Look, but don’t touch: what not to do in managing large colorectal polyps

Grimm, Ian S.; McGill, Sarah

doi:10.1016/j.gie.2018.10.008

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…Both tattooing underneath a lesion and prior incomplete endoscopic resection have been shown to cause submucosal fibrosis and complicate subsequent resection attempts. 23,24 Similarly, in this study, submucosal fibrosis was commonly identified in patients with a tattoo underneath the lesion (51 of 62 [82.3%]) and in those with prior incomplete EMR attempts (91 of 99 [92%]). On multivariate analysis, presence of severe submucosal fibrosis was the strongest predictor for failed ESD; further highlighting the detrimental consequences of both of these actions before definitive endoscopic resection.…”

Section: Discussionsupporting

confidence: 61%

2021

Gastroenterology

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BACKGROUND AND AIMS: Endoscopic submucosal dissection (ESD) in Asia has been shown to be superior to endoscopic mucosal resection (EMR) and surgery for the management of selected early gastrointestinal cancers. We aimed to evaluate technical outcomes of ESD in North America. METHODS: We conducted a multicenter prospective study on ESD across 10 centers in the United States and Canada between April 2016 and April 2020. End points included rates of en bloc resection, R0 resection, curative resection, adverse events, factors associated with failed resection, and recurrence post-R0 resection. RESULTS: Six hundred and ninety-two patients (median age, 66 years; 57.8% were men) underwent ESD (median lesion size, 40 mm; interquartile range, 25-52 mm) for lesions in the esophagus (n ¼ 181), stomach (n ¼ 101), duodenum (n ¼ 11), colon (n ¼ 211) and rectum (n ¼ 188). En bloc, R0, and curative resection rates were 91.5%, 84.2%, and 78.3%, respectively. Bleeding and perforation were reported in 2.3% and 2.9% of the cases, respectively. Only 1 patient (0.14%) required surgery for adverse events. On multivariable analysis, severe submucosal fibrosis was associated with failed en bloc, R0, and curative resection and higher risk for adverse events. Overall recurrence was 5.8% (31 of 532) at a mean follow-up of 13.3 months (range, 1-60 months). CONCLUSIONS: In this large multicenter prospective North American experience, we demonstrate that ESD can be performed safely, effectively, and is associated with a low recurrence rate. The technical resection outcomes achieved in this study are in line with the current established consensus quality parameters and further support the implementation of ESD for the treatment of select gastrointestinal neoplasms; ClinicalTrials.gov, Number: NCT02989818.

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Section: Discussionsupporting

confidence: 61%

2021

Gastroenterology

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“…The ability to optically characterize neoplasia through its biological hallmark behaviours could help optimize clinical diagnostic pathways by immediately indicating the nature of lesion and facilitate, in cases of benign aetiology, immediate local excision (or conversely caution such an approach in lesions with benign appearances but containing an invasive focus). Avoidance of biopsy is increasingly advocated in these cases as such an act can introduce architectural distortion in the samples and induce fibrosis in the residual lesion (confounding luminal excision) 32 . In lesions where biopsy is still indicated, the fluorescent signal profile could indicate the site of most relevant yield re cancer detection.…”

Section: Discussionmentioning

confidence: 99%

“…Detailed region by region biopsy collated to continuous FI perfusion criteria may too yield digital tumour margin delineation and heterogeneity appreciation. Greater patient numbers is of course needed too and, with early proof of principle now provided, a larger clinical study is now ongoing to develop and validate these findings 32 while AI methods are also being developed to enable real-time deployment 34 .…”

Section: Discussionmentioning

confidence: 99%

Digital dynamic discrimination of primary colorectal cancer using systemic indocyanine green with near-infrared endoscopy

Dalli

Loughman

Hardy

et al. 2021

Sci Rep

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As indocyanine green (ICG) with near-infrared (NIR) endoscopy enhances real-time intraoperative tissue microperfusion appreciation, it may also dynamically reveal neoplasia distinctively from normal tissue especially with video software fluorescence analysis. Colorectal tumours of patients were imaged mucosally following ICG administration (0.25 mg/kg i.v.) using an endo-laparoscopic NIR system (PINPOINT Endoscopic Fluorescence System, Stryker) including immediate, continuous in situ visualization of rectal lesions transanally for up to 20 min. Spot and dynamic temporal fluorescence intensities (FI) were quantified using ImageJ (including videos at one frame/second, fps) and by a bespoke MATLAB® application that provided digitalized video tracking and signal logging at 30fps (Fluorescence Tracker App downloadable via MATLAB® file exchange). Statistical analysis of FI-time plots compared tumours (benign and malignant) against control during FI curve rise, peak and decline from apex. Early kinetic FI signal measurement delineated discriminative temporal signatures from tumours (n = 20, 9 cancers) offering rich data for analysis versus delayed spot measurement (n = 10 cancers). Malignant lesion dynamic curves peaked significantly later with a shallower gradient than normal tissue while benign lesions showed significantly greater and faster intensity drop from apex versus cancer. Automated tracker quantification efficiently expanded manual results and provided algorithmic KNN clustering. Photobleaching appeared clinically irrelevant. Analysis of a continuous stream of intraoperatively acquired early ICG fluorescence data can act as an in situ tumour-identifier with greater detail than later snapshot observation alone. Software quantification of such kinetic signatures may distinguish invasive from non-invasive neoplasia with potential for real-time in silico diagnosis.

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“…Benign lesions may be distinguished from malignancies based on endoscopic appearance using Kudo pit pattern or NICE classification [ 26 , 27 ]. Some argue benign appearing lesions shouldn’t be biopsied excessively, if at all, if advanced endoscopic resection is to be considered due to the possibility of fibrosis [ 30 ]. Therefore, the optimal technique of endoscopic biopsy for colorectal lesions remains unclear.…”

Section: Discussionmentioning

confidence: 99%