All Title Author
Keywords Abstract


Clinical Practice of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms by a Colonoscopist with Limited Gastric Experience

DOI: 10.1155/2013/262171

Full-Text   Cite this paper   Add to My Lib

Abstract:

Objectives. Endoscopic submucosal dissection (ESD) for early colorectal neoplasms is regarded as a difficult technique and should commence after receiving the experiences of ESD in the stomach. The implementation of colorectal ESD in countries where early gastric cancer is uncommon might therefore be difficult. The aim is to delineate the feasibility and the learning curve of colorectal ESD performed by a colonoscopist with limited experience of gastric ESD. Methods. The first fifty cases of colorectal ESD, which were performed by a single colonoscopist between July 2010 and April 2013, were enrolled. Results. The mean of age was 64 (±9.204) years with mean size of neoplasm at 33 (±12.63)?mm. The mean of procedure time was 70.5 (±48.9)?min. The rates of en bloc resection, R0 resection, and curative resection were 86%, 86%, and 82%, respectively. Three patients had immediate perforation, but no patient developed delayed perforation or delayed bleeding. Conclusion. Our result disclosed that it is feasible for colorectal ESD to be performed by a colonoscopist with little experience of gastric ESD through satisfactory training and adequate case selection. 1. Introduction Endoscopic submucosal dissection for early colorectal neoplasm has been gradually utilized and its safety and effectiveness have been shown in Japan, other Asian countries, and in the West [1–4]. Compared with endoscopic mucosal resection (EMR), ESD could be used to resect larger lesions in a whole piece and, therefore, affords more accurate pathological examination and less local recurrence rate [5, 6]. The development of ESD technique arose from the stomach and esophagus and finally to the colorectum and received consequent approval for the medical procedure from the Japanese insurance system. Compared with ESD in the stomach and esophagus, colorectal ESD is regarded as more risky and difficult. Therefore, it is recommended that at least 30 cases of gastric ESD should be completed before colorectal ESD is attempted [7, 8]. However, early gastric cancer cases are few in countries outside of Japan. Colorectal cancer remains one of the most common malignancies in the word. In Taiwan, it has been the cancer with highest incidence for the fifth consecutive year [9]. It is quite essential to use a less invasive technique to manage large adenomatous polyps or superficially invasive carcinoma of the colorectum. If the experience of gastric ESD is mandatory for colorectal ESD learning, it would be difficult for a colonoscopist outside of Japan to master this technique. We report our result of

References

[1]  Y. Saito, T. Uraoka, Y. Yamaguchi et al., “A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video),” Gastrointestinal Endoscopy, vol. 72, no. 6, pp. 1217–1225, 2010.
[2]  Y. Saito, H. Kawano, Y. Takeuchi et al., “Current status of colorectal endoscopic submucosal dissection in Japan and other Asian countries: progressing towards technical standardization,” Digestive Endoscopy, vol. 24, supplement 1, pp. 67–72, 2012.
[3]  A. Probst, D. Golger, M. Anthuber, B. M?rkl, and H. Messmann, “Endoscopic submucosaL dissection in large sessiLe lesions of the rectosigmoid: learning curve in a European center,” Endoscopy, vol. 44, pp. 660–667, 2012.
[4]  H. Thorlacius, N. Uedo, and E. Toth, “Implementation of endoscopic submucosal dissection for early colorectal neoplasms in Sweden,” Gastroenterology Research and Practice, vol. 2013, Article ID 758202, 6 pages, 2013.
[5]  K. Hotta, T. Fujii, Y. Saito, and T. Matsuda, “Local recurrence after endoscopic resection of colorectal tumors,” International Journal of Colorectal Disease, vol. 24, no. 2, pp. 225–230, 2009.
[6]  T. Nakajima, Y. Saito, S. Tanaka, et al., “Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan,” Surgical Endoscopy, vol. 27, pp. 3262–3270, 2013.
[7]  K. Ohata, T. Ito, H. Chiba, Y. Tsuji, and N. Matsuhashi, “Effective training system in colorectal endoscopic submucosal dissection,” Digestive Endoscopy, vol. 24, supplement 1, pp. 84–89, 2012.
[8]  K. Niimi, M. Fujishiro, S. Kodashima et al., “Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms,” Endoscopy, vol. 42, no. 9, pp. 723–729, 2010.
[9]  Taiwan Cancer Registry, Source: Health Promotion Administration, Ministry of Health and Welfare, 2010.
[10]  R. J. Schlemper, R. H. Riddell, Y. Kato et al., “The vienna classification of gastrointestinal epithelial neoplasia,” Gut, vol. 47, no. 2, pp. 251–255, 2000.
[11]  T. Watanabe, M. Itabashi, Y. Shimada, et al., “Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer,” International Journal of Clinical Oncology, vol. 17, pp. 1–29, 2012.
[12]  H. Ueno, H. Mochizuki, Y. Hashiguchi et al., “Risk factors for an adverse outcome in early invasive colorectal carcinoma,” Gastroenterology, vol. 127, no. 2, pp. 385–394, 2004.
[13]  T. Uraoka, A. Parra-Blanco, and N. Yahagi, “Colorectal endoscopic submucosal dissection: is it suitable in western countries?” Journal of Gastroenterology and Hepatology, vol. 28, pp. 406–414, 2013.
[14]  R. M. Coman, T. Gotoda, and P. V. Draganov, “Training in endoscopic submucosal dissection,” World Journal of Gastrointestinal Endoscopy, vol. 5, pp. 369–378, 2013.
[15]  K. Hotta, T. Oyama, T. Shinohara et al., “Learning curve for endoscopic submucosal dissection of large colorectal tumors,” Digestive Endoscopy, vol. 22, no. 4, pp. 302–306, 2010.
[16]  T. Sakamoto, Y. Saito, S. Fukunaga, T. Nakajima, and T. Matsuda, “Learning curve associated with colorectal endoscopic submucosal dissection for endoscopists experienced in gastric endoscopic submucosal dissection,” Diseases of the Colon and Rectum, vol. 54, no. 10, pp. 1307–1312, 2011.
[17]  M. Y. Tseng, J. C. Lin, T. Y. Huang, et al., “Endoscopic submucosal dissection for early colorectal neoplasms: clinical experience in a tertiary medical center in taiwan,” Gastroenterology Research and Practice, vol. 2013, Article ID 891565, 7 pages, 2013.
[18]  E. S. Kim, K. B. Cho, K. S. Park et al., “Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors,” Endoscopy, vol. 43, no. 7, pp. 573–578, 2011.
[19]  E.-J. Lee, J. B. Lee, Y. S. Choi et al., “Clinical risk factors for perforation during endoscopic submucosal dissection (ESD) for large-sized, nonpedunculated colorectal tumors,” Surgical Endoscopy, vol. 26, pp. 1587–1594, 2012.
[20]  P.-H. Zhou, L.-Q. Yao, and X.-Y. Qin, “Endoscopic submucosal dissection for colorectal epithelial neoplasm,” Surgical Endoscopy and Other Interventional Techniques, vol. 23, no. 7, pp. 1546–1551, 2009.
[21]  N. Yoshida, N. Yagi, Y. Inada, et al., “Prevention and management of complications of and training for colorectal endoscopic submucosal dissection,” Gastroenterology Research and Practice, vol. 2013, Article ID 287173, 9 pages, 2013.
[22]  D. P. Hurlstone, R. Atkinson, D. S. Sanders, M. Thomson, S. S. Cross, and S. Brown, “Achieving R0 resection in the colorectum using endoscopic submucosal dissection,” British Journal of Surgery, vol. 94, no. 12, pp. 1536–1542, 2007.
[23]  M. Fujishiro, N. Yahagi, N. Kakushima et al., “Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases,” Clinical Gastroenterology and Hepatology, vol. 5, no. 6, pp. 678–683, 2007.
[24]  H. Isomoto, H. Nishiyama, N. Yamaguchi et al., “Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms,” Endoscopy, vol. 41, no. 8, pp. 679–683, 2009.
[25]  T. Toyonaga, M. Man-i, R. Chinzei et al., “Endoscopic treatment for early stage colorectal tumors: the comparison between EMR with small incision, simplified ESD, and ESD using the standard flush knife and the ball tipped flush knife,” Acta Chirurgica Lugoslavica, vol. 57, no. 3, pp. 41–46, 2010.
[26]  N. Yoshida, Y. Naito, M. Kugai et al., “Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors,” World Journal of Gastroenterology, vol. 16, no. 33, pp. 4180–4186, 2010.
[27]  Y. Takeuchi, T. Ohta, F. Matsui, K. Nagai, and N. Uedo, “Indication, strategy and outcomes of endoscopic submucosal dissection for colorectal neoplasm,” Digestive Endoscopy, vol. 24, supplement 1, pp. 100–104, 2012.
[28]  K. Hotta, Y. Yamaguchi, Y. Saito, T. Takao, and H. Ono, “Current opinions for endoscopic submucosal dissection for colorectal tumors from our experiences: indications, technical aspects and complications,” Digestive Endoscopy, vol. 24, supplement 1, pp. 110–116, 2012.

Full-Text

comments powered by Disqus

Contact Us

service@oalib.com

QQ:3279437679

微信:OALib Journal