Hybrid endoscopic submucosal dissection in the colon: Cutting corners or trimming fat?

Gorospe, Emmanuel C.; Song, Louis M. Wong Kee

doi:10.1016/j.gie.2015.08.059

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…This statement underscores the importance of margin-negative resection and en bloc resection, which are more commonly achieved with conventional ESD than with EMR. When performing EMR, the ability to perform adequate en bloc resection is generally limited to lesions < 20 mm in an effort to minimize the risk of perforation [11,27,28]. For lesions > 20 mm in size, piecemeal EMR is typically advised, although this method may result in more challenging histopathologic assessment and risk of residual polyp tissue or local recurrence.…”

Section: Discussionmentioning

confidence: 99%

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

et al. 2020

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Background and Aim: Hybrid endoscopic submucosal dissection (hybrid ESD) has become increasingly utilized to overcome the complexity of conventional ESD. The aim of this study was to perform a systematic review and meta-analysis to evaluate the efficacy and safety of hybrid ESD for the treatment of colorectal lesions. Methods: Individualized search strategies were developed in accordance with PRISMA guidelines. Pooled proportions were calculated with rates estimated using random effects models. Measured outcomes included en-bloc, procedure-associated adverse events, recurrence, and need for surgery. Subgroup analyses were performed to compare effectiveness of traditional versus hybrid ESD. Results: Sixteen studies (n=751 patients) were included with an average lesion size of 27.96±10.55 mm. En-bloc resection rates were 81.63% [(95% CI, 72.07-88.44);I2=80.89]. Adverse events, recurrence, and need for surgery occurred in 7.74% [(95% CI, 4.78-12.31);I2=65.84], 4.52% [(95% CI, 1.40-13.65);I2=76.81], and 3.64% of cases [(95% CI, 1.76-7.37);I2=15.52]. Mean procedure duration was 48.83±22.37 min. On subgroup analyses comparing outcomes for conventional (n=1703) versus hybrid ESD (n=497), procedure duration was significantly shorter for hybrid ESD (mean difference 18.45 min; P=0.003) with lower adverse event rates (P=0.043); however, hybrid ESD was associated with lower rates of en-bloc resection (P<0.001). There was no difference in rates of recurrence or surgery (all P>0.05). Conclusion: While hybrid ESD is safe and effective for removal of colorectal lesions with a shorter procedure duration, fewer adverse events, and no difference in recurrence compared to conventional ESD, hybrid ESD was associated with a lower en-bloc resection rate.

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Section: Discussionmentioning

confidence: 99%

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

et al. 2020

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“…Hybrid endoscopic resection techniques that combine the ease and safety profile of EMR with the complete resection potential of ESD are also effective strategies for en bloc resection of colorectal lesions and offer a reasonable rescue treatment for cases of difficult ESD [27]. A more recent prospective, randomized controlled study comparing optimized hybrid ESD to standard ESD demonstrated similar en bloc resection rates among both groups (94.1 % vs 100 %; P = .493) with shorter procedure duration in the hybrid ESD group while maintaining a comparable adverse event rate profile [28,29].…”

Section: Locationmentioning

confidence: 99%

“…Hybrid resection methodsincluding precut EMR-that blend the principles of EMR and ESD have also proven efficacious for en bloc, resection of colorectal neoplasias and as a rescue treatment in cases of difficult ESD [27][28][29]. Recent comparisons of optimized hybrid versus conventional ESD have shown comparable en bloc resection rates and adverse event profiles with significantly shorter mean procedure times in the hybrid ESD groups, but, like ESD, are limited to expert centers [28,29].…”

Section: Introductionmentioning

confidence: 99%

Dissection-enabled scaffold-assisted resection (DeSCAR): a novel technique for resection of residual or non-lifting gastrointestinal neoplasia of the colon, expanded experience and follow-up

et al. 2020

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Background and study aims Colonic lesions may not be amenable to conventional endoscopic mucosal resection (EMR) due to previous manipulation, submucosal invasion, or lesion flatness. In 2018, we described Dissection-enabled Scaffold Assisted Resection (DeSCAR) to be safe for the endoscopic resection of non-lifting or residual colonic lesions 1 In this study, we expand our original cohort to describe our expanded experience with patients undergoing DeSCAR and assess the efficacy, safety, and feasibility of DeSCAR for endoscopic resection of non-lifting or residual colonic lesions. Patients and methods We retrospectively reviewed 57 patients from 2015–2019 who underwent DeSCAR for colonic lesions with incomplete lifting and/or previous manipulation. Cases were reviewed for location, prior manipulation, rates of successful resection, adverse events, and endoscopic follow up to assess for residual lesions. Results Fifty-seven lesions underwent DeSCAR. Of the patients, 51 % were female, and average patient age was 69 years. Lesions were located in the cecum (n = 16), right colon (n = 27), left colon (n = 10), and rectum (n = 4). Average lesion size was 27.7 mm. Previous manipulation occurred in 54 cases (72 % biopsy, 44 % resection attempt, 18 % intralesional tattoo). The technical success rate for resection of non-lifting lesions was 98 %. There were two delayed bleeding episodes (one required endoscopic intervention) and one small perforation (managed by endoscopic hemoclip closure). Endoscopic follow up was available in 31 patients (54 %) with no residual adenoma in 28 patients (90 % of those surveilled). Conclusions Our expanded experience with DeSCAR demonstrates high safety, feasibility, and effectiveness for the endoscopic management of non-lifting or residual colonic lesions.

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“…While the recommendations for BE endoscopic surveillance are well defined ( Reid et al, 1988b ; Wang and Sampliner, 2008 ), histologic BE staging suffers from inter- and intraobserver variability ( Spechler, 2005 ). The reliability and adequacy of current methods for EA surveillance is therefore controversial ( Spechler, 2020 ), and reliable “biomarkers” for accurate prediction of risk of progression from BE to EA are necessary ( Gorospe and Wong Kee Song, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Recurring Translocations in Barrett’s Esophageal Adenocarcinoma

et al. 2021

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Barrett’s esophagus (BE) is a premalignant metaplasia in patients with chronic gastroesophageal reflux disease (GERD). BE can progress to esophageal adenocarcinoma (EA) with less than 15% 5-year survival. Chromosomal aneuploidy, deletions, and duplication are early events in BE progression to EA, but reliable diagnostic assays to detect chromosomal markers in premalignant stages of EA arising from BE are lacking. Previously, we investigated chromosomal changes in an in vitro model of acid and bile exposure-induced Barrett’s epithelial carcinogenesis (BEC). In addition to detecting changes already known to occur in BE and EA, we also reported a novel recurring chromosomal translocation t(10:16) in the BE cells at an earlier time point before they undergo malignant transformation. In this study, we refine the chromosomal event with the help of fluorescence microscopy techniques as a three-way translocation between chromosomes 2, 10, and 16, t(2:10;16) (p22;q22;q22). We also designed an exclusive fluorescent in situ hybridization for esophageal adenocarcinoma (FISH-EA) assay that detects these chromosomal breakpoints and fusions. We validate the feasibility of the FISH-EA assay to objectively detect these chromosome events in primary tissues by confirming the presence of one of the fusions in paraffin-embedded formalin-fixed human EA tumors. Clinical validation in a larger cohort of BE progressors and non-progressors will confirm the specificity and sensitivity of the FISH-EA assay in identifying malignant potential in the early stages of EA.

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Hybrid endoscopic submucosal dissection in the colon: Cutting corners or trimming fat?

Abstract: Although hardcore ESD enthusiasts may regard hybrid ESD as a "cop-out" procedure, its potential to bridge the gap between standard ESD, a highly complex procedure, and that of a commonly practiced endoscopic technique (ie, snare resection) is quite appealing.

Cited by 7 publications

References 12 publications

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis

Dissection-enabled scaffold-assisted resection (DeSCAR): a novel technique for resection of residual or non-lifting gastrointestinal neoplasia of the colon, expanded experience and follow-up

Recurring Translocations in Barrett’s Esophageal Adenocarcinoma

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