Skip to main content
SpringerLink
Log in

The Feasibility of Performing Colorectal Endoscopic Submucosal Dissection Without Previous Experience in Performing Gastric Endoscopic Submucosal Dissection

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Experience in gastric endoscopic submucosal dissection (ESD) has been suggested as a prerequisite for performing colorectal ESD by some experts.

Aims

To evaluate the feasibility of performing colorectal ESD without experience in gastric ESD.

Methods

Between November 2009 and December 2013, ESD was attempted for 250 colorectal lesions by an endoscopist having extensive colonoscopy experience but no prior experience of gastric ESD. All attempts were categorized according to the chronological order of procedures: group 1, attempts 1–50; group 2, attempts 51–100; group 3, attempts 101–150; group 4, attempts 151–200; and group 5, attempts 201–250. Procedure-related outcomes were analyzed.

Results

En bloc resection rate ≥80 % was achieved after initial ten ESD attempts. The ESD success rate (72, 80, 90, 90, and 94 % in group 1–5, respectively; p for trend = 0.001), perforation rate (14, 14, 6, 6, and 0 % in group 1–5, respectively; p for trend = 0.003), and macroperforation rate (6, 6, 2, 2, and 0 % in group 1–5, respectively; p for trend = 0.042) improved as experience accumulated. Performing >100 ESDs, rectal location, and absence of submucosal fibrosis were independent predictors of successful procedure.

Conclusion

Colorectal ESD can be safely and effectively performed by an endoscopist having extensive experience in colonoscopy-related procedures even without previous experience of gastric ESD. Meticulous case selection for ESD novice and active supervision by expert endoscopists during the initial learning period may minimize the risk of perforation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Saito Y, Uraoka T, Matsuda T, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007;66:966–973.

    Article  PubMed  Google Scholar 

  2. Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007;66:100–107.

    Article  PubMed  Google Scholar 

  3. Byeon JS, Yang DH, Kim KJ, et al. Endoscopic submucosal dissection with or without snaring for colorectal neoplasms. Gastrointest Endosc. 2011;74:1075–1083.

    Article  PubMed  Google Scholar 

  4. Jung HY. Endoscopic resection for early gastric cancer: current status in Korea. Dig Endosc. 2012;24:159–165.

    Article  PubMed  Google Scholar 

  5. Gotoda T, Jung HY. Endoscopic resection (endoscopic mucosal resection/endoscopic submucosal dissection) for early gastric cancer. Dig Endosc. 2013;25:55–63.

    Article  PubMed  Google Scholar 

  6. Chang DK. Current status of colorectal endoscopic submucosal dissection in Korea. Clin Endosc. 2012;45:288–289.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Kim ES, Cho KB, Park KS, et al. Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy. 2011;43:573–578.

    Article  CAS  PubMed  Google Scholar 

  8. Suh JP, Youk EG, Lee EJ, et al. Endoscopic submucosal dissection for nonpedunculated submucosal invasive colorectal cancer: is it feasible? Eur J Gastroenterol Hepatol. 2013;25:1051–1059.

    Article  PubMed  Google Scholar 

  9. Choi MH, Choi YS, So CS, et al. The iatrogenic complications of colonoscopic polypectomy: a multicenter retrospective study. Intest Res. 2013;11:46–51 [in Korean].

    Article  Google Scholar 

  10. Ahn JY, Jung HY, Choi KD, et al. Endoscopic and oncologic outcomes after endoscopic resection for early gastric cancer: 1370 cases of absolute and extended indications. Gastrointest Endosc. 2011;74:485–493.

    Article  PubMed  Google Scholar 

  11. Chung IK, Lee JH, Lee SH, et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009;69:1228–1235.

    Article  PubMed  Google Scholar 

  12. Shin KY, Jeon SW, Cho KB, et al. Clinical outcomes of the endoscopic submucosal dissection of early gastric cancer are comparable between absolute and new expanded criteria. Gut Liver. 2015;9:181–187.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Sakamoto T, Saito Y, Fukunaga S, Nakajima T, Matsuda T. Learning curve associated with colorectal endoscopic submucosal dissection for endoscopists experienced in gastric endoscopic submucosal dissection. Dis Colon Rectum. 2011;54:1307–1312.

    Article  PubMed  Google Scholar 

  14. Niimi K, Fujishiro M, Goto O, Kodashima S, Koike K. Safety and efficacy of colorectal endoscopic submucosal dissection by the trainee endoscopists. Dig Endosc. 2012;24:154–158.

    Article  PubMed  Google Scholar 

  15. Hotta K, Oyama T, Shinohara T, et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc. 2010;22:302–306.

    Article  PubMed  Google Scholar 

  16. Probst A, Golger D, Anthuber M, Markl B, Messmann H. Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center. Endoscopy. 2012;44:660–667.

    Article  CAS  PubMed  Google Scholar 

  17. Deprez PH, Bergman JJ, Meisner S, et al. Current practice with endoscopic submucosal dissection in Europe: position statement from a panel of experts. Endoscopy. 2010;42:853–858.

    Article  CAS  PubMed  Google Scholar 

  18. Iacopini F, Bella A, Costamagna G, et al. Stepwise training in rectal and colonic endoscopic submucosal dissection with differentiated learning curves. Gastrointest Endosc. 2012;76:1188–1196.

    Article  PubMed  Google Scholar 

  19. Yang DH, Byeon JS, Lee KH, et al. Is endoscopic closure with clips effective for both diagnostic and therapeutic colonoscopy-associated bowel perforation? Surg Endosc. 2010;24:1177–1185.

    Article  PubMed  Google Scholar 

  20. Hirao M, Masuda K, Asanuma T, et al. Endoscopic resection of early gastric cancer and other tumors with local injection of hypertonic saline-epinephrine. Gastrointest Endosc. 1988;34:264–269.

    Article  CAS  PubMed  Google Scholar 

  21. Sakamoto T, Matsuda T, Nakajima T, Saito Y. Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors. Clin Gastroenterol Hepatol. 2012;10:22–26.

    Article  PubMed  Google Scholar 

  22. Park HW, Byeon JS, Park YS, et al. Endoscopic submucosal dissection for treatment of rectal carcinoid tumors. Gastrointest Endosc. 2010;72:143–149.

    Article  PubMed  Google Scholar 

  23. Toyonaga T, Man IM, Morita Y, et al. The new resources of treatment for early stage colorectal tumors: EMR with small incision and simplified endoscopic submucosal dissection. Dig Endosc. 2009;21:S31–S37.

    Article  PubMed  Google Scholar 

  24. Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27:417–434.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  26. Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol. 2008;43:641–651.

    Article  PubMed  Google Scholar 

  27. Tanaka S, Saitoh Y, Matsuda T, et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2015;50:252–260.

    Article  PubMed  Google Scholar 

  28. Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001;33:367–373.

    Article  CAS  PubMed  Google Scholar 

  29. Uraoka T, Saito Y, Ikematsu H, Yamamoto K, Sano Y. Sano’s capillary pattern classification for narrow-band imaging of early colorectal lesions. Dig Endosc. 2011;23:112–115.

    Article  PubMed  Google Scholar 

  30. Ishiguro A, Uno Y, Ishiguro Y, Munakata A, Morita T. Correlation of lifting versus non-lifting and microscopic depth of invasion in early colorectal cancer. Gastrointest Endosc. 1999;50:329–333.

    Article  CAS  PubMed  Google Scholar 

  31. Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58:S3–S43.

  32. Endoscopic Classification Review Group. Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy. 2005;37:570–578.

  33. Kudo S, Lambert R, Allen JI, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008;68:S3–S47.

    Article  PubMed  Google Scholar 

  34. Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–255.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Watanabe T, Itabashi M, Shimada Y, et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol. 2012;17:1–29.

    Article  PubMed  Google Scholar 

  36. Lee SH, Shin SJ, Park DI, et al. Korean guideline for colonoscopic polypectomy. Clin Endosc. 2012;45:11–24.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Fujishiro M, Yahagi N, Kakushima N, et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol. 2007;5:678–683.

    Article  PubMed  Google Scholar 

  38. Lee EJ, Lee JB, Choi YS, et al. Clinical risk factors for perforation during endoscopic submucosal dissection (ESD) for large-sized, nonpedunculated colorectal tumors. Surg Endosc. 2012;26:1587–1594.

    Article  PubMed  Google Scholar 

  39. Tomiki Y, Kawai M, Takehara K, et al. Clinical pathway to discharge 3 days after colorectal endoscopic submucosal dissection. Dig Endosc. 2015. doi:10.1111/den.12468.

  40. Toyonaga T, Man-i M, Fujita T, et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy. 2010;42:714–722.

    Article  CAS  PubMed  Google Scholar 

  41. Han KS, Sohn DK, Choi DH, et al. Prolongation of the period between biopsy and EMR can influence the nonlifting sign in endoscopically resectable colorectal cancers. Gastrointest Endosc. 2008;67:97–102.

    Article  PubMed  Google Scholar 

  42. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72:1217–1225.

    Article  PubMed  Google Scholar 

  43. Sato K, Ito S, Kitagawa T, et al. Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc. 2014;28:2959–2965.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea

    Dong-Hoon Yang, Yerim Song, Sang Hyoung Park, Soo-Kyung Park, Jong Wook Kim, Kee Wook Jung, Kyung-Jo Kim, Byong Duk Ye, Seung-Jae Myung, Suk-Kyun Yang, Jin-Ho Kim & Jeong-Sik Byeon

  2. Department of Internal Medicine, Yeosu Jeil Hospital, Yeosu, South Korea

    Gwi Hong Jeong

  3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Young Soo Park

Authors
  1. Dong-Hoon Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gwi Hong Jeong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yerim Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang Hyoung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Soo-Kyung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jong Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kee Wook Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kyung-Jo Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Byong Duk Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Seung-Jae Myung
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Suk-Kyun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jin-Ho Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Young Soo Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jeong-Sik Byeon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jeong-Sik Byeon.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, DH., Jeong, G.H., Song, Y. et al. The Feasibility of Performing Colorectal Endoscopic Submucosal Dissection Without Previous Experience in Performing Gastric Endoscopic Submucosal Dissection. Dig Dis Sci 60, 3431–3441 (2015). https://doi.org/10.1007/s10620-015-3755-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-015-3755-0

Keywords

Search

Navigation