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DOI: 10.1055/a-1723-3194
Endoscopic submucosal resection: a technique using novel devices for incision and resection of neoplastic lesions
Abstract
Background Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established techniques for treatment of superficial gastrointestinal neoplasia. Limitations of EMR are low en bloc resection rates for larger lesions, resulting in frequent recurrences. Major disadvantages of ESD are technical difficulty and long procedure times. We evaluated technical feasibility and safety of newly designed devices for en bloc resection of lesions measuring 20–40 mm in a technique called endoscopic submucosal resection (ESR).
Methods This case series included 93 lesions from different locations (11 stomach, 25 colon, 57 rectum) with a median size of 29 mm (range 10–70). ESR was performed using two novel instruments for circumferential mucosal incision and deep submucosal resection, respectively.
Results Resection by ESR was feasible in all cases. En bloc and R0 rates were insufficient when ESR was attempted without prior circumferential mucosal incision, but were 70 % and 63 %, respectively, when mucosal incision was done before application of the submucosal resection device. We observed three complications (two delayed bleedings, one microperforation) but no cases of emergency surgery or 30-day mortality.
Conclusions Results demonstrated feasibility and excellent safety of ESR using two novel devices for en bloc resection of early gastrointestinal neoplasia. The technique offered relative technical ease and high efficacy.
* Deceased
Publication History
Received: 03 June 2021
Accepted: 16 December 2021
Accepted Manuscript online:
16 December 2021
Article published online:
04 February 2022
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
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References
- 1 Belderbos TD, Leenders M, Moons LM. et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46: 388-402
- 2 Knabe M, Pohl J, Gerges C. et al. Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol 2014; 109: 183-189
- 3 Fuccio L, Ponchon T. Colorectal endoscopic submucosal dissection (ESD). Best Pract Res Clin Gastroenterol 2017; 31: 473-480
- 4 Yoshida N, Inoue K, Dohi O. et al. Efficacy of precutting endoscopic mucosal resection with full or partial circumferential incision using a snare tip for difficult colorectal lesions. Endoscopy 2019; 51: 871-876
- 5 McCarty TR, Bazarbashi AN, Thompson CC. et al. Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis. Endoscopy 2021; 53: 1048-1058
- 6 Bogie RMM, Veldman MHJ, Snijders LARS. et al. Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis. Endoscopy 2018; 50: 263-282
- 7 Fuccio L, Repici A, Hassan C. et al. Why attempt en bloc resection of non-pedunculated colorectal adenomas? A systematic review of the prevalence of superficial submucosal invasive cancer after endoscopic submucosal dissection. Gut 2018; 67: 1464-1474
- 8 Metter K, Farin G, Bader A. et al. Endoskopische Submukosa-Resektion (ESR) – ein neues Verfahren zur Entfernung mukosaler/submukosaler Läsionen im Gastrointestinaltrakt (GIT) -klinischer Test hierfür geeigneter, neuartiger HF-chirurgischer Resektionsinstrumente: “Flat Adenoma Resection Instruments (FARIn)”. Z Gastroenterol 2018; 56: KV 477
- 9 Metter K, Dumoulin FL, Grund KE. et al. Zwischen EMR und ESD: Endoskopische Submukosaresektion (ESR) zur optimierten en bloc Resektion kolorektaler Läsionen bis 50 mm. Z Gastroenterol 2019; 57: KV 471
- 10 Grund KE, Aepli P, Dumoulin FL. et al. Wichtige, aber bislang vernachlässigte Parameter bei EPE, EMR und ESD und die Rolle der Endoskopischen Submukosa Resektion (ESR). Z Gastroenterol 2020; 58: PCh 049
- 11 Gölder SK, Schaller T, Farin G. et al. Partially insulated cutting instruments for hybrid endoscopic submucosal dissection – the Flat Adenoma Resection Instruments (FARIn). Endoscopy 2016; 48: E218-E219
- 12 Dinis-Ribeiro M, Areia M, de Vries AC. et al. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 2012; 44: 74-94
- 13 Evans JA, Chandrasekhara V, Chathadi KV. et al. The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc 2015; 82: 1-8
- 14 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
- 15 Kaltenbach T, Anderson JC, Burke CA. et al. Endoscopic removal of colorectal lesions – recommendations by the US Multi-Society Task Force on Colorectal Cancer. Gastrointest Endosc 2020; 91: 486-519
- 16 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
- 17 Pimentel-Nunes P, Pioche M, Albéniz E. et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019; 51: 980-992
- 18 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86.e17
- 19 Fleischmann C, Probst A, Ebigbo A. et al. Endoscopic submucosal dissection in Europe: results of 1000 neoplastic lesions from the German Endoscopic Submucosal Dissection Registry. Gastroenterology 2021; 161: 1168-1178