Colorectal endoscopic mucosal resection (EMR)

Kandel, Pujan; Wallace, Michael B.

doi:10.1016/j.bpg.2017.05.006

Cited by 45 publications

(43 citation statements)

References 106 publications

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“…The main limitation of EMR is the inability to resect large lesions en bloc, which can increase the risk of recurrence and hinder histopathologic examination. 2 Endoscopic submucosal dissection (ESD) is an alternative technique that was developed in Japan specifically for the en bloc resection of GI neoplastic lesions regardless of their size. The advantages of ESD over EMR for select lesions has led to its routine application in Asia, but it has yet to be widely accepted in the West.…”

mentioning

confidence: 99%

Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection For Barrett’s Esophagus and Colorectal Neoplasia

Yang

Othman

Draganov

2019

Clinical Gastroenterology and Hepatology

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Endoscopic resection has become the first-line therapy for the management of superficial neoplasia throughout the gastrointestinal tract. Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established yet distinct techniques for the treatment of superficial gastrointestinal neoplasia. EMR is simpler and faster but is limited by its ability to resect large lesions en bloc. Limitations of piecemeal EMR of large lesions include a high rate of recurrence and a less-than-ideal tissue specimen for accurate histologic evaluation. ESD, on the other hand, allows en bloc resection regardless of lesion size, reducing risk for recurrence and facilitating precise histologic staging. However, ESD can take longer than EMR, is technically more complex, and traditionally has been associated with a higher rate of adverse events. Ultimately, the optimal endoscopic technique should be selected based on organ location, type of neoplastic lesion, and local expertise. The role of ESD has expanded in Eastern regions, beyond squamous cell lesions in the esophagus and gastric cancer to include superficial Barrett's esophagus (BE) and colon neoplasia. However, there is controversy in Western regions over use of ESD for BE and colon neoplasia. We discuss the clinical outcomes of EMR and ESD for the treatment of superficial BE and colon neoplasia, focusing on practical considerations for formulating the most appropriate endoscopic resection approach for each patient.

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confidence: 99%

Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection For Barrett’s Esophagus and Colorectal Neoplasia

Yang

Othman

Draganov

2019

Clinical Gastroenterology and Hepatology

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“…Серьезным недостатком данного метода является более высокий риск рецидива опухоли и сложность морфологической оценки краев опухоли и глубины инвазии. Альтернативной методикой может быть эндоскопическая диссекция в подслизистом слое, но она является дорогостоящей, длительной операцией, технически более сложной и, в связи с этим, выполняется в ограниченном числе клиник [7,8] Интраоперационное кровотечение 10,5% --2.2% 9,2% Послеоперационное кровотечение 1,5% --1,5% 1,2% Перфорации 0 -2,9% 0 2,4% Рецидив 12,2% 19% 20% 1,4% 12%…”

Section: Introductionunclassified

Endoscopic Piecemeal Resection of Large Benign Colorectal Neoplasia: Results of a Russian Multicenter Study

Завьялов¹,

Kashin²,

Олевская

et al. 2020

Koloproktologiâ

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AIM: to assess the safety of endoscopic piecemeal mucosal resection (EPMR) of large epithelial colorectal lesions and to identify risk factors for tumor recurrence.PATIENTS AND METHODS: results of EPMR were evaluated in retrospective study, which was carried out in five regional endoscopic centers. The criterion for inclusion in the study was benign colorectal lesion of 20 mm and larger.RESULTS: we found that complications of EPMR occurred in 13% of cases. In 9.2% it was intraoperative bleeding, which was stopped endoscopically. Postoperative bleeding was detected in 1.2% of patients, perforation – in 2.4%. Tumor recurrence developed in 12%. We have revealed a direct correlation between tumor recurrence and intraoperative bleeding (p=0.013) and a size of lesion >4 cm (p=0.012); the inverse correlation between the tumor recurrence and the fullness of the lifting during the removal (p=0.008) and the male gender of the patient (p=0.043).CONCLUSION: significant risk factors of tumor recurrence after endoscopic piecemeal resection of large benign colorectal neoplasia were identified before the procedure (gender and tumor size) and intraoperatively (completeness of lifting and the intraoperative bleeding).

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“…Concerning endoscopic therapy, the original method is snaring, which is quite simple and much more suitable for pedunculated neoplasm. In 1980s, endoscopic mucosal resection (EMR) has been gradually developed from Japan 4 , where local liquid injection into the submucosal layer decreases the perforation rate and increases the cut area and range of colonic neoplasm 5 . However, as restricted by the scope of snare, usually the neoplasm larger than 2 cm is difficult for complete resection by a single EMR procedure.…”

Section: Introductionmentioning

confidence: 99%

Comparison between endoscopic submucosal snaring with circumferential mucosal incision (ESS-CMI) and endoscopic submucosal dissection (ESD) in treating colonic neoplasm - a cost-effective retrospective study

Jin¹,

Yu²,

Zhu³

et al. 2019

Preprint

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Background To evaluate and compare the safety, efficacy and cost of endoscopic submucosal snaring with circumferential mucosal incision (ESS-CMI) with endoscopic submucosal dissection (ESD) in various types of colonic neoplasms. Methods Patients who were admitted in our endoscopic center for colonic neoplasm therapy were screened, with the Chinese item of “endoscopic submucosal dissection” and the English abbreviation of ESD, for the period between January 2011 and December 2017. Initially enrolled patients were further categorized into ESD and ESS-CMI groups after careful assessment of detailed operation procedures. Data on patients’ and colonic neoplasm’s characteristics, recurrence, treatment, follow-up and disease status were collected after medical records review. Further cost-effective analysis includes two main aspects: treatment effect and complication as well as the cost and efficiency. Results A total of 278 patients was selected. Though there were no significant differences in basic anthropometric and disease status data such as age, gender, neoplasm type, degree and the method of follow up, the location of rectum, the longest side and the surface area were significantly higher in ESD group than those in ESS-CMI group. For ESS-CMI, further cost-effective study showed the similar treatment effect and complication rate but significantly decreased cost, operation time and average hospital stay, when compared with ESD. Further subgroup analysis showed that there were no significant differences between the ESS-CMI successful and failure groups. Conclusion ESS-CMI might become a new and better choice for colonic neoplasm therapy, based on its decreased operation cost but similar treatment efficacy and complication rate as ESD.

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Colorectal endoscopic mucosal resection (EMR)

Cited by 45 publications

References 106 publications

Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection For Barrett’s Esophagus and Colorectal Neoplasia

Endoscopic Mucosal Resection vs Endoscopic Submucosal Dissection For Barrett’s Esophagus and Colorectal Neoplasia

Endoscopic Piecemeal Resection of Large Benign Colorectal Neoplasia: Results of a Russian Multicenter Study

Comparison between endoscopic submucosal snaring with circumferential mucosal incision (ESS-CMI) and endoscopic submucosal dissection (ESD) in treating colonic neoplasm - a cost-effective retrospective study

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