Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Abstract

-Context -Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. Objectives -To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. Methods -A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique.Complications and recurrence were analyzed. Patients were followed up for 18 months. Results -There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). Conclusions -Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review

“…EMR has been extensively used throughout the gastrointestinal tract to remove early neoplastic lesions; it is widely accepted for the treatment of colon adenomas and superficial colorectal tumors (Swan et al, 2009;Bergmann and Beger, 2003;Su et al, 2005;Bories et al, 2006;Katsinelos et al, 2006;Arebi et al, 2007;Hurlstone et al, 2008;Urban et al, 2008;Mahadeva and Rembacken, 2009;Luigiano et al, 2009;Huang et al, 2009;Lim et al, 2010;Ferrara et al, 2010;Conio et al, 2010a;Saito et al, 2010a;Toyonaga et al, 2010;Hochdörffer et al, 2010;Moss et al, 2011;Kao et al, 2011;Tajika et al, 2011;Santos et al, 2011;Mannath et al, 2011;Kim et al, 2012;Lee et al, 2012;Kobayashi et al, 2012;Fasoulas et al, 2012;Buchner et al, 2012;Binmoeller et al, 2012;Terasaki et al, 2012;Carvalho et al, 2013;Kim et al, 2013;Masci et al, 2013;Dior et al, 2013;Cipolletta et al, 2014;Maguire and Shellito, 2014;Gómez et al, 2014;Grgov et al, 2014;Belle et al, 2014;Knabe et al, 2014;Wang et al, 2014a;…”

Factors associated with increased bleeding post‐endoscopic mucosal resection

“…Endoscopic mucosal resection (EMR) has evolved as a safe technique to remove flat/sessile lesions in the GI tract. EMR has been used mostly for colorectal and esophageal lesions . However, it can also be used for selected patients with gastric or duodenal lesions .…”

Digital Chromoendoscopy for Diagnosis of Diminutive Colorectal Lesions

“…Colonoscopy is the best diagnostic method, and the use of chromoendoscopy (CE) with indigo carmine and crystal violet may help characterize the morphology of lesions, whose correct interpretation is crucial in choosing the appropriate treatment. When associated with magnification, this method can provide high accuracy in differentiating neoplastic from non-neoplastic lesions after pit pattern analysis [7–12], in the assessment of invasion depth of carcinomas [13], and in the diagnosis of diminutive residual tumor after endoscopic resection [14], thus increasing the efficiency of the endoscopic procedure [15]. Some studies indicate that CE may increase the detection rate of small flat adenomas in diagnostic colonoscopies [16, 17].…”