The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection

Lee, Dong Seok; Jeon, Seong Woo; Park, S. Y.; Jung, Min Kyu; Cho, C. M.; Tak, Won Young; Kweon, Young-Oh; Kim, S. K.

doi:10.1055/s-0030-1255591

Cited by 120 publications

(117 citation statements)

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“…Moreover, a histologically complete resection was achieved for 96.6% (28/29) of the current series. This is important as a high rate of histologically complete resections with ESD may give several advantages for the treatment of foregut NETs [17][18][19] . First, a histologically complete resection …”

Section: Discussionmentioning

confidence: 99%

“…ESD has the advantage of a high probability of en bloc and histologically complete resection even in huge lesions because the technique involves dissection of the submucosal tissue beneath the lesion [14][15][16] . To date, the fact that ESD can facilitate a histologically complete resection of NETs has been verified for the use of ESD for treatment of rectal carcinoid tumors (now referred to as NETs) [17][18][19] . However, no systematic data have yet been published in which ESD has been applied to foregut NETs.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Zhang²,

Chen³

et al. 2012

WJG

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AIM:To evaluate the feasibility and efficacy of endoscopic submucosal dissection (ESD) for foregut neuroendocrine tumors (NETs). METHODS:From April 2008 to December 2010, patients with confirmed histological diagnosis of foregut NETs were included. None had regional lymph node enlargement or distant metastases to the liver or lung on preoperative computerized tomography scanning or endoscopic ultrasonography (EUS). ESD was attempted under general anesthesia. After making several marking dots around the lesion, a mixture solution was injected into the submucosa. The mucosa was incised outside the marking dots. Dissection of the submucosal layer beneath the tumor was performed under direct vision to achieve complete en bloc resection of the specimen. Tumor features, clinicopathological characteristics, complete resection rate, and complications were evaluated. Foregut NETs were graded as G1, G2, or G3 on the basis of proliferative activity by mitotic count or Ki-67 index. All patients underwent regular follow-up to evaluate for any local recurrence or distant metastasis. RESULTS:Those treated by ESD included 24 patients with 29 foregut NETs. The locations of the 29 lesions are as follows: esophagus (n = 1), cardia (n = 1), stomach (n = 23), and duodenal bulb (n = 4). All lesions were found incidentally during routine upper gastrointestinal endoscopy for other indications, and none had symptoms of carcinoid syndrome. Preoperative EUS showed that all tumors were confined to the submucosa. Among the 24 gastric lesions, 16 lesions in 11 patients were type I gastric NETs arising in chronic atrophic gastritis with hypergastrinemia, while the other 8 solitary lesions were type Ⅲ because of absence of atrophic gastritis in these cases. All of the tumors were removed in an en bloc fashion. The average maximum diameter of the lesions was 9.4 mm (range: 2-30 mm), and the procedure time was 20.3 min (range: 10-45 min). According to the World Health Organization 2010 classification, histological evaluation determined that 26 lesions were NET-G1, 2 gastric lesions were NET-G2, and 1 esophageal lesion was neuroendocrine carcinoma (NEC). Complete resection was achieved in 28 lesions (28/29, 96.6%), and all of them were confined to the submucosa in histopathologic assessment with no lymphovascular invasion. The remaining patient with NEC underwent additional surgery because the resected specimens revealed angiolymphatic and muscularis invasion, as well as incomplete Li QL et al . ESD for foregut NETs 5800October 28, 2012|Volume 18|Issue 40| WJG|www.wjgnet.com resection. Delayed bleeding occurred in 1 case 3 d after ESD, which was managed by endoscopic treatment. There were no procedure-related perforations. During a mean follow-up period of 24.4 mo (range: 12-48 mo), local recurrence occurred in only 1 patient 7 mo after initial ESD. This patient successfully underwent repeat ESD. Metastasis to lymph nodes or distal organs was not observed in any patient. No patients died during the study period.CONCLUSION: ESD appears to...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Zhang²,

Chen³

et al. 2012

WJG

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“…25 Several studies reported that ESD could be a feasible and safe procedure for treatment of carcinoid tumors showing good clinical outcomes. [34][35][36][37][38] Our study has several limitations. First, the study was a retrospective analysis.…”

Section: Discussionmentioning

confidence: 99%

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Lee

Kim

Park

et al. 2014

Korean J Gastroenterol

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Background/Aims: Endoscopic submucosal dissection (ESD) is an effective procedure for en-bloc curative resection of the colorectal tumor. As it requires high technical skills and experience in therapeutic endoscopy, it is important to understand learning curve of ESD technique. The aim of this study was to retrospectively describe the clinical results of ESD and to evaluate learning curve for the ESD of colorectal tumors. Methods: A total of 90 patients with 90 colorectal neoplasms, who had undergone ESD at a tertiary referral hospital from July 2009 to December 2012, were enrolled. The ESD was performed by a single endoscopist. All ESD cases were divided into three periods: first, cases 1-30; second, cases 31-60; and third, cases 61-90. Results: The en-bloc resection rates in third period (100%) was significantly higher than that of the first (93.3%) and second period (80%) (p=0.025). The perforation rate in third period (0%) also significantly decreased compared with that of the first (13.3%) and second period (20%) (p=0.032). To calibrate the difference of tumor size among periods, proficiency was calculated, as the procedure time per specimen area (min/cm 2 ). The proficiency in third period (4.3) was significantly shorter than that of the first (16.8) and second period (10.2) (p=0.004). Conclusions: The learning curve of colorectal ESD in our study shows that at least 60 cases of ESD have to be conducted to acquire sufficient skill of degree without perforation. (Korean J Gastroenterol 2014;64:198-205)

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“…Some investigators have reported that conventional snare polypectomy or EMR resulted in unsatisfactory complete resection of colonic carcinoid tumors [27][28][29]. Lee et al stated that the positive resection vertical margin rate was 28.6% by EMR [15]. Concurrently, ESD has recently been reported to be useful for treating colorectal superficial tumors [12,13].…”

Section: Follow-up (Median; Month)mentioning

confidence: 99%

“…Concurrently, Endoscopic Submucosal Dissection (ESD), which enables en bloc resection regardless of tumor size, has recently been reported to be useful for treating colorectal superficial tumors [12][13][14]. There are many reports on the efficacy of ESD to treat colorectal carcinoids [15][16][17][18]. However, because ESD has the disadvantages of a high frequency of complications and need for advanced technical skills, this technique is not yet a standard treatment.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Endoscopic Mucosal Resection after Circumferential Mucosal Incision of Small Rectal Carcinoid Tumors

Andoh¹

2011

J Gastrointest Digest Sys

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Background: Endoscopic mucosal resection is widely used for treating rectal carcinoid tumors. However, histopathology has revealed that submucosal invasion leads to incomplete resection. Endoscopic submucosal dissection, which enables en bloc resection regardless of tumor size, has recently been reported to be useful in treating rectal carcinoid tumors; however, it is not widely used as standard treatment because of technical demands. We use endoscopic mucosal resection after circumferential mucosal incision, which is performed after mucosal resection around the lesion to treat rectal carcinoid tumors. To our knowledge, this is the first report of endoscopic mucosal resection after circumferential mucosal incision for colorectal carcinoid tumors.

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The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection

Abstract: This study suggests that ESD might be a feasible treatment technique for small rectal carcinoid tumors. It showed superior efficacy and comparable safety to EMR.

Cited by 120 publications

References 10 publications

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Endoscopic submucosal dissection for foregut neuroendocrine tumors: An initial study

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Efficacy of Endoscopic Mucosal Resection after Circumferential Mucosal Incision of Small Rectal Carcinoid Tumors

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