Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

Soune, Philippe Ah; Ménard, Charles; Ezzedine, Salah; Desjeux, Ariadne; Grimaud, Jean–Charles; Barthet, Marc

doi:10.3748/wjg.v16.i5.588

Cited by 35 publications

(36 citation statements)

References 49 publications

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“…Auch andere Gruppen berichten Serien resezierter großer Polypen [5,6,7] mit Rezidivraten von 12%, 17% und 4%, die zu 66%, 89% und 99% erneut endoskopisch therapiert werden konnten. Damit sind auch bei Rezidiven die Erfolgsraten für eine erneute endoskopische Abtragung hoch.…”

Section: Leitthema Seit Vielen Jahren Ist Die Endoskopische Entfernununclassified

“…Unter den 121 endoskopisch komplett entfernten Adenomen (73,6% "Piecemeal-Resektionen") fand sich im medianem Follow-up über 72,2 Monate bei 99 Patienten eine Rezidivrate von 26,3% (n=26), wovon 19 Befunde erneut endoskopisch therapiert werden konnten. Sechs Patienten (23,1%) wurden operiert, wobei bei 4 Polypenrezidiven bereits ein invasives Karzinom vorlag.Auch andere Gruppen berichten Serien resezierter großer Polypen [5,6,7] mit Rezidivraten von 12%, 17% und 4%, die zu 66%, 89% und 99% erneut endoskopisch therapiert werden konnten. Damit sind auch bei Rezidiven die Erfolgsraten für eine erneute endoskopische Abtragung hoch.…”

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“…Die Rezidivraten liegen deutlich unter denen der "Piecemeal-Resektion" und der Pathologe kann die Radikalität der Resektion zu den lateralen Rändern und vor allem auch zur Tiefe zuverlässig beurteilen. Auch andere Gruppen berichten Serien resezierter großer Polypen [5,6,7] mit Rezidivraten von 12%, 17% und 4%, die zu 66%, 89% und 99% erneut endoskopisch therapiert werden konnten. Damit sind auch bei Rezidiven die Erfolgsraten für eine erneute endoskopische Abtragung hoch.…”

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Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

Rüth

Spatz

Anthuber

2011

Chirurg

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The knowledge that due to the adenoma-cancer sequence polyps will develop sooner or later into invasive cancer demands the complete removal of colorectal polyps. The majority of polyps can be endoscopically removed. The indications for surgical removal of polyps are a previous incomplete endoscopic resection, location not amenable to endoscopic removal and lesions which are macroscopically highly suspicious for malignancy and cannot be detached by submucosal saline injection. If a surgical approach is indicated minimally invasive surgery in the hands of an experienced laparoscopic surgeon is a suitable option. Adenomas suspicious for malignancy in the lower two thirds of the rectum should not be treated by time-consuming endoscopic submucosal dissection (ESD) and can be quickly and safely removed transanally, conventionally or by transanal endoscopic microsurgery (TEM) by a full thickness én bloc resection. This allows the pathologist to determine the depth of invasion and the completeness of resection in terms of the circumferential margin and a definitive radical surgical approach is only necessary in high risk situations.

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Section: Leitthema Seit Vielen Jahren Ist Die Endoskopische Entfernununclassified

unclassified

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Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

Rüth

Spatz

Anthuber

2011

Chirurg

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“…Fortunately, no distal metastasis was found in preoperative examinations. ESD has been reported to be a safe and effective treatment for giant tumor [29], so we chose ESD instead of open surgery. For over a year from the first dissection, there was no recurrence of the diarrhea and his activities of daily living (ADL) were maintained.…”

Section: Discussionmentioning

confidence: 99%

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

et al. 2013

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McKittrick-Wheelock syndrome can be successfully treated by emergent dialysis, prescription of bicarbonate, and endoscopic submucosal dissection, which allow elderly people suffering from this syndrome to maintain their activities of daily living. In patients with this syndrome, a large colonic villous adenoma secretes excessive amounts of mucus and causes severe electrolyte depletion and dehydration. An 81-year-old man who had been suffering from chronic renal failure (creatinine 256.4 lmol/L), hypertension, and arrhythmia presented with frequent mucous diarrhea for a month. He was hospitalized for appetite loss, vomiting, general fatigue, and acute renal failure. His blood tests and blood gas analysis revealed urea nitrogen 58.9 mmol/L, creatinine 954.7 lmol/L, pH 7.13, and a base excess of -20.1 mmol/L. Although his symptoms were improved by the emergent dialysis and rehydration, he suffered a relapse only 4 days after he was discharged. At the second admission, a nearcircumferential tumor was found in the rectum by the colonoscopy, which was pathologically confirmed as a villous adenoma. Considering his age and complications, endoscopic submucosal dissection was selected, and internal use of sodium bicarbonate was prescribed. Diarrhea and appetite loss were improved by these treatments, and the creatinine level was also improved to 168.0 lmol/L.

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“…There are reports of large right-sided sessile polyps being removed endoscopically. 10,11 However, the overall frequency of colonic perforation for polypectomy has been estimated to be about 1 in 200. 12 Furthermore, one study advocating EMR at colonoscopy for large colorectal polyps reported on a series of 151 polyps undergoing EMR with 3 perforations and 2 cases of copious haemorrhage requiring emergency bowel resection.…”

Section: Discussionmentioning

confidence: 99%

Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

Wood

Lord

Wheeler

et al. 2011

annals

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INTRODUCTION Polypectomy at colonoscopy may be difficult or dangerous. In such instances colonic resection may be indicated. Novel combined laparoscopic-endoscopic procedures have the potential to allow safe extensive extramucosal resection, thus avoiding resection. Laparoscopic colon mobilisation provides a more favourable orientation for endoscopic mucosal resection and facilitates identification of possible perforation sites with immediate laparoscopic repair or resection if necessary. This study aimed to assess the efficacy and safety of laparo-endoscopic resection (LER) of colonic polyps. PATIENTS AND METHODS Data were collected prospectively on consecutive patients undergoing LER. The mode of presentation, referral pattern, lesion site and size, hospital stay, procedural details, complications, histology and further treatment were recorded. RESULTS A total of 13 patients underwent attempted LER (16 polyps in total) and this was completed for 10, with a median hospital stay of 2 days. Five polyps were removed whole and eight piecemeal. Excision was clinically complete in all cases. Three procedures were converted to colonic resection. One lesion appeared malignant, indicating a conversion to laparoscopic right hemicolectomy. Two polyps were not amenable to LER and resection was performed. One patient underwent subsequent colonic resection based on the histological findings. There were no perforations or serious complications. CONCLUSIONS LER is a safe and effective treatment for large and inaccessible colonic polyps that would otherwise be treated by colonic resection.

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Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

Abstract: EMR for tumors larger than 4 cm is a safe and effective procedure that could compete with endoscopic submucosal dissection, despite providing incomplete histological assessment.

Cited by 35 publications

References 49 publications

Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

Kolorektale Adenome: Pro konventionelle/laparoskopische Resektion

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

Laparo-endoscopic resection for extensive and inaccessible colorectal polyps: a feasible and safe procedure

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