Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: Large multicenter 10‐year study

Tanaka, Hidenori; Oka, Shiro; Tanaka, Shinji; Nagata, Shinji; Kitajima, Masaki; Kuwai, Toshio; Hiraga, Yoshikazu; Mizumoto, Takeshi; Okanobu, Hideharu; Chayama, Kazuaki

doi:10.1111/den.13797

Cited by 17 publications

(10 citation statements)

References 34 publications

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“…This incidence is similar to other techniques for nonlifting polyps, such as CAST, which is associated with an advanced DMI risk of 5.3 % 11 . It also compares favorably to a 16.7 % perforation risk of endoscopic submucosal dissection for polyps with severe fibrosis 13 . A possible explanation for the relatively low perforation risk of EMR-C could be the limited cap depth of only 4 mm combined with a more rigid colorectal wall due to extensive submucosal fibrosis.…”

Section: Discussionmentioning

confidence: 93%

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Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps

et al. 2021

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Background Suboptimal lifting increases complexity of endoscopic mucosal resection (EMR) for benign colorectal polyps. Cap-assisted EMR (EMR-C) may allow fibrotic polyp tissue to be captured in the snare. This study evaluated the efficacy and safety of EMR-C for benign nonlifting colorectal polyps. Methods This was a multicenter study, which prospectively registered all EMR-C procedures (2016–2018) for presumed benign nonlifting colorectal polyps. Results 70 nonlifting polyps with a median size of 25 mm (interquartile range [IQR] 15–40) were treated with EMR-C. Complete polyp removal was achieved in 68 (97.1 %), including 47 (67.1 %) with EMR-C alone. Overall, 66 polyps showed benign histology, and endoscopic follow-up after a median of 6 months (IQR 6–10) showed recurrence in 19.7 %. First (n = 10) and second (n = 2) benign recurrences were all treated endoscopically. Deep mural injury type III–V occurred in 7.4 % and was treated successfully with clips. Conclusion EMR-C may be an alternative therapeutic option for removal of benign nonlifting polyp tissue. Although recurrence still occurs, repeat endoscopic therapy usually leads to complete polyp clearance.

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Section: Discussionmentioning

confidence: 93%

“…Another major advantage of EMR-C is that it requires only minimal adjustment to the standard lift-and-cut EMR technique. Advanced resection techniques, such as endoscopic submucosal dissection or endoscopic full-thickness resection, have also been suggested as salvage treatment [12,13], but these require specific expertise.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps

et al. 2021

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“…Colorectal endoscopic submucosal dissection (ESD) has been standardized by device development and establishment of technique 1–10 . However, submucosal fibrosis is a factor associated with the difficulties in performing an ESD 11–15 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and therapeutic strategies for colorectal tumor with positive muscle‐retracting sign

Tanaka,

Takehara,

Morimoto

et al. 2023

DEN Open

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ObjectivesEndoscopic submucosal dissection (ESD) for colorectal tumors with positive muscle‐retracting (MR) sign often results in incomplete resection or discontinuation owing to the difficulty of submucosal dissection. The present study aimed to evaluate the usefulness of endoscopic ultrasonography (EUS) in diagnosing the MR sign and performing ESD using the pocket‐creation method (PCM).MethodsThirty‐six cases of colorectal tumors with positive MR sign during ESD between January 2015 and December 2021 were retrospectively reviewed. Cases were divided into two groups: 1) the conventional method (CM) group, comprising 29 cases, and 2) the PCM group with seven cases, in which preoperative EUS and ESD using PCM were performed. Treatment outcomes were compared between the groups. The diagnostic yield of EUS for the MR sign was evaluated among large sessile tumors >20 mm in which preoperative EUS was performed.ResultsHistologic diagnosis was adenoma or Tis carcinoma in 12 cases (33%), T1 carcinoma in 18 cases (50%), T2 carcinoma in four cases (11%), and unevaluable in two cases (6%). The sensitivity and specificity of the EUS‐MR sign for large sessile tumors were 87.5% and 83.3%, respectively. ESD was achieved in all cases in the PCM group, although it was discontinued in eight cases (28%) in the CM group. There were significant differences between the PCM and CM groups in en bloc resection (100% vs. 48%, p = 0.013) and R0 resection rates (71% vs. 31%, p = 0.049).ConclusionThe MR sign can be predicted by preoperative EUS, and ESD using PCM allows en bloc resection.

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“…Colorectal endoscopic submucosal dissection (ESD) has been standardized as a minimally invasive treatment method for colorectal tumors. 1 , 2 , 3 , 4 , 5 , 6 , 7 However, there are cases that still require a high degree of skill and specialized techniques. Scope operability along with anatomical features such as wall thinness, folds, and flexures can affect technical difficulty.…”

Section: Introductionmentioning

confidence: 99%

“…Colorectal endoscopic submucosal dissection (ESD) has been standardized as a minimally invasive treatment method for colorectal tumors 1–7 . However, there are cases that still require a high degree of skill and specialized techniques.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of single‐balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score‐matched analysis

et al. 2021

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Objectives A single‐balloon overtube (SBO) can improve poor scope operability during colonic endoscopic submucosal dissection (ESD). We aimed to evaluate the clinical usefulness of SBO for ESD in the proximal colon and the predictive factors for cases in which SBO is useful. Methods A total of 88 tumors located in the proximal colon resected by balloon‐assisted ESD (BA‐ESD) using SBO and 461 tumors resected by conventional ESD (C‐ESD) between June 2015 and November 2020 were considered. Seventy‐eight tumors each in the BA‐ESD and C‐ESD groups were matched by propensity score matching. ESD outcomes were compared between the groups, and a decision tree analysis was performed to explore the predictive factors for cases in which SBO is useful. Results There were no significant differences between the groups in the major outcomes such as en bloc resection rate (95% vs. 99%, p = 0.17), R0 resection rate (92% vs. 96%, p = 0.30), mean dissection speed (16 mm 2 /min vs. 16 mm 2 /min, p = 0.53), and intraoperative perforation rate (5% vs. 6%, p = 0.73). Even when considering cases with poor preoperative scope operability, there were no significant differences between the groups. Comparison of tumors ≥40 mm in diameter between the groups confirmed that the intraoperative perforation rate was significantly lower in the BA‐ESD group than in the C‐ESD group (0% vs. 24%, p = 0.0188). Conclusion SBO is useful for ESD of tumors ≥40 mm in diameter in the proximal colon to prevent intraoperative perforation, which usually has a long procedure time.

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Salvage endoscopic submucosal dissection for local residual/recurrent colorectal tumor after endoscopic resection: Large multicenter 10‐year study

Cited by 17 publications

References 34 publications

Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps

Efficacy and safety of cap-assisted endoscopic mucosal resection for treatment of nonlifting colorectal polyps

Diagnostic and therapeutic strategies for colorectal tumor with positive muscle‐retracting sign

Efficacy of single‐balloon overtube for endoscopic submucosal dissection in the proximal colon: A propensity score‐matched analysis

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