Clinical impact of endoscopic clip closure of perforations during endoscopic submucosal dissection for colorectal tumors

Takamaru, Hiroyuki; Saito, Yutaka; Yamada, Masayoshi; Tsuruki, Eriko So; Kinjo, Yuzuru; Otake, Yosuke; Sakamoto, Taku; Nakajima, Takeshi; Matsuda, Takahisa

doi:10.1016/j.gie.2016.01.014

Cited by 60 publications

(53 citation statements)

References 27 publications

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“…The risk factor for perforation was a prolonged procedure time, and the risk factors for postoperative bleeding were a prolonged procedure time, tumor location in the rectum, and definitive colon cancer with a pathological diagnosis. Previous studies indicated several risk factors for serious complications with the colorectal ESD including the tumor location, fibrosis of the lesion, difficult endoscopic operability, and rich vascularity (27,40,47,51,54-62) The present retrospective study did not indicate these factors to be risk factors for serious complications, so further studies may be required to assess the reasons for the discrepancies in these findings. A prolonged procedure time being recognized as a risk factor in the present study was probably due to the difficulties associated with ESD, including those based on the tumor location, fibrosis, and difficult endoscopic operability, as previously reported.…”

Section: Discussioncontrasting

confidence: 66%

Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan

et al. 2018

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Objective The aim of this study was to clarify the safety of colorectal endoscopic submucosal dissection (ESD) during the era of health insurance coverage starting from April 2012 in Japan. Methods Between April 2012 and May 2016, ESD was applied to 398 lesions in 373 patients. Risk factors for serious complications of colorectal ESD, perforation and post-ESD bleeding, were evaluated focusing on the resected specimen size, location, growth pattern, invasion depth, histopathology, postoperative clipping, and procedure time. In addition, the relationship between serious complications and patients' background characteristics was analyzed. Results Among 373 patients, perforation occurred in 12 patients and post-ESD bleeding in 19 patients. A univariate analysis showed that the risk factors for perforation were the lesion size, the resected specimen size, and a long operation time. A multivariate analysis showed that a long operation time was a risk factor for perforation during colorectal ESD. A univariate analysis indicated that significant risk factors for postoperative bleeding were a long operation time, rectal lesion, and cancer. All patients with serious complications were treated by an endoscopic procedure without blood transfusion or the need to convert to open surgery. Conclusion The present study suggests that colorectal ESD may be accepted with relative safety in Japan as a common therapeutic approach for early colorectal cancer.

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Section: Discussioncontrasting

confidence: 66%

Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan

et al. 2018

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“…Perforation is one of the complications that could cause a severe adverse event. Several studies have reported that tumor size, morphology, location, and procedure time were important factors associated with intraoperative perforation [16–18]. Regarding patient and lesion characteristics in this study, there were no differences between the two groups except for age.…”

Section: Discussioncontrasting

confidence: 44%

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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“…Generally, standard endoclips are successful at closing most perforations that occur during ESD because, typically, these will be small. 59,60 Adjunctive methods have been developed that enable endoclips to close large defects after EMR and ESD. 61,62 In addition, over-the-scope clip systems potentially can close large luminal defects that approach 2 cm in size.…”

Section: Coagulation and Closure After Endoscopic Submucosal Dissectionmentioning

confidence: 99%

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States

Draganov

Wang

Othman

et al. 2019

Clinical Gastroenterology and Hepatology

338

262

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Endoscopic submucosal dissection (ESD) is an established endoscopic resection method in Asian countries, which is increasingly practiced in Europe and by early adopters in the United States for removal of early cancers and large lesions from the luminal gastrointestinal tract. The intent of this expert review is to provide an update regarding the clinical practice of ESD with a particular focus on its use in the United States. This review is framed around the 16 best practice advice points agreed upon by the authors, which reflect landmark and recent published articles in this field. This expert review also reflects our experience as advanced endoscopists with extensive experience in performing and teaching others to perform ESD in the United States. Best Practice Advice 1: Endoscopic submucosal dissection should be recognized as a mature endoscopic technique that enables complete removal of lesions that are too large for en bloc endoscopic mucosal resection or are at increased risk of containing cancer. Best Practice Advice 2: The safety and feasibility of endoscopic submucosal dissection for early gastric cancer is well established. The absolute indications for curative endoscopic resection include moderately and well-differentiated, nonulcerated, mucosal lesions that are ≤2 cm in size. Best Practice Advice 3: Other relative (expanded) indications for gastric endoscopic submucosal dissection include moderately and well-differentiated superficial cancers that are >2 cm, lesions ≤3 cm with ulceration or that contain early submucosal invasion, and poorly differentiated superficial cancers ≤2 cm in size. The risk of lymph node metastasis when endoscopic submucosal dissection is performed for these indications is higher than when it is performed for absolute indications but remains acceptably low. Best Practice Advice 4: Endoscopic submucosal dissection may be considered in selected patients with Barrett's esophagus with the following features: large or bulky area of nodularity, lesions with a high likelihood of superficial submucosal invasion, recurrent dysplasia, endoscopic mucosal resection specimen showing invasive carcinoma with positive margins, equivocal preprocedural histology, and intramucosal carcinoma. Best Practice Advice 5: Endoscopic submucosal dissection is the primary modality for treatment of squamous cell dysplasia and cancer confined to the superficial esophageal mucosa. Any degree of submucosal invasion caries an increased risk of lymph node metastasis and alternative/additional therapy should be considered. Best Practice Advice 6: Duodenal endoscopic submucosal dissection is associated with an increased risk of intraprocedural perforation and delayed adverse events. Duodenal endoscopic submucosal dissection should be limited to endoscopists with extensive experience in performing endoscopic submucosal dissection in other locations. It is strongly suggested that endoscopists in the United States refrain from performing duodenal endoscopic submucosal dissection during the early phase of their endo...

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Clinical impact of endoscopic clip closure of perforations during endoscopic submucosal dissection for colorectal tumors

Cited by 60 publications

References 27 publications

Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan

Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan

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

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States

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