Endoscopic resection of adenoma-like mass in chronic ulcerative colitis using a combined endoscopic mucosal resection and cap assisted submucosal dissection technique

Smith, Lesley-Ann; Baraza, Wal; Tiffin, Nick; Cross, Simon S.; Hurlstone, David P.

doi:10.1002/ibd.20497

Cited by 59 publications

(34 citation statements)

References 21 publications

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“…Accordingly Smith et al [29] stated the efficacy and safety of the combined ESD-EMR using the Olympus KD-630 L insulation-tipped knife even for the resection of an adenoma-like mass in chronic ulcerative colitis in 67 patients. The authors reported at a median of 18 months follow-up, an overall cure rates for the ESD-assisted EMR cohort of 98% Bleeding complications occurred in 7/67 (10%) of cases in absence of bowel perforations.…”

Section: Discussionmentioning

confidence: 99%

Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

et al. 2010

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BackgroundEndoscopic submucosal dissection (ESD) is an advanced technique of therapeutic endoscopy alternative to endoscopic mucosal resection (EMR) for superficial gastrointestinal neoplasms >2 cm. ESD allows for the direct dissection of the submucosa and large lesions can be resected en bloc. ESD is not limited by resection size, increases histologically complete resection rates and may reduce the local recurrence.Nevertheless, the technique is time-consuming, technically demanding and associated with a high complication rate. To reduce the risk of complications, different devices and technical advances have been proposed with conflicting results and, still, ESD en bloc resections of huge lesions are associated with increased complications.Case PresentationWe successfully used a combined ESD/EMR technique for huge rectal laterally spreading tumors (LSTs). ESD was used for circumferential resection of 2/3 of the lesion followed by piecemeal resection (2-3 pieces) of the central part of the tumour.In all three patients we obtained the complete dissection of the polyp and the complete histological evaluation in absence of complications and recurrence at 6 months' follow up.ConclusionsIn the treatment of rectal LSTs, the combined treatment - ESD/EMR resection may be considered a suitable therapeutic option, indicated in selected cases as an alternative to surgery, in which the two techniques are neither reliable nor safe separately. However, to confirm our results, larger trials with longer follow up are required together with improvement of the technique and of the technical devices.

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Section: Discussionmentioning

confidence: 99%

Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

et al. 2010

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“…However, mucosal and submucosal fibrosis induced by long-standing inflammatory activity in CUC makes it difficult to perform endoscopic resection of ALM. Recently, Smith et al reported the effectiveness of a combined endoscopic mucosal resection and cap-assisted submucosal dissection technique for adenoma-like mass in CUC [6]. Exactly, ESD-assisted EMR technique should be a promising treatment for ALM in CUC to avoid unnecessary surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Combination of Endoscopic Resection and Heat Ablation Is a Promising Endoscopic Therapy for Adenoma-Like Dysplastic Lesion in Chronic Ulcerative Colitis

Matsumura¹,

Nakase²,

Chiba³

2009

Case Rep Gastroenterol

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In January 2007, a 74-year-old male was admitted to our hospital for treatment of an adenoma-like dysplastic lesion (ALM). He had a four-year history of ulcerative colitis. Endoscopic findings revealed that a protruded lesion with an approximate size of 3 cm at the splenic flexure was surrounded by pseudopolyps. Lifting of the tumor was poor despite injection of normal saline around it. Therefore, the combination of endoscopic resection and heat ablation therapy with argon plasma coagulation was performed. Histopathological examination of the resected specimen showed tubular adenoma with high-grade atypia. Endoscopic examination 15 months after this treatment revealed no occurrence of ALM. Whether or not there is a possibility of local recurrence after ablation therapy in addition to endoscopic resection performed in this case remains unclear. However, this endoscopic therapy is a promising option for ALM in chronic ulcerative colitis.

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“…Two studies reported that as long as complete resection of circumscribed lateral spreading lesions and lesions with high grade dysplasia is achieved, these patients may be followed with surveillance. 109,110 In our practice, as long as patients have complete resection of polypoid or nonpolypoid lesions with no flat dysplasia elsewhere in the colon, we follow them with endoscopic surveillance with chromoendoscopy. Figure 6 highlights our approach to patients with endoscopically visible lesions in the setting of IBD.…”

Section: Endoscopic Polypectomymentioning

confidence: 99%

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

Tharian

George

Navaneethan

2016

Inflammatory Bowel Diseases

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The role of endoscopy in inflammatory bowel disease (IBD) has grown over the last decade in both diagnostic and therapeutic realms. It aids in the initial diagnosis of the disease and also in the assessment of the extent and severity of disease. IBD is associated with development of multiple complications such as strictures, fistulae, and colon cancers. Endoscopy plays a pivotal role in the diagnosis of colon cancer in patients with IBD through incorporation of chromoendoscopy for surveillance. In addition, endoscopic resection with surveillance is recommended in the management of polypoid dysplastic lesions without flat dysplasia. IBD-associated benign strictures with obstructive symptoms amenable to endoscopic intervention can be managed with endoscopic balloon dilation both in the colon and small intestine. In addition, endoscopy plays a major role in assessing the neoterminal ileum after surgery to risk-stratify patients after ileocolonic resection and assessment of a patient with ileoanal pouch anastomosis surgery and management of postsurgical complications. Our article summarizes the current evidence in the role of endoscopy in the diagnosis and management of complications of IBD.

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Endoscopic resection of adenoma-like mass in chronic ulcerative colitis using a combined endoscopic mucosal resection and cap assisted submucosal dissection technique

Cited by 59 publications

References 21 publications

Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

Rectal laterally spreading tumors successfully treated in two steps by endoscopic submucosal dissection and endoscopic mucosal resection

Combination of Endoscopic Resection and Heat Ablation Is a Promising Endoscopic Therapy for Adenoma-Like Dysplastic Lesion in Chronic Ulcerative Colitis

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

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