Matched case‐control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors

Kobayashi, Nozomu; Yoshitake, Naoto; Hirahara, Yoshitaka; Konishi, Jun; Saito, Yutaka; Matsuda, Takahisa; Ishikawa, Tsutomu; Sekiguchi, Ryuzo; Fujimori, Takahiro

doi:10.1111/j.1440-1746.2011.06942.x

Cited by 107 publications

(119 citation statements)

References 21 publications

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“…The overall incidence of bleeding and perforation with ESD is 11% and 6% respectively [32][33][34]. Due to the widespread acceptance of gastric and oesophageal ESDs, the number of medical facilities that perform colorectal ESDs grew in recent years [35,36]. The reported rate of perforation is 1.4-10.4% which is associated with large tumour size (>30 mm) and the presence of fibrosis.…”

Section: Endoscopic Mucosal Resection (Emr)/endoscopic Submucosal Dismentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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Keywords:GI endoscopy adverse events GI emergencies Bleeding Haemorrhage Perforation Infection Embolization Diagnosis and management of severe complications a b s t r a c t Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.

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Section: Endoscopic Mucosal Resection (Emr)/endoscopic Submucosal Dismentioning

confidence: 99%

Emergencies after endoscopic procedures

Rolanda

Caetano

Dinis-Ribeiro

2013

Best Practice & Research Clinical Gastroenterology

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“…As is well known, a higher en bloc resection rate can provide a lower recurrence rate after endoscopic resection. 4 Controversy still exists regarding whether the ESD technique should be applied for the treatment of large SSA/P; therefore, the application of precutting EMR for colorectal lesions <30 mm in size, especially large SSA/P, may be feasible for clinical practice. Although the perforation rate of precutting EMR has not been reported for a large number of cases and precutting EMR for colorectal lesions with fibrosis should be applied carefully, precutting EMR does not require an additional device when the circumferential incision is made using the tip of a snare.…”

Section: Precutting Endoscopic Mucosal Resection For Colorectal Lesionsmentioning

confidence: 99%

“…2 This technique is also applied to duodenal ampullary and non-ampullary adenomas. 4,5 A 77-year-old man presented with a 10-mm-sized superficial colonic polyp located at the anastomosis site after sigmoidectomy for a sigmoid colon cancer (Fig 1a). The lesion was detected during follow-up colonoscopy after surgery in a previous hospital, and the endoscopist attempted to carry out conventional EMR.…”

Section: Letters Techniques and Imagesmentioning

confidence: 99%

Precutting endoscopic mucosal resection for colorectal lesions

Tamai

Kamba

Sumiyama

2017

Digestive Endoscopy

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Letters, Techniques and Images Standardization of endoscopic resection for colorectal lesions over 10 mm Precutting endoscopic mucosal resection for colorectal lesionsPrecutting endoscopic mucosal resection (EMR) is defined by Japan Gastroenterology Endoscopy Society as a technique in which snaring is done without dissecting the submucosal layer after incising the circumference of the lesion by using a knife for endoscopic submucosal dissection (ESD) or the tip of a snare (Fig. 1).1 Conventional EMR is a common technique for resecting colorectal lesions, and the size of the lesion that can be resected safely en bloc using the conventional EMR technique is regarded as a lesion <20 mm in size. However, a recent study reported that even in cases with a lesion <20 mm in size, the incomplete polyp resection rate that was confirmed by obtaining biopsies from the resection margin was relatively high, particularly for lesions 15-20 mm in size (23.3%) and sessile serrated adenomas/polyps (SSA/P) (31.0%).2 Sakamoto et al.3 examined the efficacy of the precutting EMR technique for large colorectal neoplasia and reported an en bloc resection rate of 83.3% for colorectal lesions 20-30 mm in size; in addition, no perforation was observed. As is well known, a higher en bloc resection rate can provide a lower recurrence rate after endoscopic resection. 4 Controversy still exists regarding whether the ESD technique should be applied for the treatment of large SSA/P; therefore, the application of precutting EMR for colorectal lesions <30 mm in size, especially large SSA/P, may be feasible for clinical practice. Although the perforation rate of precutting EMR has not been reported for a large number of cases and precutting EMR for colorectal lesions with fibrosis should be applied carefully, precutting EMR does not require an additional device when the circumferential incision is made using the tip of a snare. Thus, precutting EMR should be considered an easy method for resecting large colorectal lesions. CONFLICTS OF INTEREST

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“…Bleeding during the procedure is very common but only rarely can be significant to the extent which requires the procedure to be stopped [21] . Compared to conventional EMR, the rate of perforation with ESD is higher, at about 1%-4% and it might require emergent surgical treatment but most of the time, perforations can be successfully managed conservatively [9,21,22] . In Japan, where there is a high incidence of the gastric cancer, a mass screening program with photofluorography, double-contrast radiography, chromoendoscopy, and endoscopy has been conducted since 1960 [23][24][25][26][27][28] .…”

Section: Introductionmentioning

confidence: 99%

“…En-bloc resection with standard endoscopic mucosal resection (EMR) techniques is limited to lesions less than 2 cm in diameter, while ESD yields a higher complete resection regardless of size. EMR remains the typical approach in Western countries to treat dysplastic lesions and early cancers [6][7][8][9] while in Asia, ESD has become the preferred therapeutic modality of superficial tumors in both the upper and lower gastrointestinal tract [3] . It is even considered that it brought about a renaissance of therapeutic endoscopy [10] as it is able to offer organ-sparing cure in patient with early gastrointestinal (GI) cancers [11] .…”

Section: Introductionmentioning

confidence: 99%

Training in endoscopic submucosal dissection

Coman

Gotoda²,

Draganov³

2013

WJGE

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Endoscopic submucosal dissection (ESD) represents an important advancement in the therapy of early neoplastic gastrointestinal lesions by providing higher en-bloc curative resection rate with lower recurrence compared to endoscopic mucosal resection (EMR) and by sparing the involved organ and protecting patient' s quality of life. Despite these advantages ESD is associated with long procedure times and a higher rate of complications, making ESD a challenging procedure which requires advanced endoscopic skills. Thus, there has been a recognized need for structured training system for ESD to enhance trainee experience and, to reduce the risks of complications and inadequate treatment. ESD has a very flat learning curve. However, we do not have uniformly accepted benchmarks for competency. Nevertheless, it appears that, in Japan, more than 30 supervised gastric ESD procedures are required to achieve technical proficiency and minimize complications. A number of training algorithms have been proposed in Japan with the aim to standardize ESD training. These algorithms cannot be directly applied in the West due to substantial differences including the availability of highly qualified mentors, the type of pathology seen, choice of devices, and trainee's background. We propose a training algorithm for Western physicians which integrates both hands-on training courses, animal model work as well as visits to expert centers. No specific preceptor training programs have been yet developed but there is a consensus that these programs are important for permeation of ESD worldwide. Key words: Endoscopic submucosal dissection; Training; Learning curve; Early gastrointestinal cancer; Endoscopic mucosal resection Core tip: Endoscopic submucosal dissection (ESD) is a complex procedure associated with high complication rate. In Japan, training in ESD follows the traditional mentor/apprentice approach but significant variability in training approaches exists. We review the learning curves for ESD and describe the training algorithm proposed in Japan aiming to standardize training, and its applicability in the West. We highlight the challenges for ESD dissemination in the West, describing both the consensus and the diverging opinions between Asian and Western training models. Finally, we emphasize the need for structured training system to enhance trainee experience and, most importantly, to reduce the risks of complications and inadequate treatment.Coman RM, Gotoda T, Draganov PV. Training in endoscopic submucosal dissection. World J Gastrointest Endosc 2013; 5(8): 369-378 Available from:

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Matched case‐control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors

Abstract: Endoscopic submucosal dissection is a promising technique for the treatment of colorectal tumors, giving an excellent outcome in comparison with EMR.

Cited by 107 publications

References 21 publications

Emergencies after endoscopic procedures

Emergencies after endoscopic procedures

Precutting endoscopic mucosal resection for colorectal lesions

Training in endoscopic submucosal dissection

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