Endoscopic submucosal dissection of T1 cancer with colonic diverticulum by pocket‐creation method

Yoshida, Naohisa; Naito, Yuji; Kishimoto, Mitsuo

doi:10.1111/den.12897

Cited by 6 publications

(8 citation statements)

References 6 publications

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“… 15 In contrast, all cases in which strategy B was applied for lesions involving the diverticulum achieved R0 resection, except for one case in which ESD was discontinued during the procedure. This difference in results may be due to the use of the PCM in strategy B. Yoshida et al 14 reported successful treatment of diverticulum-related lesions with ESD using PCM. It provides not only scope stability, but also good counter traction.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum

Ikezawa

Toyonaga²,

Tanaka³

et al. 2022

Clin Endosc

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Background/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD.Methods: D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed.Results: The en bloc resection rate was 96.2%. The rates of R0 and curative resection in strategies A and B were 80.8%, 73.1%, 84.6%, and 70.6%, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively.Conclusions: D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.

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Section: Discussionmentioning

confidence: 99%

Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum

Ikezawa

Toyonaga²,

Tanaka³

et al. 2022

Clin Endosc

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show abstract

“…There have been seven isolated case reports describing ESD for colorectal tumors associated with diverticulum; in six cases the tumors involved a diverticulum and in one case the tumor was near a diverticulum 8 9 10 11 12 13 14 . In only one of these cases was failure to achieve en-bloc resection reported, and that was in a patient with a tumor involving a diverticulum.…”

Section: Discussionmentioning

confidence: 99%

“…These are beneficial factors in management of colorectal tumors associated with a diverticulum because tumors can directly invade the serosa in this uncommon location 3 7 . Although several individual cases of ESD treatment of such colonic tumors have been reported 8 9 10 11 12 13 14 , use of ESD for treating a colonic tumor found near or involving a diverticulum remains controversial. Here, we report on a series of 12 consecutive patients with colorectal tumors near or involving a diverticulum treated by ESD.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series

et al. 2019

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Background and study aims Surgery is the standard treatment for colon tumors associated with diverticulum. Use of endoscopic submucosal dissection (ESD) to treat such tumors is controversial. The aim of this study was to assess the safety and feasibility of ESD in treating superficial colorectal tumors situated near or involving diverticulum. Patients and methods Consecutive patients from two referral centers who had colorectal tumors near or involving diverticulum treated by ESD were retrospectively studied. Clinicopathological characteristics and clinical outcomes were analyzed. Results Of the 12 patients studied, six had tumors near diverticulum and six had tumors involving diverticulum. The overall en-bloc R0 resection rate, median tumor size and procedure time were 67 %, 26.5 mm (range, 15 – 80 mm) and 110 minutes (range, 50 – 220 minutes), respectively. For tumors near diverticulum group, the en-bloc R0 resection rate was 100 % and no adverse events (AEs) or residual/recurrent tumors were observed. In contrast, for intradiverticular tumors group, the en-bloc R0 resection rate was low at 33 %, and one AE (perforation) was observed. The diverticula were ≥ 6 mm in diameter in the patients with incomplete resection. However, all but one diverticulum was unrecognized before ESD. Two residual tumors were detected at the 12-month surveillance and one required surgery. Conclusions This case series indicates that ESD is safe and feasible for treating colorectal tumors near a diverticulum and might be feasible for tumors involving a diverticulum smaller than 6 mm. Selection for smaller diverticulum size may contribute to higher en-bloc R0 resection rates.

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“…Three previous reports of colon endoscopic submucosal dissection (ESD) in the setting of diverticular involvement described the clip and line technique [1], the pocket creation method [2,3], and the inversion of the diverticulum with a cap [2]. However, these techniques are either complex or not always feasible.…”

mentioning

confidence: 99%

Underwater endoscopic submucosal dissection in saline solution with rubber-band countertraction for a cecal polyp extending into a diverticulum

Mavrogenis¹,

Mavrogenis²,

Anastasiadis³

et al. 2019

aog

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Endoscopic submucosal dissection of T1 cancer with colonic diverticulum by pocket‐creation method

Cited by 6 publications

References 6 publications

Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum

Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum

Endoscopic submucosal dissection in management of colorectal tumors near or involving a diverticulum: a retrospective case series

Underwater endoscopic submucosal dissection in saline solution with rubber-band countertraction for a cecal polyp extending into a diverticulum

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