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Efficacy and safety of endoscopic submucosal dissection for submucosal tumors of the colon and rectum

Published:October 05, 2017DOI:https://doi.org/10.1016/j.gie.2017.09.027

      Background and Aims

      Endoscopic submucosal dissection (ESD) of colorectal submucosal tumors (SMTs) is becoming increasingly common; however, there have been few large consecutive studies analyzing its therapeutic efficacy and safety. The aim of this study was to evaluate the efficacy, safety, and long-term outcomes of ESD for colorectal SMTs.

      Methods

      This retrospective study included 412 consecutive patients with colorectal SMTs who underwent ESD at the Zhongshan Hospital of Fudan University from January 2008 to July 2014. Tumor histopathology, completeness of resection, adverse events, tumor recurrence, and distant metastasis were analyzed.

      Results

      Complete resection was achieved for 358 lesions (86.9%). Thirteen patients had serious adverse events (3.2%) including bleeding and perforation, and 28 patients (6.8%) had post-ESD electrocoagulation syndrome (PEECS). Because more ESDs for colorectal SMTs were performed by endoscopists, the rate of complete resection increased (78.5% vs 88.5%), and the rate of serious adverse events decreased (9.2% vs 2.0%). SMTs in the colon increased the risk of incomplete resection (19.6% vs 11.3%), serious adverse events (8.7% vs 1.6%), and PEECS (16.3% vs 4.1%). SMTs originating from the muscularis propria and sized ≥20 mm increased the rate of PEECS (22.7% vs 5.9% and 31.3% vs 5.8%, respectively).

      Conclusion

      ESD is effective for resection of colorectal SMTs and rarely causes serious adverse events. Tumor location and the experience of endoscopists influence the complete resection rate and the development of serious adverse events. ESD is feasible for large tumors and tumors in the muscularis propria, but this is associated with relatively high risks of adverse events.

      Abbreviations:

      ESD (endoscopic submucosal dissection), NET (neuroendocrine tumor), PEECS (post-ESD electrocoagulation syndrome), SMT (submucosal tumor)
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      References

        • Nishida T.
        • Hirota S.
        • Yanagisawa A.
        • et al.
        Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version.
        Int J Clin Oncol. 2008; 13: 416-430
        • Hwang J.H.
        • Kimmey M.B.
        American Gastroenterological Association Institute medical position statement on the management of gastric subepithelial masses.
        Gastroenterology. 2006; 130: 2215-2216
        • Modlin I.M.
        • Lye K.D.
        • Kidd M.
        A 5-decade analysis of 13,715 carcinoid tumors.
        Cancer. 2003; 97: 934-959
        • Take I.
        • Shi Q.
        • Qi Z.P.
        • et al.
        Endoscopic resection of colorectal granular cell tumors.
        World J Gastroenterol. 2015; 21: 13542-13547
        • Seow-En I.
        • Foo F.J.
        • Tang C.L.
        Jejunojejunal intussusception secondary to submucosal lipoma resulting in a 5-year history of intermittent abdominal pain.
        Case Reports. 2014; 2014 (bcr2014207297-bcr2014207297)
        • Choi C.W.
        • Kang D.H.
        • Kim H.W.
        • et al.
        Comparison of endoscopic resection therapies for rectal carcinoid tumor: endoscopic submucosal dissection versus endoscopic mucosal resection using band ligation.
        J Clin Gastroenterol. 2013; 47: 432-436
        • Saito Y.
        • Otake Y.
        • Sakamoto T.
        • et al.
        Indications for and technical aspects of colorectal endoscopic submucosal dissection.
        Gut Liver. 2013; 7: 263-269
      1. Zhou P. Yao L. Qin X. Atlas of digestive endoscopic resection. Springer, Netherlands2014
      2. Chen T, Zhou PH, Chu Y, et al. Long-term outcomes of submucosal tunneling endoscopic resection for upper gastrointestinal submucosal tumors. Ann Surg. Epub 2016 Jan 19.

        • Chen W.
        • Zheng R.
        • Baade P.D.
        • et al.
        Cancer statistics in China, 2015.
        CA Cancer J Clin. 2016; 66: 115-132
        • Yangong H.
        • Shi C.
        • Shahbaz M.
        • et al.
        Diagnosis and treatment experience of rectal carcinoid (a report of 312 cases).
        Int J Surg. 2014; 12: 408-411
        • Dupart J.
        • Zhang W.
        • Trent J.C.
        Gastrointestinal stromal tumor and its targeted therapeutics.
        Chin J Cancer. 2011; 30: 303-314
        • Zhou P.H.
        • Yao L.Q.
        • Qin X.Y.
        • et al.
        Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors: a retrospective study.
        Surg Endosc. 2010; 24: 2607-2612
        • Choi H.H.
        • Kim J.S.
        • Cheung D.Y.
        • et al.
        Which endoscopic treatment is the best for small rectal carcinoid tumors?.
        World J Gastrointest Endosc. 2013; 5: 487-494
        • Chen T.
        • Yao L.Q.
        • Xu M.D.
        • et al.
        Efficacy and safety of endoscopic submucosal dissection for colorectal carcinoids.
        Clin Gastroenterol Hepatol. 2016; 14: 575-581
        • Lee J.M.
        • Kim J.H.
        • Kim M.
        • et al.
        Endoscopic submucosal dissection of a large colonic lipoma: report of two cases.
        World J Gastroenterol. 2015; 21: 3127-3131
        • Shi Q.
        • Zhong Y.S.
        • Yao L.Q.
        • et al.
        Endoscopic submucosal dissection for treatment of esophageal submucosal tumors originating from the muscularis propria layer.
        Gastrointest Endosc. 2011; 74: 1194-1200
        • Li Q.L.
        • Yao L.Q.
        • Zhou P.H.
        • et al.
        Submucosal tumors of the esophagogastric junction originating from the muscularis propria layer: a large study of endoscopic submucosal dissection (with video).
        Gastrointest Endosc. 2012; 75: 1153-1158
        • Yoshida N.
        • Yagi N.
        • Inada Y.
        • et al.
        Prevention and management of complications of and training for colorectal endoscopic submucosal dissection.
        Gastroenterol Res Pract. 2013; 2013: 287173
        • Tanaka S.
        • Terasaki M.
        • Kanao H.
        • et al.
        Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors.
        Dig Endosc. 2012; 24: 73-79
        • Tanaka S.
        • Tamegai Y.
        • Tsuda S.
        • et al.
        Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan.
        Dig Endosc. 2010; 22: S2-S8
        • Cha J.M.
        • Lim K.S.
        • Lee S.H.
        • et al.
        Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study.
        Endoscopy. 2013; 45: 202-207
        • Hotta K.
        • Oyama T.
        • Shinohara T.
        • et al.
        Learning curve for endoscopic submucosal dissection of large colorectal tumors.
        Dig Endosc. 2010; 22: 302-306
        • Anderloni A.
        • Jovani M.
        • Hassan C.
        • et al.
        Advances, problems, and complications of polypectomy.
        Clin Exp Gastroenterol. 2014; 7: 285-296
        • Hong M.J.
        • Kim J.H.
        • Lee S.Y.
        • et al.
        Prevalence and clinical features of coagulation syndrome after endoscopic submucosal dissection for colorectal neoplasms.
        Dig Dis Sci. 2015; 60: 211-216
        • Choo W.K.
        • Subhani J.
        Complication rates of colonic polypectomy in relation to polyp characteristics and techniques: a district hospital experience.
        J Interv Gastroenterol. 2012; 2: 8-11

      Linked Article

      • Endoscopic submucosal dissection for resection of submucosal tumors of the colon and rectum: Within reach, or the edge of tomorrow?
        Gastrointestinal EndoscopyVol. 87Issue 2
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          The terms submucosal tumor (SMT) and subepithelial tumor (SET) are often used synonymously. SET has been suggested to more distinctly describe tumors of the muscularis mucosa, submucosal layer, and muscularis propria, whereas SMT more specifically describes tumors arising from the submucosal layer. Although SETs are usually benign, a subset including gastrointestinal stromal tumors (GIST), neuroendocrine tumors (NET), and granular cell tumors (GCT) have malignant potential. Management options for smaller SETs with suspected malignant potential have typically included serial endoscopic and endosonographic surveillance or resection with EMR, whereas larger lesions are generally referred for surgical resection.
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