Efficacy and safety of endoscopic resection techniques of large colorectal lesions: experience of a referral center in Italy

Papparella, Luigi Giovanni; Barbaro, Federico; Pecere, Silvia; Gibiino, Giulia; Scotti, G; Napoli, Marco; Boškoski, Ivo; Petruzziello, Lucio; Costamagna, Guido

doi:10.1097/meg.0000000000002252

Cited by 3 publications

(4 citation statements)

References 34 publications

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“…Previous reports on the clinical outcomes of hybrid ESD and C-ESD for colorectal lesions are summarized in Table 4. 11,17,[19][20][21][22][23][24][25][26] Although several studies have shown that the en bloc resection rate is significantly lower with the use of hybrid ESD techniques (56.8%-94.1%) than with the use of C-ESD techniques (81.5%-100%), most did not classify hybrid ESD into preplanned SH-ESD and unplanned RH-ESD. [18][19][20]22 In general, planned SH-ESD is used for relatively small tumors that can be easily snared, whereas unplanned RH-ESD is used for lesions that are difficult to resect.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies found no significant difference in the incidence of complications, including bleeding and perforation, between C-ESD and hybrid ESD. 17,26 The wall of the large intestine is thinner than that elsewhere in the gastrointestinal tract and is more susceptible to perforation than the stomach, making ESD more difficult. However, RH-ESD may be an option when resection is difficult, such as when the lesion is in the cecum or when severe fibrosis is present.…”

Section: Discussionmentioning

confidence: 99%

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Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases

Yamaguchi¹,

Fukuzawa²,

Kawai³

et al. 2023

Clin Endosc

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Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD).Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes.Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]).Conclusions: RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases

Yamaguchi¹,

Fukuzawa²,

Kawai³

et al. 2023

Clin Endosc

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“…With the development of surgery, ESD can be used throughout the gastrointestinal tract to treat increasingly larger tumours 16 17. According to the conventional method, after serially sliced, the sectioned specimens with a length greater than 4 cm should be cut into two segments to fit the size of the dehydration cassettes.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two pathological processing methods for large endoscopic submucosal dissection (ESD) specimens

Jiang

Wen

et al. 2022

J Clin Pathol

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AimsAccurate histopathological evaluation of the endoscopic submucosal dissection (ESD) specimens is essential for clinicians to guide further triage and management. This study aimed to report a novel processing technique for large ESD (≥4 cm) specimens.Methods92 patients with colorectal neoplasms who had undergone ESD were included. 46 ESD specimens were treated with conventional handling process, while the rest 46 cases were given the optimised method. Macrobiocassettes and L-shaped embedding moulds were applied in the optimised method. We evaluated the efficacy of this improved procedure in terms of the number of paraffin blocks, storage space and time consumption of pathological assessment.ResultsThe average diameter of ESD specimens was 4.5±0.4 cm and 4.7±0.5 cm in the control and test group (p=0.023), respectively. In control group, 398 paraffin blocks of 46 cases were obtained. With the same cases number and larger lesion size, only 276 blocks were achieved in test group (p<0.001). As for the storage space, the total volume of paraffin blocks and slides (4554.0 cm3 and 1207.5 cm3) of optimised method was significantly reduced compared with the control group (6208.8 cm3 and 1741.3 cm3) (p=0.001, p<0.001). In addition, the optimised method was superior to the conventional one in shortening time consumption of pathological assessment (164.5 min and 269.0 min, p<0.001).ConclusionsThe optimised technique not only reduced the workload and storage space, but also facilitated accurate pathological assessment.

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“…However, conventional EMR does not facilitate en bloc resection of large colorectal lesions. High local recurrence rates were detected at follow-up colonoscopy after piecemeal EMR (12 %–26 %) 1 2 3 4 .…”

Section: Introductionmentioning

confidence: 99%

Feasibility of progressive polyp contraction with underwater endoscopic mucosal resection in ≥ 20 mm superficial colorectal lesions

et al. 2022

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Background and study aims: Underwater endoscopic mucosal resection (UEMR) does not always result in en bloc resection of large colorectal lesions. The aim of this study is to demonstrate the feasibility of en bloc resection with progressive polyp contraction with underwater endoscopic mucosal resection (PP-CUE) of large superficial colorectal lesions. The advantage of PP-CUE is to enable resection of a superficial non-polypoid lesion that is larger than the snare diameter. Patients and methods: Eleven consecutive lesions in ten patients who underwent UEMR with PP-CUE of large superficial colorectal lesions (20 mm or greater) were included. Results: The median lesion diameter was 24 mm (interquartile range [IQR], 20-24 mm). All lesions were larger than the rotatable snare (15 mm) used. Median procedure time and PP-CUE time were 11 min (IQR, 8.5-12.3) and 2.3 min (IQR, 1.9-3.4), respectively. Pathological diagnoses of resected specimens included six adenomas, three sessile serrated lesions and two slightly invasive submucosal carcinomas. En bloc and R0 resection rates were both 91% (10/11). No adverse events occurred. Conclusions: The PP-CUE is useful to resect superficial non-polypoid colorectal lesions 20-25 mm in diameter in an en bloc fashion.

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Efficacy and safety of endoscopic resection techniques of large colorectal lesions: experience of a referral center in Italy

Cited by 3 publications

References 34 publications

Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases

Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases

Comparison of two pathological processing methods for large endoscopic submucosal dissection (ESD) specimens

Feasibility of progressive polyp contraction with underwater endoscopic mucosal resection in ≥ 20 mm superficial colorectal lesions

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