Endoscopy 2019; 51(09): 871-876
DOI: 10.1055/a-0956-6879
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Efficacy of precutting endoscopic mucosal resection with full or partial circumferential incision using a snare tip for difficult colorectal lesions

Naohisa Yoshida
1  Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Ken Inoue
1  Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Osamu Dohi
1  Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Ritsu Yasuda
1  Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Ryohei Hirose
1  Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Yuji Naito
1  Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Takaaki Murakami
2  Department of Gastroenterology, JCHO Kyoto Kuramaguchi Medical Center, Kyoto, Japan
,
Kiyoshi Ogiso
3  Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
,
Yutaka Inada
4  Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
,
Yoshikazu Inagaki
5  Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan
,
Yukiko Morinaga
6  Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Mitsuo Kishimoto
6  Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
,
Yoshito Itoh
1  Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
› Author Affiliations
Further Information

Publication History

submitted 19 August 2018

accepted after revision 16 May 2019

Publication Date:
15 July 2019 (online)

Abstract

Background We analyzed the efficacy of precutting endoscopic mucosal resection (EMR), which is a method of making a full or partial circumferential mucosal incision around a tumor with a snare tip for en bloc resection.

Methods We reviewed cases from 2011 to 2018 in which precutting EMR (n = 167) and standard EMR (n = 557) were performed for lesions of 10 – 30 mm. Precutting EMR was indicated for benign lesions of 20 – 30 mm or lesions of < 20 mm for which standard EMR was difficult. Through propensity score matching of the two groups, the therapeutic outcomes for 35 lesions of ≥ 20 mm and 98 lesions of < 20 mm in each group were analyzed.

Results In the two sizes of lesion, there were significant differences between the precutting and standard groups in the en bloc resection rate (≥ 20 mm 88.6 % vs. 48.5 %, P < 0.001; < 20 mm 98.0 % vs. 85.7 %, P = 0.004) and the histological complete resection rate (≥ 20 mm 71.4 % vs. 42.9 %, P = 0.02; < 20 mm 87.8 % vs. 67.3 %, P < 0.001).

Conclusion Precutting EMR enabled high en bloc resection rates in cases involving difficult lesions.