Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis

Belderbos, Tim D.; Leenders, Max; Moons, Leon M.G.; Siersema, Peter D.

doi:10.1055/s-0034-1364970

Cited by 326 publications

(313 citation statements)

References 53 publications

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“…Pedunculated colorectal polyps and flat or depressed colorectal tumors are good indications for endoscopic polypectomy (EP) and endoscopic mucosal resection (EMR), respectively [2,3] . Al-though EMR is widely used for endoscopic removal of flat or depressed colorectal tumors, en bloc resection of lesions >20 mm is difficult using EMR [4][5][6] . A fragmented resection technique called endoscopic piecemeal mucosal resection is often employed in such cases [4][5][6] , but a high incidence of local recurrence has been reported in colorectal tumors treated with this resection technique [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

“…Al-though EMR is widely used for endoscopic removal of flat or depressed colorectal tumors, en bloc resection of lesions >20 mm is difficult using EMR [4][5][6] . A fragmented resection technique called endoscopic piecemeal mucosal resection is often employed in such cases [4][5][6] , but a high incidence of local recurrence has been reported in colorectal tumors treated with this resection technique [4][5][6] . Endoscopic submucosal dissection (ESD), which allows en bloc resection of flat or depressed colorectal tumors >20 mm, has recently been introduced and become a standard procedure in Japan [4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

“…A fragmented resection technique called endoscopic piecemeal mucosal resection is often employed in such cases [4][5][6] , but a high incidence of local recurrence has been reported in colorectal tumors treated with this resection technique [4][5][6] . Endoscopic submucosal dissection (ESD), which allows en bloc resection of flat or depressed colorectal tumors >20 mm, has recently been introduced and become a standard procedure in Japan [4][5][6] . In fact, many studies addressing the efficacy of ESD show that the rates of en bloc and curative resection are higher in patients treated with ESD than in those treated with EMR [7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Okamoto¹,

Watanabe²,

Komeda³

et al. 2017

Oncology

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antithrombotic therapy and rectal tumor location were strongly associated with POB following colorectal ESD. The incidence of POB was higher in patients on heparin bridge therapy (HBT) for the replacement of antithrombotic therapy than in patients with no HBT. Four of 7 patients (57.1%) on antithrombotic therapy experienced POB from the rectal lesions. Conclusion: Antithrombotic therapy and rectal lesions result in a higher POB incidence after colorectal ESD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Okamoto¹,

Watanabe²,

Komeda³

et al. 2017

Oncology

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“…The risk of lymph node metastasis is low following neoplastic invasion of the mucosa, lamina propria, muscularis mucosa, and superficial submucosa of the colorectum, due to the regional absence of a rich lymph vascular network (2,4). Surgical resection has historically been recognized as the gold-standard treatment (either open or laparoscopic assisted), but less invasive techniques [i.e., trans anal endoscopic microsurgery (TEMS), endoscopic mucosectomy resection (EMR), or endoscopic submucosal dissection (ESD)] are emerging as important and safe treatment options (5)(6)(7). Nonetheless, there is little data available in the literature concerning the short and long-term outcomes of these new, less invasive treatments, as compared to traditional surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic versus surgical resection for early colorectal cancer—a systematic review and meta-analysis

Silva

Moura

Bernardo

et al. 2016

J. Gastrointest. Oncol.

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Background: To investigate the available data on the treatment of early colorectal cancer (CRC), either endoscopically or surgically.Methods: Two independent reviewers searched MEDLINE, EMBASE, CENTRAL COCHRANE, LILACS and EBSCO for articles published up to August 2015. No language or dates filters were applied.Inclusion criteria were studies with published data about patients with early colonic or rectal cancer undergoing either endoscopic resection (i.e., mucosectomy or submucosal dissection) or surgical resection (i.e., open or laparoscopic). Extracted data items undergoing meta-analysis were en bloc resection rate, curative resection rate, and complications. A complementary analysis was performed on procedure time. The risk of bias among studies was evaluated with funnel-plot expressions, and sensitivity analyses were carried out whenever a high heterogeneity was found. The risk of bias within studies was assessed with the Newcastle score.Results: A total of 12,819 articles were identified in the preliminary search. After applying inclusion and exclusion criteria, three cohort studies with a total of 768 patients undergoing endoscopic resection and 552 patients undergoing surgical resection were included. The en bloc resection rate risk difference was −11% Conclusions: According to the current available data, the treatment of early CRC by surgical resection is associated with higher curative resection rates and higher en bloc resection rates, despite of higher complications rates, as compared to endoscopic resection. Shorter procedure times are associated with the endoscopic methods of treatment, however high heterogeneity levels limit this conclusion.

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“…Bledebos, et al reported the results of a meta-analysis of colonic EMR showing that the recurrence rate was 15% and that piecemeal resection had a higher recurrence rate as compared to en bloc resection (20% versus 3% respectively). 12 Ikematsu, et al reported long term outcomes after resection of submucosal invasive colorectal cancer by ESD or surgery. In patients with low risk lesions (lesion entirely resected, well to moderately differentiated adenocarcinoma, no vascular invasion and submucosal invasion <1 mm), there were recurrence rates of 0% and 6% for rectal and colonic lesions, while in patients with high risk lesions, the recurrence rates were 1.4% and 16% for rectal and colonic lesions respectively.…”

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confidence: 99%

Endoscopy: From Diagnosis to Therapeutics

Benson

Mizrahi²

2015

Gastro Open J

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Two decades ago, gastroenterologists used endoscopy for the diagnosis of Gastrointestinal (GI) lesions, thereby helping surgeons to localize lesion that necessitated resection and treatment with surgery. Today, the gastroenterology field has advanced beyond the diagnostic era and now, a large number of GI lesions can be treated via endoluminal procedures performed by the gastroenterologist with no need for surgical intervention.In recent years, the improvement of endoscopic imaging and tools, such as snares, clips and needles which can be delivered through the endoscope channel, have helped to change the field of gastroenterology. This allowed for the development and advancement of Endoscopic Mucosal Resection (EMR) and Endoscopic Submucosal Dissection (ESD). The pioneers of EMR and ESD were from Japan and the first articles describing these techniques were published in the 1990s. 1,2Two classification systems are used for describing GI lesions to be considered for EMR and ESD. One system is the Japanese classification 3 and the second is the Paris system, which was proposed in 2002. 4 The Japanese classification was originally developed for early gastric cancer management, but it can be applied to lesions throughout the GI tract. Once lesions are classified, EMR can be performed in different GI locations, including the esophagus, stomach, colon and rectum. When lesions are more complex and beyond the mucosa, ESD can be performed with careful dissection.Endoscopic ultrasound (EUS) may be useful in deciding whether to perform EMR or ESD. EUS can aid in determining the penetration of the tumor to layers beyond the mucosa when the lesion is localized in proximal parts of the colon. If the lesion cannot be reached by a regular EUS endoscope special high frequency mini-probes may be used through the colonoscope working channel.Two methods are used in performing EMR. The first method is 'suck and cut' and the second method is 'lift and cut'. Both usually begin with a submucosal injection prior to resection of the lesion the suc and cut method may be used also without submucosal injection especially when being performed in the esophagus. The injection is used to expand the submucosa, separating the deeper muscolaris propria from the more superficial mucosa and submucosa layers. Several solutions may be used as the injectate. These include normal saline with or without diluted epinephrine, hypertonic saline, dextrose solution, sodium hyaluronate, fibrinogen combination, glycerol, and fructose solutions all of those may be mixture with methylene blue depend on the preference of the endoscopist.5-8 Conio, et al. compared the solutions and showed that the disappearing time of normal saline is approximately 3 minutes with or without epinephrine, while the disappearing times of 50% dextrose and 10% glycerol and hyaluronic acid solutions were 4.7, 4.2 and 22 minutes respectively. 9After injection, one of the two resection methods can be applied. The 'suck and cut'

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Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis

Cited by 326 publications

References 53 publications

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Risk Factors for Postoperative Bleeding in Endoscopic Submucosal Dissection of Colorectal Tumors

Endoscopic versus surgical resection for early colorectal cancer—a systematic review and meta-analysis

Endoscopy: From Diagnosis to Therapeutics

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