Selective tissue elevation by pressure for endoscopic mucosal resection of colorectal adenoma: first clinical trial

Belle, Sebastian; Szyrach, Mara N.; Ströbel, Philipp; Post, Stefan; Enderle, Markus D.; Kähler, Georg

doi:10.1007/s00464-011-1873-0

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…3c ). Bleeding rate was particularly high in the study by Belle et al 25 , in which 25/66 patients required hemostasis with clips. If this atypical study is excluded, the bleeding rate is 4.8 % (95 % CI 3.4 %-6.5 %) and remains significantly higher with EMR.…”

Section: Resultsmentioning

confidence: 90%

Management of colorectal laterally spreading tumors: a systematic review and meta-analysis

et al. 2019

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Objective and study aims To evaluate the efficacy and safety of different endoscopic resection techniques for laterally spreading colorectal tumors (LST). Methods Relevant studies were identified in three electronic databases (PubMed, ISI and Cochrane Central Register). We considered all clinical studies in which colorectal LST were treated with endoscopic resection (endoscopic mucosal resection [EMR] and/or endoscopic submucosal dissection [ESD]) and/or transanal minimally invasive surgery (TEMS). Rates of en-bloc/piecemeal resection, complete endoscopic resection, R0 resection, curative resection, adverse events (AEs) or recurrence, were extracted. Study quality was assessed with the Newcastle-Ottawa Scale and a meta-analysis was performed using a random-effects model. Results Forty-nine studies were included. Complete resection was similar between techniques (EMR 99.5 % [95 % CI 98.6 %-100 %] vs. ESD 97.9 % [95 % CI 96.1 – 99.2 %]), being curative in 1685/1895 (13 studies, pooled curative resection 90 %, 95 % CI 86.6 – 92.9 %, I 2 = 79 %) with non-significantly higher curative resection rates with ESD (93.6 %, 95 % CI 91.3 – 95.5 %, vs. 84 % 95 % CI 78.1 – 89.3 % with EMR). ESD was also associated with a significantly higher perforation risk (pooled incidence 5.9 %, 95 % CI 4.3 – 7.9 %, vs. EMR 1.2 %, 95 % CI 0.5 – 2.3 %) while bleeding was significantly more frequent with EMR (9.6 %, 95 % CI 6.5 – 13.2 %; vs. ESD 2.8 %, 95 % CI 1.9 – 4.0 %). Procedure-related mortality was 0.1 %. Recurrence occurred in 5.5 %, more often with EMR (12.6 %, 95 % CI 9.1 – 16.6 % vs. ESD 1.1 %, 95 % CI 0.3 – 2.5 %), with most amenable to successful endoscopic treatment (87.7 %, 95 % CI 81.1 – 93.1 %). Surgery was limited to 2.7 % of the lesions, 0.5 % due to AEs. No data of TEMS were available for LST. Conclusions EMR and ESD are both effective and safe and are associated with a very low risk of procedure related mortality.

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Section: Resultsmentioning

confidence: 90%

Management of colorectal laterally spreading tumors: a systematic review and meta-analysis

et al. 2019

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“…We showed that a water jet dissector placed directly on the mucosa resulted in selective deposition of liquid in the submucosa followed by mucosal elevation (lift-off). After animal studies and comparison of different injecting solutions [ 22 , 31 ], we presented the first data from clinical application [ 32 ]. A total of 59 patients underwent resection of 70 lesions with a maximum diameter of 80 mm (mean 27 mm).…”

Section: Application Methodsmentioning

confidence: 99%

Improved Techniques for Endoscopic Mucosal Resection (EMR) in Colorectal Adenoma

Sold¹,

Kähler²

2014

Visc Med

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Background: Endoscopic therapy of colorectal adenomas and early cancers is a standard method. Besides oncological criteria, the method is limited by polyp location, size, and texture. Method: Based on the current literature, technical modifications and developments in endoscopic mucosal resection are described. Results: Numerous approaches exist to improve the conditions of resection, including optimisation of mucosal elevation and modification of techniques, tools, and devices. Conclusion: Endoscopic therapy of sessile and flat colorectal polyps remains a challenge. Some of the presented modifications can help to address this challenge.

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“…dual, hook, insulation-tipped (IT), triangle-tipped (TT) [ 18 , 19 , 20 , 21 ]), some of them allowing also for submucosal injection (e.g. flush knife [ 22 ] or hybrid knife [ 23 , 24 ]). Hemostasis during the dissection procedure is achieved either with the knife itself in coagulation mode or – in the case of larger vessels – with dedicated hemostatic forceps or hemoclips.…”

Section: Practical Aspects Of Colorectal Esdmentioning

confidence: 99%

“…These substances allowed long-lasting elevation and more efficient dissection [ 72 , 73 , 74 ] and even had autodissective properties [ 75 ], thus greatly reducing procedure time. Moreover, the hybrid knife [ 23 , 24 ] or flush knife [ 22 ] allow submucosal injection and dissection to be carried out with a single device. Finally, specific cutting devices are being evaluated, e.g.…”

Section: Optimizing the Esd Procedure: Current Developmentsmentioning

confidence: 99%

Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

Dumoulin

Sido

Bollmann³

et al. 2014

Visc Med

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Background: Endoscopic submucosal dissection (ESD) - initially developed for the treatment of early gastric cancer in Japan - is an attractive option for en bloc resection of larger sessile or flat colorectal neoplasia. Methods: A review of the current literature on colorectal ESD was carried out. Results: In contrast to conventional endoscopic mucosal resection (EMR), ESD for larger colorectal neoplasia yields high en bloc resection rates and very low recurrence rates. The frequency of delayed bleeding is similar for EMR and ESD. Higher perforation rates during ESD are mostly due to microperforations identified and treated during the intervention, and are therefore of minor clinical relevance. A major disadvantage of ESD is the necessity for high-level endoscopic skills and long procedure times. ESD also has the potential to replace laparoscopic surgery or transanal endoscopic microsurgery mainly due to its lower complication rates. Conclusion: ESD for the resection of larger flat or sessile colorectal lesions has potential advantages over conventional EMR or minimally invasive surgery. Due to the low incidence of early gastric cancer, experience with ESD will remain limited in Western countries. The spread of colorectal ESD will depend on adequate training opportunities and also on modifications yielding a reduction in procedure time.

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Selective tissue elevation by pressure for endoscopic mucosal resection of colorectal adenoma: first clinical trial

Abstract: This first clinical trial to analyze STEP technique demonstrated that STEP used to elevate large mucosal lesions in any location is feasible and facilitates EMR for colorectal adenoma.

Cited by 8 publications

References 21 publications

Management of colorectal laterally spreading tumors: a systematic review and meta-analysis

Management of colorectal laterally spreading tumors: a systematic review and meta-analysis

Improved Techniques for Endoscopic Mucosal Resection (EMR) in Colorectal Adenoma

Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

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