 91%

The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection?

Kim

Han

et al. 2016

Intest Res

View full text Add to dashboard Cite

show abstract

“…Its advantages compared to surgery are its less invasive nature and its low rate of complications. However, ESD requires the performance of advanced endoscopic techniques, and it can cause intraoperative perforation and postoperative bleeding, with reported rates of 1-6 % and 1-2.4 %, respectively, on colonic ESD [25][26][27][28][29][30]. Rates reported for complete resection and curative resection for ESD are 84-87 % and 80-90 %, respectively [9,[30][31][32], which are considered acceptable.…”

Section: Discussionmentioning

confidence: 88%

Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection

Ohara

Toyonaga

Watanabe

et al. 2015

Clin J Gastroenterol

View full text Add to dashboard Cite

A 66-year-old woman presented to us with malaise, anorexia and rectal mucous discharge, and her laboratory data showed severe hyponatremia, hypokalemia, hypochloremia and renal failure. Computed tomography revealed massive occupation of the rectum by a large tumor. Colonoscopy revealed a mucus-rich villous tumor in the rectum. As there were no other factors that could cause an electrolyte disorder, she was diagnosed with McKittrick-Wheelock syndrome (MWS). The current standard treatment for MWS is partial surgical colectomy. However, surgeries are invasive and postoperative complications sometimes become an issue. After confirming no signs of submucosal invasion of the tumor by magnifying chromoendoscopic examination, endoscopic submucosal dissection (ESD) was indicated. The tumor was completely removed en bloc without adverse events. The histology showed a mucosal adenocarcinoma containing a villous component, 24.5 x 17.0 cm in size. This removal dramatically improved the patient's symptoms and the electrolyte abnormalities without medication. Although several sessions of endoscopic balloon dilation were required to treat postoperative stricture, she has been symptom-free and had no recurrence for 4 years after treatment. We experienced a case of MWS treated by ESD instead of surgery. ESD should be feasible and beneficial for the treatment of MWS.

show abstract

“…reported that risk factors for incomplete resection while using colorectal ESD are SM deep invasion, unfavorable histological type at the deepest site of SM invasion, and a submucosal severe fibrosis . Recently, a similar report has also been published . At present, as the safety of colorectal ESD has already been established, high‐quality colorectal ESD needs to be developed.…”

Section: Problems With Esd As Total Excisional Biopsy For Ct1 Colorecmentioning

confidence: 85%

Towards safer and appropriate application of endoscopic submucosal dissection for T1 colorectal carcinoma as total excisional biopsy: Future perspectives

Tanaka

Asayama

Shigita

et al. 2014

Digestive Endoscopy

View full text Add to dashboard Cite

According to the Japanese Society for Cancer of the Colon and Rectum Guidelines 2014 for the Treatment of Colorectal Cancer, cases with T1 colorectal carcinoma should be considered for additional colectomy with lymph node dissection when histologically complete en bloc resection is endoscopically carried out and when one of the four risk factors listed below is present. These four risk factors are: (i) submucosal (SM) invasion depth ≥1000 μm; (ii) positive vascular invasion; (iii) poorly differentiated adenocarcinoma, signet ring cell carcinoma, or mucinous carcinoma; and (iv) grade 2/3 budding at the deepest part of SM invasion. However, the probability of lymph node metastasis is extremely low if none of these risk factors are present, with the exception of SM invasion depth ≥1000 μm. Consequently, it is assumed that there will be an increasing number of cases where no additional surgery is done, or cases of moderate invasive carcinoma in which endoscopic treatment is carried out to achieve an excisional biopsy, for which complete resection is applicable. In these cases, the preoperative diagnosis, resection techniques such as endoscopic submucosal dissection, features of resected specimens, and the accuracy of pathological diagnosis are all extremely important.

show abstract

Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors

Cited by 105 publications

References 29 publications

The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection?

The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection?

Electrolyte depletion syndrome (McKittrick–Wheelock syndrome) successfully treated by endoscopic submucosal dissection

Towards safer and appropriate application of endoscopic submucosal dissection for T1 colorectal carcinoma as total excisional biopsy: Future perspectives

Contact Info

Product

Resources

About