Hospital Authority audit of the outcome of endoscopic resection of superficial upper gastro-intestinal lesions in Hong Kong

Teoh, Anthony Y.; Chiu, Philip Wai Yan; Chan, Stephen; Cheung, Frances K.; Chu, Kent‐Man; Kao, Sau-Shan; Lai, T W; Lau, CW; Law, Simon; Leung, Canice T L; Leung, Wai Keung; Tong, Daniel; Tsang, Skm

doi:10.12809/hkmj144380

Cited by 3 publications

(11 citation statements)

References 33 publications

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“…The search identified a total of 602 articles and 28 full-text records were assessed foreligibility after screening and full text review. Finally, 14 studies 10 11 12 13 14 15 16 17 18 19 20 21 22 23 were included in the current meta-analysis. The flow-chart is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis

Pérez-Cuadrado-Robles

Quénéhervé²,

Margos

et al. 2018

Endosc Int Open

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Background and study aims Endoscopic submucosal dissection (ESD) has been developed as an option for treatment of esophageal, gastric and colorectal lesions. However, there is no consensus on the role of ESD in duodenal tumors. Methods This systematic review and meta-analysis compared ESD and endoscopic mucosal resection (EMR) in sporadic non-ampullary superficial duodenal tumors (NASDTs), including local experience. We conducted a search in PubMed, Scopus and the Cochrane library up to August 2017 to identify studies that compared both techniques reporting at least one main outcome (en-bloc/complete resection, local recurrence). Pooled outcomes were calculated under fixed and random-effect models. Subgroup analyses were conducted. Results A total of 753 patients presenting with 784 NASDTs (242 ESD, 542 EMR) in 14 studies were included. Tumor size (MD: 5.88, [CI95 %: 2.15, 9.62], P = 0.002, I 2 = 79 %) and procedure time (MD: 65.65, [CI95 %: 40.39, 90.92], P < 0.00001, I 2 = 88 %) were greater in the ESD group. En-bloc resection rate was significantly higher in Asian studies (OR: 2.16 [CI95 %: 1.15, 4.08], P = 0.02, I 2 : 46 %). ESD provided a higher complete resection rate (OR: 1.63 [I95 %: 1.06, 2.50], P = 0.03, I 2 : 59 %), but there was no risk difference in the risk of local recurrence (RD: – 0.03 [CI95 %: – 0.07, 0.01], P = 0.15, I 2 : 0 %) or delayed bleeding. ESD was associated with an increased number of intraoperative perforations [RD: 0.12 (CI95 %: 0.04, 0.20), P = 0.002, I 2 : 56 %] and emergency surgery for delayed perforations. The inclusion of eligible studies was limited to retrospective series with inequalities in comparative groups. Conclusions Duodenal ESD for NASDTs may achieve higher en-bloc and complete resections at the expense of a greater perforation rate compared to EMR. The impact on local recurrence remains uncertain.

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Section: Resultsmentioning

confidence: 99%

ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis

Pérez-Cuadrado-Robles

Quénéhervé²,

Margos

et al. 2018

Endosc Int Open

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“…There are few retrospective studies in the literature comparing ESD and EMR in duodenal lesions, and most of them have been reported by Japanese authors. In many cases, they included subepithelial and epithelial tumors all confounded 7 8 9 and considered patients with pedunculated lesions 10 or familial adenomatous polyposis 11 . Additionally, the criteria to choose ESD or EMR relies on the local experience and tumor characteristics; therefore, the populations are quite heterogeneous within different series.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this procedure being technically challenging, the en-bloc resection rates in Asian series have been reported as above 90 % 13 . However, the included number of lesions is less than 10 in most of these reports 7 9 11 12 14 15 , and the impact of en-bloc resection in local recurrence is still unclear. In our series, we considered 37 NASDTs who underwent ESD.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors

Pérez-Cuadrado-Robles

Quénéhervé²,

Margos

et al. 2018

Endosc Int Open

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Background and study aims The choice of endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) in non-ampullary superficial duodenal tumors (NASDTs) is challenging and the benefits of ESD remain unclear. The aim was to comparatively analyze the feasibility, outcomes and safety of these techniques in these lesions. Patients and methods This is an observational and retrospective study. All consecutive patients presenting with NASDTs who underwent EMR or ESD between 2005 and 2017 were included. The following main outcomes were comparatively evaluated: en-bloc and complete (R0) resection rates, and local recurrence. Secondary outcomes were perforation and delayed bleeding. Results One hundred sixty-six tumors in 150 patients (age: 66 years, range: 31 – 83, 42.7 % males) were resected by ESD (n = 37) or EMR (n = 129) and included. The median procedure time (81 vs. 50 min, P = 0.007) and tumor size (25 vs. 20 mm, P = 0.01) were higher in the ESD group. The global malignancy rate was 50.3 %. There were no differences in en-bloc resection (29.7 % vs. 44.2 %, P = 0.115), complete resection (19.4 % vs. 35.5 %, P = 0.069), and local recurrence (14.7 % vs. 16.7 %, P = 0.788) rates. Tumor size was associated with recurrence (28 vs. 20 mm, P = 0.008), with a median follow-up of 6.5 months. Focal recurrence (n = 22, 13.3 %) was treated endoscopically in 86.4 %. En-bloc resection in the ESD group was comparable in large ( ≥ 20 mm) and small lesions (27.6 % vs. 37.5 %, P = 0.587), while this outcome decreased significantly in large lesions resected by EMR (17.4 % vs. 75 %, P < 0.001). Nine perforations were confirmed in 6 lesions (16.2 %) resected by ESD and 3 (2.3 %) by EMR ( P = 0.001). Endoscopic therapy was successful in all but 1 patient (88.9 %) presenting with a delayed perforation. Conclusions ESD may be an alternative to EMR and surgery in selected NASDTs, such as large duodenal tumors where EMR achieves low en-bloc resection rates and the local recurrence may be higher. However, this technique may have a higher risk of perforations.

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“…When the tumor is limited to the esophageal mucosa and the lesion size is <20 mm, EMR will be recommended as an alternative therapeutic modality. Furthermore, its results are similar to those achieved by surgery, with a good long-term survival outcome [16,17]. According to s study in Hong Kong [17], ESD was performed in 153 (81.8%) lesions and EMR in 34 (18.2%) lesions.…”

Section: Endoscopic Resectionmentioning

confidence: 90%

“…Furthermore, its results are similar to those achieved by surgery, with a good long-term survival outcome [16,17]. According to s study in Hong Kong [17], ESD was performed in 153 (81.8%) lesions and EMR in 34 (18.2%) lesions. The 30-day morbidity rate was 14.4%, while severe bleeding and perforations accounted for 3.2 and 4.3%, respectively.…”

Section: Endoscopic Resectionmentioning

confidence: 90%

Interventional Therapy of Esophageal Cancer

Mao

2016

Gastrointest Tumors

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Esophageal cancer (EC) is the fourth leading cause of cancer death in China. Despite a lot of advances in diagnosis and therapy, the survival rate of patients with EC is low. There is urgent need for a variety of methods and techniques to improve the survival time and alleviate the lesions of EC. Nowadays, alternative and less invasive approaches to the treatment of ECs are being identified. Here, we review several main interventional methods at different stages of EC, including endoscopic resection, stent placement, arterial infusion, photodynamic therapy, and radiofrequency ablation. This review will focus on the indications, methods, clinical outcomes, and complications of these methods, which may help guide the way forward.

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Hospital Authority audit of the outcome of endoscopic resection of superficial upper gastro-intestinal lesions in Hong Kong

Cited by 3 publications

References 33 publications

ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis

ESD versus EMR in non-ampullary superficial duodenal tumors: a systematic review and meta-analysis

Comparative analysis of ESD versus EMR in a large European series of non-ampullary superficial duodenal tumors

Interventional Therapy of Esophageal Cancer

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