Endoscopic submucosal dissection for small submucosal tumors of the rectum compared with endoscopic submucosal resection with a ligation device

Harada, Hideaki; Suehiro, Satoshi; Murakami, Daisuke; Nakahara, Ryotaro; Shimizu, Takanori; Katsuyama, Yasushi; Miyama, Yasunaga; Hayasaka, Kenji; Tounou, Shigetaka

doi:10.4253/wjge.v9.i2.70

Cited by 14 publications

(19 citation statements)

References 17 publications

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“…Carcinoid tumors, derived from neuroendocrine cells compartments, mostly arise along the intestine, among which rectum was found to be the third most frequent predilection site 1 , 2 . Currently, rectal carcinoids with adverse features for metastasis including diameters larger than 20mm, invading muscularis propria, lymphovascular invasion or positive regional lymph node, are suggested to be removed by radical surgery, while tumors in diameters 10mm or less are supposed to be treated by local resection 3 - 5 . As for the carcinoids sized between 10mm to 20mm, the management remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Local surgical excision versus endoscopic resection for rectal carcinoid: A meta-analysis.

Sui¹,

Lin²,

Peng³

et al. 2017

J. Cancer

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Purpose: To date, there is not enough evidence concerning the optimal treatment strategy for early rectal carcinoids, we conducted a meta-analysis in order to determine the feasible local treatment for these selected patients.Methods: We searched the studies from the PubMed, Cochrane database, Medline, Ovid, SpringerLink, PMC and Embase between January 2007 and April 2017. Studies of local surgical excision compared with endoscopic resection for rectal carcinoids less than 20mm without adverse features were included. Data were analyzed by using Stata SE 12.0.Results: Seven studies were included in this meta-analysis, with a total of 1056 patients. The data showed that local surgical excision was associated with higher complete resection rate than that of endoscopic resection (OR 5.837, 95%CI 2.048 to 16.632, P=0.001) but consuming longer procedural time (SMD 1.757, 95% CI 1.263 to 2.251, P=0.000). Additionally, incidences of recurrence and en bloc resection rate were comparable between two kinds of resections. The difference of post-operative complications remained unclear.Conclusions: For rectal carcinoids sized 20mm or smaller without adverse features, endoscopic resection might be an efficient treatment, which achieved a comparable oncological safety as local surgical excision.

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Section: Introductionmentioning

confidence: 99%

Local surgical excision versus endoscopic resection for rectal carcinoid: A meta-analysis.

Sui¹,

Lin²,

Peng³

et al. 2017

J. Cancer

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“…Histologically complete resection rates of 28.6 % to 100 % have been reported for conventional polypectomy or EMR for rectal NET G1 2 . In addition, some studies reported R0 resection rates as high as 82.8 % to 100 % with ESMR-L 2 8 9 , and 80.6 % to 100 % with ESD 3 8 9 . However, 1 of the main reasons for the difficulties encountered during endoscopic resection of NET G1 is that most of them extend to the submucosa 1 , necessitating resection of the submucosal layer under the NET.…”

Section: Discussionmentioning

confidence: 99%

Underwater endoscopic mucosal resection: a new endoscopic method for resection of rectal neuroendocrine tumor grade 1 (carcinoid) ≤ 10 mm in diameter

et al. 2018

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Background and study aims Rectal neuroendocrine tumors grade 1 (NET G1; carcinoid) ≤ 10 mm in diameter often extend into the submucosa, making their complete histological resection difficult using endoscopic techniques. Endoscopic submucosal resection with a ligation device (ESMR-L) and endoscopic submucosal dissection (ESD) are commonly used to overcome these difficulties. We also previously reported that underwater endoscopic mucosal resection (UEMR) could facilitate resection of rectal NET G1. This study aimed to evaluate the safety and efficacy of UEMR for removing rectal NET G1 ≤ 10 mm in diameter. 6 consecutive patients with rectal NET G1 ≤ 10 mm in diameter underwent UEMR at our hospital. The rate of en bloc resection was 100 %, and the rate of R0 resection was 83 %. The median procedure time was 8 min (range 5 – 12 min). No perforations or delayed bleeding occurred in this study. In conclusion, UEMR allows the safe and reliable resection of rectal NET G1 ≤ 10 mm in diameter with comparable results to ESMR-L or ESD, including high en bloc and R0 resection rates with no increase in significant adverse events. A multicenter trial is required to confirm the validity of the present results.

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“…1,2 In the context of large colon lipomas, several endoscopic techniques have been reported, such as loop-assisted techniques and snare resection. However, in situations where the dimensions of the lesion make these methods unfeasible, endoscopic submucosal dissection (ESD), 3,4 other dissection-based techniques and, most importantly, simple unroofing may offer effective alternative treatment options. [5][6][7][8][9][10] Mentioned for the first time in 1997, the unroofing technique relies on intraluminal expulsion of the residual submucosal content following snare resection of the distal part of the subepithelial mass 11 (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…In the context of large colon lipomas, several endoscopic techniques have been reported, such as loop‐assisted techniques and snare resection. However, in situations where the dimensions of the lesion make these methods unfeasible, endoscopic submucosal dissection (ESD), 3,4 other dissection‐based techniques and, most importantly, simple unroofing may offer effective alternative treatment options 5–10 …”

Section: Introductionmentioning

confidence: 99%

Endoscopic treatment of large symptomatic colon lipomas: A systematic review of efficacy and safety

2020

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Background Various techniques have been described for endoscopic resection of large symptomatic colon lipomas. Lipoma unroofing might provide a safer, more time efficient and easier technique compared to dissection-based techniques, endoscopic mucosal resection (EMR) or loop-assisted resection. The aim of this systematic review was to compare efficacy and safety (endoscopic resolution rates, clinical remission rates and adverse events) of lipoma unroofing with respect to dissection-based techniques, EMR or loop-assisted resection. Methods As most outcomes were binary in nature and several outcomes did not occur in some studies, routine calculation of standard errors in outcome probability was not possible. Therefore, original patient data were extracted, after which efficacy and safety were compared. Results Twenty four studies met the selection criteria, which encompassed 77 lesions (46.8% female, mean age 63 years (interquartile range (IQR) 53–72 years), mean size 45.4 mm (IQR 30.0–60.0 mm). Ten patients underwent unroofing (13.0%), whereas 7 (9.1%), 31 (40.3%) and 29 patients (37.7%) underwent dissection-based techniques, EMR and loop-assisted-snare resection, respectively. Endoscopic resolution rates were 60%, 100% ( p = 0.103), 93.6% ( p = 0.024) and 93.1% ( p = 0.028). Clinical remission rates were identical in all four groups (100%). Amongst patients who underwent EMR and loop-assisted techniques, adverse events were identified in 12.9% ( p = 0.556) and 13.8% ( p = 0.556), respectively, compared to none in the unroofing and dissection-based resection group. Conclusions In patients with large colon lipomas, endoscopic treatment by unroofing, dissection-based resection, EMR and loop-assisted resection provided similar clinical remission rates. Amongst patients undergoing EMR and loop-assisted resection, increased endoscopic resolution rates were seen at the expense of more adverse events, although the latter did not reach statistical significance. Until more reliable comparative data are available, the most optimal resection technique should rely on local expertise and patient profile.

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Endoscopic submucosal dissection for small submucosal tumors of the rectum compared with endoscopic submucosal resection with a ligation device

Cited by 14 publications

References 17 publications

Local surgical excision versus endoscopic resection for rectal carcinoid: A meta-analysis.

Local surgical excision versus endoscopic resection for rectal carcinoid: A meta-analysis.

Underwater endoscopic mucosal resection: a new endoscopic method for resection of rectal neuroendocrine tumor grade 1 (carcinoid) ≤ 10 mm in diameter

Endoscopic treatment of large symptomatic colon lipomas: A systematic review of efficacy and safety

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