Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis

Bahin, Farzan F.; Heitman, Steven J.; Bourke, Michael J.

doi:10.1136/gutjnl-2017-313823

Cited by 95 publications

(65 citation statements)

References 57 publications

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“…47 In a large Australian study, ESD was modeled to be a costeffective modality if applied selectively for colorectal lesions with low-risk submucosally invasive (T1) cancer. 48 The rationale for this being that ESD could lower overall cost by reducing the number of surgical resections and by potentially eliminating short-term surveillance, thereby reducing the total number of surveillance colonoscopies.…”

Section: Colorectal Endoscopic Submucosal Dissectionmentioning

confidence: 99%

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States

Draganov

Wang

Othman

et al. 2019

Clinical Gastroenterology and Hepatology

338

262

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Endoscopic submucosal dissection (ESD) is an established endoscopic resection method in Asian countries, which is increasingly practiced in Europe and by early adopters in the United States for removal of early cancers and large lesions from the luminal gastrointestinal tract. The intent of this expert review is to provide an update regarding the clinical practice of ESD with a particular focus on its use in the United States. This review is framed around the 16 best practice advice points agreed upon by the authors, which reflect landmark and recent published articles in this field. This expert review also reflects our experience as advanced endoscopists with extensive experience in performing and teaching others to perform ESD in the United States. Best Practice Advice 1: Endoscopic submucosal dissection should be recognized as a mature endoscopic technique that enables complete removal of lesions that are too large for en bloc endoscopic mucosal resection or are at increased risk of containing cancer. Best Practice Advice 2: The safety and feasibility of endoscopic submucosal dissection for early gastric cancer is well established. The absolute indications for curative endoscopic resection include moderately and well-differentiated, nonulcerated, mucosal lesions that are ≤2 cm in size. Best Practice Advice 3: Other relative (expanded) indications for gastric endoscopic submucosal dissection include moderately and well-differentiated superficial cancers that are >2 cm, lesions ≤3 cm with ulceration or that contain early submucosal invasion, and poorly differentiated superficial cancers ≤2 cm in size. The risk of lymph node metastasis when endoscopic submucosal dissection is performed for these indications is higher than when it is performed for absolute indications but remains acceptably low. Best Practice Advice 4: Endoscopic submucosal dissection may be considered in selected patients with Barrett's esophagus with the following features: large or bulky area of nodularity, lesions with a high likelihood of superficial submucosal invasion, recurrent dysplasia, endoscopic mucosal resection specimen showing invasive carcinoma with positive margins, equivocal preprocedural histology, and intramucosal carcinoma. Best Practice Advice 5: Endoscopic submucosal dissection is the primary modality for treatment of squamous cell dysplasia and cancer confined to the superficial esophageal mucosa. Any degree of submucosal invasion caries an increased risk of lymph node metastasis and alternative/additional therapy should be considered. Best Practice Advice 6: Duodenal endoscopic submucosal dissection is associated with an increased risk of intraprocedural perforation and delayed adverse events. Duodenal endoscopic submucosal dissection should be limited to endoscopists with extensive experience in performing endoscopic submucosal dissection in other locations. It is strongly suggested that endoscopists in the United States refrain from performing duodenal endoscopic submucosal dissection during the early phase of their endo...

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Section: Colorectal Endoscopic Submucosal Dissectionmentioning

confidence: 99%

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States

Draganov

Wang

Othman

et al. 2019

Clinical Gastroenterology and Hepatology

338

262

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“…Even with the advent of endoscopic mucosal resection (EMR) as a safe and effective treatment of such large lesions, the referral rate for surgery remains high [3][4][5]. Cost ana-lyses demonstrated that EMR is cheaper than endoscopic submucosal dissection and surgery [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

et al. 2020

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Background and study aims Endoscopic mucosal resection (EMR) is increasingly used for the treatment of large colonic polyps (≥ 20 mm). A drawback of EMR is local adenoma recurrence. Therefore, we studied the impact of argon plasma coagulation (APC) of the EMR edge on local adenoma recurrence. Patients and methods This was a retrospective study of patients with laterally spreading tumors (LST) ≥ 20 mm, who underwent EMR from January 2009 to August 2018 and follow-up endoscopic assessment. A cap-fitted endoscope was used to assess completeness of resection by systematically inspecting the EMR defect for any macroscopic disease. This was followed by forced APC of the resection edge followed by clip closure of the defect. Surveillance colonoscopy was performed at 6 months after resection to detect recurrence. Results Two hundred forty-six patients met the inclusion criteria. Most were female (53 %) and white (80 %), with a Median age of 64 years. Median polyp size was 35 mm (interquartile range, 30–45 mm). Most polyps were located in the right colon (77 %) and were removed by piecemeal EMR (70 %). Eleven patients (5 %) had residual tumor at the resection site. Conclusions We observed low adenoma recurrence after argon plasma coagulation of the EMR edge with a cap fitted colonoscope in patients with LST ≥ 20 mm of the colon, which requires further validation in a randomized controlled study.

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“…This practice shows no signs of abating, 12 despite fervent pleas that EMR by an experienced endoscopist should be the first-line treatment for large LSTs, for reasons of both efficacy and cost. [13][14][15][16] To improve the outcomes in patients with large colorectal polyps, endoscopists in the West would do well to emulate their Japanese colleagues. This would entail sharpening our powers of observation and lesion description, increasing our use of electronic chromoendoscopy, and finding better means to share high-resolution images with colleagues and referral physicians.…”

mentioning

confidence: 99%

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

Grimm

McGill

2019

Gastrointestinal Endoscopy

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Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis

Abstract: NCT02000141.

Cited by 95 publications

References 57 publications

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States

AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States

Cap-fitted endoscopic mucosal resection of ≥ 20 mm colon flat lesions followed by argon plasma coagulation results in a low adenoma recurrence rate

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

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