Risk factors for conversion to snare resection during colorectal endoscopic submucosal dissection in an expert Western center

Pérez-Cuadrado-Robles, Enrique; Snauwaert, Christophe; Moreels, Tom G.; Jouret‐Mourin, Anne; Deprez, Pierre Henri; Piessevaux, Hubert

doi:10.1055/a-0650-4562

Cited by 14 publications

(9 citation statements)

References 35 publications

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“…Our study showed LSTs localized mostly in the right colon, similar to those of previous studies in different countries [12][13][14][15][16][17]. LST-G-M was the most common subtype, which contradicted the data from Western countries [3].…”

Section: Discussionsupporting

confidence: 65%

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

Shen

Zhang

Zhao

et al. 2020

Gastroenterology Research and Practice

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Background. The coexistence of colorectal polyps with laterally spreading tumors (LSTs) is commonly observed during colonoscopy. However, there are rare studies that assess the malignant risks for LSTs with colorectal polyps, which might largely contribute to further strategies of treatment and follow-up plans in LSTs. Methods. We conducted a retrospective cohort study that enrolled 206 patients with LSTs in the Endoscopy Center and Endoscopy Research Institute, Renji Hospital, Shanghai Jiao Tong University, China. The subjects with LSTs were divided into two groups: the nonpolyp group with 89 patients and the polyp group with 117 patients. Binary logistic regression was used to identify the independent predictors of outcomes of interest. Results. The risk of the polyps’ coexistence phenomenon increased in males compared with females (OR=2.138, p=0.047), especially in those between 50 and 75 years old (OR=7.074, p=0.036). Tumor size (3–4 cm), LSTs with tubulovillous types, and history of polyps statistically increased the risk of the polyp coexistence phenomenon (OR=5.768, p=0.003; OR=36.345, p=0.024; OR=13.245, p<0.0001, respectively). LST-NG-PD (OR=20.982, p=0.017) and LSTs≥5 cm (OR=37.604, p=0.038) notably increased the malignant risk of LSTs. When the simultaneous polyps are located in the right colon, the risk of malignant LSTs (OR=58.540, p=0.013) positively increased. Conclusion. The simultaneous colorectal polyps in the right colon were the most important risk factor to predict the malignant risk of LSTs.

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Section: Discussionsupporting

confidence: 65%

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

Shen

Zhang

Zhao

et al. 2020

Gastroenterology Research and Practice

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“…14,15 Thus, referral of these patients to a center with adequate competence in advanced resection, including ESD, should be recommended. 24,25 The very low NNT of 5 for SMIC when resecting large rectal GM-LSTs well compensates the additional risk of adverse events when replacing piecemeal EMR with ESD. On the other extreme of the spectrum, nonrectal GM-LSTs that are smaller than 4 cm present with a risk of covert SMIC that approximates 5%.…”

Section: Discussionmentioning

confidence: 99%

Risk of Covert Submucosal Cancer in Patients With Granular Mixed Laterally Spreading Tumors

D’Amico

Amato

Iannone

et al. 2021

Clinical Gastroenterology and Hepatology

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Granular mixed laterally spreading tumors (GM-LSTs) have an intermediate level of risk for submucosal invasive cancer (SMICs) without clear signs of invasion (covert); the optimal resection method is uncertain. We aimed to determine the risk of covert SMIC in GM-LSTs based on clinical and endoscopic factors. METHODS:We collected data from 693 patients (50.6% male; median age, 69 years) with colorectal GM-LSTs, without signs of invasion, who underwent endoscopic resection (74.2%) or endoscopic submucosal dissection (25.2%) at 7 centers in Italy from 2016 through 2019. We performed multivariate and univariate analyses to identify demographic and endoscopic factors associated with risk of SMIC. We developed a multivariate model to calculate the number needed to treat (NNT) to detect 1 SMIC. RESULTS:Based on pathology analysis, 66 patients (9.5%) had covert SMIC. In multivariate analyses, increased risk of covert SMIC were independently associated with increasing lesion size (odds ratio per mm increase, 1.02, 95% CI, 1.01-1.03; P [ .003) and rectal location (odds ratio, 3.08; 95% CI, 1.62-5.83; P [ .004). A logistic regression model based on lesion size (with a cutoff of 40 mm) and rectal location identified patients with covert SMIC with 47.0% sensitivity, 82.6% specificity, and an area under the curve of 0.69. The NNT to identify 1 patient with a nonrectal SMIC smaller than 4 cm was 20; the NNT to identify 1 patient with a rectal SMIC of 4 cm or more was 5. CONCLUSIONS:In an analysis of data from 693 patients, we found the risk of covert SMIC in patients with GM-LSTs to be approximately 10%. GM-LSTs of 4 cm or more and a rectal location are high risk and should be treated by en-bloc resection. ClinicalTrials.gov, Number: NCT03836131.

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“…An endoscopist who had 7 years of experience with CR-ESD performed the CR-ESDs. This study described an overall en bloc resection rate of 89.5%, with 81.4% of resections performed only with a knife and 8.1% of resections involving use of a snare [14]. This study illustrates the reality of performing CR-ESD in a Western setting.…”

Section: Discussionmentioning

confidence: 72%

The introduction of colorectal endoscopic submucosal hydrodissection at a Western Center: results and learning curve

Zabala

Parra‐Blanco

Beg

et al. 2019

Preprint

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Background Colorectal endoscopic submucosal dissection (CR-ESD) is an evolving technique in Western countries. The use of hydrodissection has been established as an effective technique for safe resection. However, it is unknown if the adoption of this technique can help a novice perform ESD safely without prior experience or formal tutorial. Here we aimed to determine the results of the introduction of endoscopic submucosal hydrodissection for the treatment of complex colorectal polyps and establish the learning curve for this technique, at a European tertiary hospital. Methods This study included data from 80 consecutive CR-ESDs performed for complex colorectal polyps, by a single endoscopist within a structured training program. The main outcome was en bloc resection rate, while secondary outcomes included complications (perforation and bleeding), knife en bloc (KEB) resection rate, knife-snare en bloc resection rate, conversion rate to endoscopic piecemeal mucosal resection (EPMR), complete resection rate, curative resection rate. To explore the impact of experience, procedures were divided into 4 groups of 20 each, with outcomes measures compared between these. Results The overall en bloc resection rate was 75%. KEB resection was obtained in 15%, 25%, 50%, and 80% cases in the consecutive periods (period 1 vs 4, p<0.001; periods 1, 2 and 3 vs 4, p<0.001). Conversion rate to EPMR was obtained in 40%, 25%, 25% and 5% respectively (period 1,2 and 3 vs 4; p=0.031). Curative resection was achieved in 55%, 75%, 70% and 95% respectively (p=0.037). Series results were 75% R0 resection, 23.7% conversion to EPMR, and 1.2% incomplete resection. Complications included perforations (7.5%) and bleeding (3.75%), there was no significant difference in the 4 periods of training. Multivariate analysis revealed factors more likely to result in non-en bloc versus en bloc resection were polyp size > 35 mm [70% vs. 23.4%; OR 13.2 (95% CI: 1.7-100.9); p=0. 013], severe fibrosis [40% vs. 11.7%; OR 10.2 (95% CI: 1.2-86.3); p= 0.033] and non-use of CO2 [65% vs. 30%; OR 0.09 (95% CI: 0.01-0.53); p= 0.008]. Conclusions CR-ESD by hydrodissection can be implemented in a western centre and offers safe and effective treatment for complex polyps.

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Risk factors for conversion to snare resection during colorectal endoscopic submucosal dissection in an expert Western center

Abstract: During ESD, the presence of poor lifting, LST-NG morphology, and a difficult retroflexed approach were factors associated with the need to convert to rescue EMR. Conversion to rescue EMR remains a valuable strategy.

Cited by 14 publications

References 35 publications

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

The Coexistence of Colorectal Polyps in the Right Colon Increases the Malignant Risk of Laterally Spreading Tumors

Risk of Covert Submucosal Cancer in Patients With Granular Mixed Laterally Spreading Tumors

The introduction of colorectal endoscopic submucosal hydrodissection at a Western Center: results and learning curve

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