Retrospective study of technical aspects and complications of endoscopic submucosal dissection for large superficial colorectal tumors

Nawata, Yoshitaka; Homma, Kiyoaki; Suzuki, Yoshihiro

doi:10.1111/den.12217

Cited by 29 publications

(18 citation statements)

References 12 publications

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“…Although large lesions are associated with a longer procedure time, size did not affect the complete resection rate and speed. Furthermore, in one study, the larger diameter of a lesion was associated with a greater procedure speed [30,31].…”

Section: Discussionmentioning

confidence: 97%

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Białek

Pertkiewicz²,

Karpińska-Kaczmarczyk³

et al. 2014

European Journal of Gastroenterology &Amp; Hepatology

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Section: Discussionmentioning

confidence: 97%

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Białek

Pertkiewicz²,

Karpińska-Kaczmarczyk³

et al. 2014

European Journal of Gastroenterology &Amp; Hepatology

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“…Several studies have demonstrated that poor submucosal lifting, presence of fibrosis, and paradoxical movement of the endoscope are associated with difficult ESD and increased risk of perforation . The scissor‐type knife can be handled easily like a biopsy forceps even in an unstable position, because the operator simply grasps the target tissue and cuts it without endoscopic movements, even at a remote distance, and a scissor‐type knife might reduce the risk of perforation . This enables the operator to overcome difficult situations, such as an unstable approach to the lesion, and inability to access the submucosal layer for dissection.…”

Section: Discussionmentioning

confidence: 99%

Scissor‐type knife significantly improves self‐completion rate of colorectal endoscopic submucosal dissection: Single‐center prospective randomized trial

Yamashina

Takeuchi

Nagai

et al. 2017

Digestive Endoscopy

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Background and Aim: Colorectal endoscopic submucosal dissection (C-ESD) is recognized as a difficult procedure. Recently, scissors-type knives were launched to reduce the difficulty of C-ESD. The aim of this study was to evaluate the efficacy and safety of the combined use of a scissors-type knife and a needle-type knife with a water-jet function (WJ needleknife) for C-ESD compared with using the WJ needle-knife alone.Methods: This was a prospective randomized controlled trial in a referral center. Eighty-five patients with superficial colorectal neoplasms were enrolled and randomly assigned to undergo C-ESD using a WJ needle-knife alone (Flush group) or a scissortype knife-supported WJ needle-knife (SB Jr group). Procedures were conducted by two supervised residents. Primary endpoint was self-completion rate by the residents.Results: Self-completion rate was 67% in the SB Jr group, which was significantly higher than that in the Flush group (39%, P = 0.01). Even after exclusion of four patients in the SB Jr group in whom C-ESD was completed using the WJ needle-knife alone, the self-completion rate was significantly higher (63% vs 39%; P = 0.03). Median procedure time among the selfcompletion cases did not differ significantly between the two groups (59 vs 51 min; P = 0.14). No fatal adverse events were observed in either group. Conclusions:In this single-center phase II trial, scissor-type knife significantly improved residents' self-completion rate for C-ESD, with no increase in procedure time or adverse events. A multicenter trial would be warranted to confirm the validity of the present study.

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“…[21][22][23][24][25][26][27][28] Development of ESD in Eastern countries has enabled the en bloc resection of large superficial colorectal tumors regardless of their size and location. [29][30][31] The Japan Gastroenterological Endoscopy Society stated the indications for ESD of colorectal tumors as follows: (i) lesions for which en bloc resection with snare EMR is difficult to apply; (ii) mucosal tumors with submucosal fibrosis; (iii) sporadic localized tumors in conditions of chronic inflammation such as ulcerative colitis; and (iv) local residual or recurrent early carcinomas after endoscopic resection. 11 ESD is usually used for colorectal tumors >20 mm for which en bloc resection with snare EMR is difficult to carry out.…”

Section: Piecemeal Emr Versus En Bloc Esdmentioning

confidence: 99%

“…However, the safety and feasibility of ESD for tumors >50 mm have been reported in Japan. 12,29,31 Recently, the feasibility of ESD for the treatment of large tumors >10 cm was reported from Korea. 32 Although the article reported a long procedure time (average 270 min) and high perforation rate (22%), a high en bloc R0 resection rate (89%) was documented.…”

Section: Piecemeal Emr Versus En Bloc Esdmentioning

confidence: 99%

See 1 more Smart Citation

What is the best therapeutic strategy for colonoscopy of colorectal neoplasia? Future perspectives from the East

Shinozaki

Hayashi

Lefor

et al. 2015

Digestive Endoscopy

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Development and improvement of endoscopic techniques and devices have changed the treatment of colorectal tumors over the last decade. For the treatment of diminutive polyps, the cold snare technique of the West is becoming a promising treatment in the East because of its short procedure time and low rate of delayed bleeding by eliminating the delayed effect of electrocautery. Rather than using piecemeal endoscopic mucosal resection or surgical resection for the treatment of large superficial tumors, the technique of the East of endoscopic submucosal dissection (ESD) achieves a high success rate of en bloc R0 resection, enabling detailed pathological evaluation with less invasive treatment. This procedure should also be useful in the West where large colorectal tumors are more frequent than in the East. Regarding outcomes, however, in the literature, the definition of 'curative resection' remains somewhat inconsistent and long-term outcomes of patients with deep submucosal and/or lymphovascular invasion in the en bloc specimen have not yet been determined. Large prospective, as well as retrospective, studies of these patients are warranted. When colorectal ESD is difficult because of size or location, the pocketcreation method and/or double-balloon-assisted technique may be useful. In the East, high-quality magnified chromoendoscopy is widely available, and endoscopists try to identify focal submucosal invasion. In the West, a systematic evaluation of surveillance for the prevention of colorectal cancer has been done and is highly refined. The East and West have much to learn from each other.

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Retrospective study of technical aspects and complications of endoscopic submucosal dissection for large superficial colorectal tumors

Abstract: Procedure speed for Group B was faster than that for Group A. Group B was treated as safely as Group A.

Cited by 29 publications

References 12 publications

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Treatment of large colorectal neoplasms by endoscopic submucosal dissection

Scissor‐type knife significantly improves self‐completion rate of colorectal endoscopic submucosal dissection: Single‐center prospective randomized trial

What is the best therapeutic strategy for colonoscopy of colorectal neoplasia? Future perspectives from the East

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