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Is colorectal endoscopic submucosal dissection safe and effective for 15–19-mm tumors?

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The outcomes of colorectal endoscopic submucosal dissection (ESD) in 15–19-mm tumors are unclear. This study compared the effectiveness and safety of colorectal ESD for 15–19-mm tumors and tumors exceeding that size.

Methods

From August 2018 to December 2020, 213 cases of colorectal tumors removed by colorectal ESD at a tertiary hospital were enrolled in this study. The cases were divided into two groups according to the pathologically measured size of the resected lesion: an intermediate group (15–19 mm, n = 62) and a large group (≥ 20 mm, n = 151). The en bloc resection rate, complete resection rate, and complications were investigated retrospectively.

Results

The en bloc resection rate was significantly higher in the intermediate than large group (100% vs. 94%, p = 0.049), and the mean total procedure time was shorter in the intermediate than large group (29.2 \(\pm\) 12.6 vs. 48.4 \(\pm\) 28.8 min, p < 0.001). However, the mean procedure speed was significantly lower in the intermediate than large group (0.25 \(\pm\) 0.10 vs. 0.28 \(\pm\) 0.11 cm2/min, p = 0.031). The complete resection rate, post-procedural bleeding, and perforation rate were not significantly different between the two groups. In multivariate analyses, the total procedure time and mean procedure speed were significantly associated with lesion size.

Conclusion

Colorectal ESD of 15–19-mm lesions is effective, and has a shorter procedure time and higher en bloc resection rate than the same procedure for larger lesions.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Rutter MD, Jover R (2020) Personalizing polypectomy techniques based on polyp characteristics. Clin Gastroenterol Hepatol 18:2859–2867

    Article  PubMed  Google Scholar 

  2. Tate DJ, Desomer L, Heitman SJ et al (2020) Clinical implications of decision making in colorectal polypectomy: an international survey of Western endoscopists suggests priorities for change. Endosc Int Open 8:E445–E455

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kaltenbach T, Anderson JC, Burke CA et al (2020) Endoscopic removal of colorectal lesions-recommendations by the US Multi-Society Task Force on colorectal cancer. Gastrointest Endosc 91:486–519

    Article  PubMed  Google Scholar 

  4. Ferlitsch M, Moss A, Hassan C et al (2017) Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 49:270–297

    Article  PubMed  Google Scholar 

  5. Ishigaki T, Kudo SE, Miyachi H et al (2020) Treatment policy for colonic laterally spreading tumors based on each clinicopathologic feature of 4 subtypes: actual status of pseudo-depressed type. Gastrointest Endosc 92(1083–94):e6

    Google Scholar 

  6. Pohl H, Srivastava A, Bensen SP et al (2013) Incomplete polyp resection during colonoscopy—results of the complete adenoma resection (CARE) study. Gastroenterology 144(74–80):e1

    Google Scholar 

  7. Iacopini F, Saito Y, Bella A et al (2017) Colorectal endoscopic submucosal dissection: predictors and neoplasm-related gradients of difficulty. Endosc Int Open 5:E839–E846

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tanaka S, Kashida H, Saito Y et al (2020) Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 32:219–239

    Article  PubMed  Google Scholar 

  9. Ma MX, Bourke MJ (2018) Endoscopic submucosal dissection in the West: current status and future directions. Dig Endosc 30:310–320

    Article  PubMed  Google Scholar 

  10. Rashid MU, Alomari M, Afraz S, Erim T (2022) EMR and ESD: indications, techniques and results. Surg Oncol 43:101742

    Article  PubMed  Google Scholar 

  11. Fujiya M, Tanaka K, Dokoshi T et al (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81:583–595

    Article  PubMed  Google Scholar 

  12. Matsumoto A, Tanaka S, Oba S et al (2010) Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 45:1329–1337

    Article  PubMed  Google Scholar 

  13. Belderbos TD, Leenders M, Moons LM, Siersema PD (2014) Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 46:388–402

    Article  PubMed  Google Scholar 

  14. Yoon HJ, Sohn DK, Jung Y et al (2022) Does precutting prior to endoscopic piecemeal resection of large colorectal neoplasias reduce local recurrence? A KASID multicenter study Surg Endosc 36:3433–3441

    PubMed  Google Scholar 

  15. Yamashina T, Uedo N, Akasaka T et al (2019) Comparison of underwater vs conventional endoscopic mucosal resection of intermediate-size colorectal polyps. Gastroenterology 157(451–61):e2

    Google Scholar 

  16. Russo P, Barbeiro S, Awadie H, Libanio D, Dinis-Ribeiro M, Bourke M (2019) Management of colorectal laterally spreading tumors: a systematic review and meta-analysis. Endosc Int Open 7:E239–E259

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fuccio L, Hassan C, Ponchon T et al (2017) Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 86(74–86):e17

    Google Scholar 

  18. Matsumoto S, Uehara T, Mashima H (2019) Construction of a preoperative scoring system to predict the difficulty level of colorectal endoscopic submucosal dissection. PLoS ONE 14:e0219096

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Pickhardt PJ, Hain KS, Kim DH, Hassan C (2010) Low rates of cancer or high-grade dysplasia in colorectal polyps collected from computed tomography colonography screening. Clin Gastroenterol Hepatol 8:610–615

    Article  PubMed  Google Scholar 

  20. Nusko G, Mansmann U, Altendorf-Hofmann A, Groitl H, Wittekind C, Hahn EG (1997) Risk of invasive carcinoma in colorectal adenomas assessed by size and site. Int J Colorectal Dis 12:267–271

    Article  CAS  PubMed  Google Scholar 

  21. Kim EK, Han DS, Ro Y, Eun CS, Yoo KS, Oh YH (2016) The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection? Intest Res 14:358–364

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zwager LW, Bastiaansen BAJ, Montazeri NSM et al (2022) Deep submucosal invasion is not an independent risk factor for lymph node metastasis in T1 colorectal cancer: a meta-analysis. Gastroenterology 163:174–189

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was supported by the Soonchunhyang University Research Fund.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, 23-20 Bongmyung-dong, Dongnam-gu, Cheonan-si, Chungcheongnam-do, South Korea

    Yunho Jung, Young Sin Cho & Seong Woo Choi

  2. Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan-si, Republic of Korea

    Young Hwangbo

  3. Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea

    Seong Ran Jeon, Hyun Gun Kim & Jin-O Kim

  4. Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea

    Bong Min Ko

Authors
  1. Yunho Jung
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  2. Young Hwangbo
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  3. Young Sin Cho
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  4. Seong Woo Choi
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  6. Hyun Gun Kim
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  7. Bong Min Ko
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  8. Jin-O Kim
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Contributions

Yunho Jung: study design and wrote the main manuscript text and prepared figures. Seong Woo Choi and Young Sin Cho: data collection. Young Hwangbo: statistical analysis. Seong Ran Jeon, Hyun Gun Kim, Bong Min Ko, and Jin-O Kim: reviewed the manuscript.

Corresponding author

Correspondence to Yunho Jung.

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Jung, Y., Hwangbo, Y., Cho, Y.S. et al. Is colorectal endoscopic submucosal dissection safe and effective for 15–19-mm tumors?. Int J Colorectal Dis 38, 206 (2023). https://doi.org/10.1007/s00384-023-04498-3

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  • DOI: https://doi.org/10.1007/s00384-023-04498-3

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