Endoscopic Approach for Superficial Colorectal Neoplasms

Xu, Junfeng; Yang, Lang; Jin, Peng; Sheng, Jian-qiu

doi:10.1159/000447128

Cited by 9 publications

(7 citation statements)

References 68 publications

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“…However, this makes it difficult to obtain a precise histopathological diagnosis. Also incomplete resection and local recurrence rates are high in piecemeal EMR [1-4]. Therefore, EMR and piecemeal EMR are unsuitable for the treatment of colorectal neoplasms that is larger than 20 mm in diameter, including LSTs.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathological feature and treatment outcome of patients with colorectal laterally spreading tumors treated by endoscopic submucosal dissection

et al. 2019

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Background/AimsEndoscopic submucosal dissection (ESD) is an advanced technique that can be used to treat precancerous and early colorectal neoplasms by facilitating en bloc resection regardless of tumor size. In our study, we investigated the clinicopathological feature and the treatment outcome of patients with colorectal laterally spreading tumors (LSTs) that were treated by ESD. MethodsThe study enrolled all of 210 patients with colorectal LSTs who underwent ESD. Clinical outcomes were analyzed by retrospectively reviewing medical records. ResultsA cancerous pit pattern (Vi/Vn) was more common in pseudo-depressed (PD) subtype than in flat elevated (FE) subtype. The incidence of adenocarcinoma in the PD subtype and nodular mixed (NM) subtypes was significantly higher than in the homogenous (HG) subtype and FE subtype. The en bloc and R0 resection rates were 89.0% and 85.7%, respectively. The bleeding and perforation rates were 5.2% and 1.9%, respectively. The mean procedure time was much longer in the PD subtype than in the FE subtype. The en bloc resection rate was significantly higher in the NM subtype than in the HG subtype. However, there were no statistically significant differences in mean procedure time, en bloc resection rate, R0 resection rate, bleeding rate, or perforation rate between LST-granular and LST-nongranular types. ConclusionsThese results indicate that ESD is acceptable for treating colorectal LSTs concerning en bloc resection, curative resection, and risk of complications. Careful consideration is required for complete resection of the PD subtype and NM subtype because of their higher malignant potential.

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Section: Discussionmentioning

confidence: 99%

“…Endoscopic mucosal resection (EMR) is widely accepted and regularly used for treatment of precancerous and early colorectal neoplasms. However, this technique is not feasible and safe for en bloc resection if the tumor size is larger than 20 mm, as it may not facilitate accurate histologic diagnosis and reduced recurrence rates [1-4].…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological feature and treatment outcome of patients with colorectal laterally spreading tumors treated by endoscopic submucosal dissection

et al. 2019

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“…This process is called 'shared decision making'. 9 A recent systematic review assessing the quality of such DAs for various diseases concluded that patients using DAs have (1) a better knowledge of treatments, (2) are better informed about treatments and (3) have a better understanding of their personal values compared to patients in usual care. 10 This seems promising, but patients also increasingly use the internet as an important source of health information 11 and the DAs found through the web are not included in such large-scale systematic reviews.…”

Section: Introductionmentioning

confidence: 99%

Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

et al. 2021

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ObjectivesTo assess the communicative quality of colorectal cancer patient decision aids (DAs) about treatment options, the current systematic review was conducted.DesignSystematic review.Data sourcesDAs (published between 2006 and 2019) were identified through academic literature (MEDLINE, Embase, CINAHL, Cochrane Library and PsycINFO) and online sources.Eligibility criteriaDAs were only included if they supported the decision-making process of patients with colon, rectal or colorectal cancer in stages I–III.Data extraction and synthesisAfter the search strategy was adapted from similar systematic reviews and checked by a colorectal cancer surgeon, two independent reviewers screened and selected the articles. After initial screening, disagreements were resolved with a third reviewer. The review was conducted in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DAs were assessed using the International Patient Decision Aid Standards (IPDAS) and Communicative Aspects (CA) checklist.ResultsIn total, 18 DAs were selected. Both the IPDAS and CA checklist revealed that there was a lot of variation in the (communicative) quality of DAs. The findings highlight that (1) personalisation of treatment information in DAs is lacking, (2) outcome probability information is mostly communicated verbally and (3) information in DAs is generally biased towards a specific treatment. Additionally, (4) DAs about colorectal cancer are lengthy and (5) many DAs are not written in plain language.ConclusionsBoth instruments (IPDAS and CA) revealed great variation in the (communicative) quality of colorectal cancer DAs. Developers of patient DAs should focus on personalisation techniques and could use both the IPDAS and CA checklist in the developmental process to ensure personalised health communication and facilitate shared decision making in clinical practice.

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“…Endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are effective techniques for removal of early neoplasia of the gastrointestinal tract by separating submucosa and muscular layer [1][2][3][4]. In some situations, such as submucosal fibrosis, previous failed resection, or submucosal invasion, these techniques may not achieve en bloc and histologically complete (R0) resection [5][6][7][8]. Endoscopic full-thickness resection could be a valid alternative to conventional surgery.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic full-thickness resection of early colorectal neoplasms using an endoscopic submucosal dissection knife: a retrospective multicenter study

et al. 2020

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Background and study aims Endoscopic full-thickness resection allows resection of early gastrointestinal neoplasms not amenable to conventional endoscopic resection techniques, due to their location, presence of submucosal fibrosis, or suspected deep mural invasion. It is typically achieved using a dedicated over-the-scope device (full-thickness resection device or FTRD). The aim of our study was to evaluate the feasibility, safety, and clinical outcomes of endoscopic full-thickness resection using an endoscopic submucosal dissection (ESD) knife. Patients and methods Consecutive patients who underwent full-thickness endoscopic resection at six tertiary care centers from August 2010 to June 2017 were retrospectively included. We conducted a comparative analysis of patient characteristics, technical success, adverse events, and time to discharge between patients treated by a full-thickness resection using an ESD knife. Results Twenty-one procedures were performed using an ESD knife. En-bloc resection and R0 resection rates were 95.2 % and 65 %, respectively. Clinical symptoms of perforation occurred in 66.7 %. There was no need for surgery or additional endoscopic procedures. Conclusion Endoscopic full-thickness resection of early colorectal neoplasms using an ESD knife might be feasible and safe. It allows complete resection of lesions with no limitation in size. The technique may be preferable to an other-the-scope resection device in lesions larger than 20 mm, and to surgery in selected cases of low-risk T1 colorectal carcinomas, non-lifting adenomas, submucosal tumors, or technically challenging lesion locations.

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Endoscopic Approach for Superficial Colorectal Neoplasms

Cited by 9 publications

References 68 publications

Clinicopathological feature and treatment outcome of patients with colorectal laterally spreading tumors treated by endoscopic submucosal dissection

Clinicopathological feature and treatment outcome of patients with colorectal laterally spreading tumors treated by endoscopic submucosal dissection

Communication in decision aids for stage I–III colorectal cancer patients: a systematic review

Endoscopic full-thickness resection of early colorectal neoplasms using an endoscopic submucosal dissection knife: a retrospective multicenter study

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