Risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal neoplasms

Terasaki, Motomi; Tanaka, Shinji; Shigita, Kenjiro; Asayama, Naoki; Nishiyama, S; Hayashi, Nana; Nakadoi, Koichi; Oka, Shiro; Chayama, Kazuaki

doi:10.1007/s00384-014-1901-3

Cited by 79 publications

(68 citation statements)

References 34 publications

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“…Resection was curative in 16% (6/37) of these T1b CRC patients. In addition, the rate of post-ESD bleeding was 8%, which falls within the range of 0.5-9.5% reported previously for delayed bleeding after colorectal ESD [10]. Moreover, perforation occurred in 2 of our 37 patients (5%), which was in accordance with the findings of other Japanese studies [9,11].…”

Section: Discussionsupporting

confidence: 81%

“…ESD is a reliable method for en bloc resection regardless of the lesion size or location [6,7,8,9,10,11], and is considered useful for T1 CRC as a total excisional biopsy [8]. Here we retrospectively evaluated the outcomes of cT1b CRCs resected by ESD as total excisional biopsy and the utility of ESD to afford complete resection of the lesions, which is essential for establishing a precise histopathological diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

et al. 2015

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Background/Aims: Only the depth of submucosal invasion can be estimated prior to determining the indications for endoscopic submucosal dissection (ESD) as a curative treatment for colorectal carcinoma (CRC). Here we evaluated the outcomes of ESD for clinical T1 CRCs. Methods: Of 660 patients who underwent ESD for CRC at the Hiroshima University Hospital between June 2003 and December 2013, we examined the outcomes of 37 (6%; 26 men, 11 women; mean age ± SD, 68 ± 12 years) who underwent ESD as total excisional biopsy for various reasons, in spite of an endoscopic diagnosis of T1 CRC. Results: The mean lesion size was 25 ± 14 mm; 14 lesions were protruding and 23 were superficial. The en bloc resection rate was 100% (37/37). The histological en bloc resection rate was 92% (34/37). ESD resulted in a positive vertical margin in 3 cases. Deep submucosal invasion was seen in 3 cases, 2 of which had severe submucosal fibrosis. Although severe submucosal fibrosis was not found in other cases, pathologic examination of the deepest invasive portion of the tumor revealed poorly differentiated adenocarcinoma. The rates of post-ESD bleeding and perforation were 8% (3/37) and 5% (2/37), respectively. All patients recovered under conservative therapy. No cases of recurrence were noted in patients without additional surgical resection when the lesions satisfied the curative conditions listed in the 2014 Japanese Society for Cancer of the Colon and Rectum guidelines. Conclusion: En bloc resection by ESD as total excisional biopsy for clinical T1 CRC is a highly effective treatment and establishes a precise histological diagnosis.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

et al. 2015

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“…Although blood vessel density differs in the colon and rectum, its association with vascular invasion remains unclear. It has been reported that tumor location in the rectum is a significant independent risk factor for delayed bleeding following endoscopic submucosal dissection for colorectal neoplasms, potentially as a consequence of differences in blood vessel density (24). Guidelines from the National Comprehensive Cancer Network, the European Society for Medical Oncology and JSCCR identify vascular invasion as a risk factor for lymph node metastasis and recommend that such patients undergo surgery with lymph node dissection (2,25,26).…”

Section: Discussionmentioning

confidence: 99%

Comparative clinicopathological characteristics of colon and rectal T1 carcinoma

et al. 2016

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Abstract. Lymph node metastasis significantly influences the management of patients with colorectal carcinoma. It has been observed that the biology of colorectal carcinoma differs by location. The aim of the current study was to retrospectively compare the clinicopathological characteristics of patients with colon and rectal T1 carcinomas, particularly their rates of lymph node metastasis. Of the 19,864 patients who underwent endoscopic or surgical resection of colorectal neoplasms at Showa University Northern Yokohama Hospital, 557 had T1 surgically resected carcinomas, including 457 patients with colon T1 carcinomas and 100 patients with rectal T1 carcinomas. Analysed clinicopathological features included patient age, gender, tumor size, morphology, tumor budding, invasion depth, vascular invasion, histological grade, lymphatic invasion and lymph node metastasis. Rectal T1 carcinomas were significantly larger than colon T1 carcinomas (mean ± standard deviation: 23.7±13.1 mm vs. 19.9±11.0 mm, P<0.01) and were accompanied by significantly higher rates of vascular invasion (48.0% vs. 30.2%, P<0.01). Significant differences were not observed among any other clinicopathological factors. In conclusion, tumor location itself was not a risk factor for lymph node metastasis in colorectal T1 carcinomas, even though on average, rectal T1 carcinomas were larger and accompanied by a significantly higher rate of vascular invasion than colon T1 carcinomas.

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“…Endoscopic submucosal dissection (ESD) has been a reliable method for en-bloc resection of colorectal tumors regardless of lesion size [Tanaka et al 2007[Tanaka et al , 2008[Tanaka et al , 2012[Tanaka et al , 2013Tamegai et al 2007;Saito et al 2010;Oka et al 2010Oka et al , 2015aOka et al , 2015bTerasaki et al 2014;Ninomiya et al 2015]. Although colorectal ESD has been established as a procedure with reproducible safety and efficacy, complications such as bleeding and perforation remain problematic.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of dual red imaging in colorectal endoscopic submucosal dissection: a pilot study

Ninomiya

Tanaka

Hirano

et al. 2016

Therap Adv Gastroenterol

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Background: Dual red imaging (DRI), a novel image-enhanced endoscopic technique, is expected to improve visibility of thin vessels, but no reports of the clinical use of DRI in colorectal endoscopic submucosal dissection (ESD) have been published. We aimed to compare the visibility of vessels, demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine, and fibrosis on DRI with that on white light imaging (WLI). We applied the principle of DRI to the image of the submucosal layer during colorectal ESD as a pilot study. Methods: A total of seven physicians compared 17 DRI images to the corresponding WLI images in colorectal ESD. The physicians compared the number of arteries identified on DRI with the actual number of arteries. The physicians rated the visibility of vessels, the demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine, and fibrosis. Inter-observer agreement was also examined using the kappa statistic. Results: Visibility of vessels and the demarcation line between the submucosal and muscle layers after injection of hyaluronate sodium with minute indigo carmine improved with the use of DRI compared with that using WLI. DRI can discriminate between arteries and veins clearly through the color of the vessels. Conclusions: DRI improves the visibility of vessels, especially that of arteries, as they appear orange, and the demarcation line of the muscle layer. DRI may help to make colorectal ESD safer and faster.

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Risk factors for delayed bleeding after endoscopic submucosal dissection for colorectal neoplasms

Abstract: This study demonstrated that location of lesions in the rectum was a significant independent risk factor for delayed bleeding after ESD for colorectal neoplasms.

Cited by 79 publications

References 34 publications

Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

Comparative clinicopathological characteristics of colon and rectal T1 carcinoma

Clinical impact of dual red imaging in colorectal endoscopic submucosal dissection: a pilot study

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