A long-term follow-up study on the prognosis of endoscopic submucosal dissection for colorectal laterally spreading tumors

Cong, Zhi-Jie; Hu, Liang‐Hao; Ji, Jun-Tao; Xing, Junjie; Shan, Yongqi; Li, Zhao‐Shen; Yu, Enda

doi:10.1016/j.gie.2015.08.043

Cited by 26 publications

(24 citation statements)

References 23 publications

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“…However, the en bloc R0 resection rate was 83.7% for LST‐DL, which is somewhat higher than the en bloc R0 resection rates for ESD of colorectal LST and anorectal tumors. Cong et al reported that the en bloc R0 resection rate for ESD of colorectal LST was 81.4%, and Imai et al reported that the en bloc R0 resection rate for ESD of rectal tumors extending to the dentate line was only 53.3%. There may be two explanations for the high en bloc R0 resection rate observed in our study; the first being that devices and techniques have been developed for ESD that facilitate en bloc resections of technically difficult lesions, and the second that the procedures were completed by experienced endoscopists.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have reported the efficacy of endoscopic submucosal dissection (ESD), a novel endoscopic resection modality, for the treatment of LST . Xu et al .…”

Section: Introductionmentioning

confidence: 99%

“…demonstrated that ESD was an effective and feasible treatment for LST, with an en bloc resection rate of 98.5%, an en bloc R0 curative resection rate of 90.5%, and low bleeding (3.6%) and perforation (2.2%) rates. Cong et al . described long‐term outcomes of ESD for LST, and reported that the en bloc R0 resection rate was 83.1%.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Guo

Ling

Wang

et al. 2019

J of Digest Diseases

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Objective Endoscopic submucosal dissection (ESD) for laterally spreading tumors (LST) involving the dentate line (LST‐DL) is challenging because of the specific anatomical features of the anorectum. This study aimed to evaluate the efficacy and safety of ESD for LST‐DL. Methods Consecutive patients with LST‐DL who had undergone ESD at our hospital between January 2010 and December 2015 were retrospectively enrolled in this study. Rates of en bloc resection, R0 resection, and complications, pathological characteristics, and tumor recurrence were analyzed and compared with those of LST in the rectum not involving the dentate line (LST‐NDL). Results Altogether 49 patients with LST‐DL (median age 63 years; 39 women; median lesion size 57 mm; median follow‐up period of 24 months) and 96 patients with LST‐NDL (median age 67 years; 31 women; median lesion size 47 mm; median follow‐up period of 31 months) were enrolled. En bloc resection (93.9% [46/49] vs 94.8% [91/96]) and en bloc R0 resection rates (83.7% [41/49] vs 88.5% [85/96]), respectively, for LST‐DL and LST‐NDL, with no significant differences. However, ESD for LST‐DL had a longer procedure time (77 min vs 54 min, P = 0.02), a greater postprocedural perianal pain rate (28.6% vs 0%, P < 0.001), and more anal strictures (4.1% vs 0%, P = 0.04). The complication rates of perforation, bleeding and fever, recurrence rate, and pathological characteristics did not differ between the two groups. Conclusions ESD is a safe and effective therapeutic modality for LST‐DL. However, this procedure should be performed by experienced endoscopists and the difficulty needs to be fully considered.

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Section: Discussionmentioning

confidence: 99%

“…Many studies have reported the efficacy of endoscopic submucosal dissection (ESD), a novel endoscopic resection modality, for the treatment of LST . Xu et al .…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Guo

Ling

Wang

et al. 2019

J of Digest Diseases

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“…Niimi et al [25] reported that the 3-year disease-specific and overall survival rates were 100 and 97.1%, respectively, and the corresponding 5-year values were 100 and 95.3%, respectively. Cong et al [26] reported similar long-term outcomes of patients with laterally spreading tumors. The median follow-up duration in previous reports was approximately 3 years, whereas patients in our study were followed up for a longer period of time.…”

Section: Discussionmentioning

confidence: 87%

“…Few previous studies have reported the long-term outcomes of patients who underwent colorectal ESD [25, 26]. Niimi et al [25] reported that the 3-year disease-specific and overall survival rates were 100 and 97.1%, respectively, and the corresponding 5-year values were 100 and 95.3%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of colorectal endoscopic submucosal dissection in elderly patients

Takahashi

Mizuno

Takahashi

et al. 2016

Int J Colorectal Dis

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Background and aimsThe safety and efficacy of endoscopic submucosal dissection (ESD) in elderly patients remain unclear. The aim of this study is to clarify the short- and long-term outcomes of colorectal ESD in elderly patients.Patients and methodsA total of 482 consecutive patients with 501 colorectal lesions treated with ESD from February 2005 to December 2013 were retrospectively reviewed. Patients were divided into two groups: an elderly group (≥ 75 years of age) and a non-elderly group (< 75 years of age). Short-term outcomes of interest were procedure time, complication rate, hospital stay, en bloc resection rate, and non-curative resection rate. Long-term outcomes of interest were disease-specific survival, and overall survival rates in the elderly group (51 patients) and non-elderly group (92 patients) were also analyzed.ResultsNo significant differences were observed between the groups with respect to short-term outcomes. Two patients in each group required emergency surgery. Of the patients who underwent non-curative resection, 7/12 (58%) in the elderly group and 15/23 (65%) in the non-elderly group underwent additional surgery. The 5-year disease-specific survival rates in the elderly and non-elderly groups were both 100%, and the corresponding 5-year overall survival rates were 86.3 and 93.5%, respectively (p = 0.026).ConclusionsShort-term outcomes after colorectal ESD were equivalent in both groups, and all patients showed favorable long-term outcomes. Considering the benign prognosis of lesions resected with ESD, preoperative screening of comorbidities is essential to improve overall survival.

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Risk factors for perforation during colorectal endoscopic submucosal dissection

Yang

Hung

Chen

2022

Adv in Digestive Medicine

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Endoscopic submucosal dissection (ESD) achieves higher en bloc resection rates than endoscopic mucosal resection in early colorectal neoplasms. However, perforation occurs more frequently during ESD. We aimed to identify the risk factors for perforation during colorectal ESD. A total of 161 patients treated with colorectal ESD at a tertiary center between January 2014 and December 2019 were enrolled in this retrospective study. Perforation was defined as a deep defect of the muscularis propria, with or without direct contact with connective tissue outside the colon. Clinical risk factors for perforation during ESD, including age, sex, tumor morphology, tumor size, tumor location, procedure time, en bloc resection rate, histology, and submucosal fibrosis, were analyzed. The mean size of the ESD specimens was 38.2 ± 24.6 mm. The overall en bloc resection rate was 98.1%. Perforations occurred during ESD in 31 out of 161 patients (19.3%). All perforations were successfully treated with endoscopic closure using the hemoclips and nonsurgical management. Emergency surgery was not required in our patients. On multivariate analysis, severe submucosal fibrosis (odds ratio [OR] 3.06; 95% confidence interval [CI] 1.23‐7.59; P = .016) and location in the right colon (OR 4.54; 95% CI 1.31‐15.79; P = .017) were independent risk factors. Perforation during colorectal ESD occurred in 31 patients (19.3%), but all patients had a good outcome without surgery. Submucosal fibrosis and its location are risk factors for perforation during ESD.

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A long-term follow-up study on the prognosis of endoscopic submucosal dissection for colorectal laterally spreading tumors

Cited by 26 publications

References 23 publications

Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Clinical outcomes of endoscopic submucosal dissection for laterally spreading tumors involving the dentate line

Long-term outcomes of colorectal endoscopic submucosal dissection in elderly patients

Risk factors for perforation during colorectal endoscopic submucosal dissection

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