Abstract
Background
The endoscopic lens becomes clouded and its visibility reduces during colorectal endoscopic submucosal dissection (ESD), especially in cases with submucosal fatty tissue. Dual red imaging (DRI) is a novel image-enhanced endoscopic technique that improves endoscopic visibility.
Aims
This study aimed to evaluate the predictive factors of submucosal fatty tissue and the clinical usefulness of DRI in maintaining clear visibility during colorectal ESD.
Methods
The study participants included 586 consecutive patients with 645 colorectal tumors who underwent ESD between January 2014 and July 2017. First, the degree of submucosal fatty tissue was evaluated by reviewing recorded images, and the clinical characteristics of the patients and tumors related to severe submucosal fatty tissue were evaluated. Second, 34 tumors resected using DRI were propensity score-matched in a 1:1 ratio to other resected tumors using white light imaging (WLI), and the degree of endoscope lens cloudiness and clinical outcomes were evaluated.
Results
The proportion of tumors located in the right side of the colon, body mass index (≥ 25, BMI), and hemoglobin A1c (≥ 6.5%, HbA1c) were significantly higher in patients with severe submucosal fatty tissue. The visibility in the DRI group was significantly better than in the WLI group. Treatment outcomes in the DRI group were as good as those in the WLI group.
Conclusions
Tumor location in the right side of the colon, BMI (≥ 25), and HbA1c (≥ 6.5%) are the predictive factors of severe submucosal fatty tissue. DRI is useful in maintaining clear visibility during colorectal ESD, especially with submucosal fatty tissue.
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References
Oka S, Tanaka S, Saito Y, et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol. 2015;110:697–707.
Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27:417–434.
Tanaka S, Terasaki M, Kanao H, Oka S, Chayama K. Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc. 2012;24:73–79.
Boda K, Oka S, Tanaka S, et al. Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: a large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group. Gastrointest Endosc. 2018;87:714–722.
Shigita K, Oka S, Tanaka S, et al. Long-term outcomes after endoscopic submucosal dissection for superficial colorectal tumors. Gastrointest Endosc. 2017;85:546–553.
Asayama N, Oka S, Tanaka S, et al. Long-term outcomes after treatment for T1 colorectal carcinoma. Int J Colorectal Dis. 2016;31:571–578.
Tamaru Y, Oka S, Tanaka S, et al. Endoscopic submucosal dissection for anorectal tumor with hemorrhoids close to the dentate line: a multicenter study of Hiroshima GI Endoscopy Study Group. Surg Endosc. 2016;30:4425–4431.
Tamaru Y, Oka S, Tanaka S, et al. Long-term outcomes after treatment for T1 colorectal carcinoma: a multicenter retrospective cohort study of Hiroshima GI Endoscopy Research Group. J Gastroenterol. 2017;52:1169–1179.
Nakamura F, Saito Y, Haruyama S, et al. Short-term prospective questionnaire study of early postoperative quality of life after colorectal endoscopic submucosal dissection. Dig Dis Sci. 2017;62:3325–3335. https://doi.org/10.1007/s10620-017-4787-4.
Asayama N, Oka S, Tanaka S, Hayashi N, Arihiro K, Chayama K. Endoscopic submucosal dissection as total excisional biopsy for clinical T1 colorectal carcinoma. Digestion. 2015;91:64–69.
Kim JH, Baek IH, Kim KO, et al. Usefulness and feasibility of endoscopic submucosal dissection for colorectal tumor: a nationwide multicenter retrospective study in Korea. J Gastrointest Oncol. 2016;7:924–930.
Tanaka S, Asayama N, Shigita K, et al. Towards safer and appropriate application of endoscopic submucosal dissection for T1 colorectal carcinoma as total excisional biopsy: future perspectives. Dig Endosc. 2015;27:216–222.
Takeuchi Y, Iishi H, Tanaka S, et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis. 2014;29:1275–1284.
Niikura R, Yasunaga H, Yamada A, et al. Factors predicting adverse events associated with therapeutic colonoscopy for colorectal neoplasia: a retrospective nationwide study in Japan. Gastrointest Endosc. 2016;84:971–982.
Saito Y, Yamada M, Abe S, et al. Colorectal endoscopic submucosal dissection: technical advantages compared to endoscopic mucosal resection and minimally invasive surgery. Dig Endosc. 2014;26:52–61.
Mizushima T, Kato M, Iwanaga I, et al. Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc. 2015;29:133–139.
Ohata K, Ito T, Chiba H, Tsuji Y, Matsuhashi N. Effective training system in colorectal endoscopic submucosal dissection. Dig Endosc. 2012;24:84–89.
Imai K, Hotta K, Yamaguchi Y, et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc. 2016;83:954–962.
Asayama N, Oka S, Tanaka S, et al. Clinical usefulness of a single-use splinting tube for poor endoscope operability in deep colonic endoscopic submucosal dissection. Endosc Int Open. 2016;4:E614–E617.
Kang DU, Choi Y, Lee HS, et al. Endoscopic and clinical factors affecting the prognosis of colorectal endoscopic submucosal dissection-related perforation. Gut Liver. 2016;10:420–428.
Ninomiya Y, Oka S, Tanaka S, et al. Clinical impact of dual red imaging in colorectal endoscopic submucosal dissection: a pilot study. Ther Adv Gastroenterol. 2016;9:679–683.
Tanaka H, Oka S, Tanaka S. Endoscopic hemostasis for spurting duodenal bleeding using dual red imaging. Dig Endosc. 2017;29:816–817.
Ono S, Fujishiro M, Goto O, Kodashima S, Omata M. Submerging endoscopic submucosal dissection leads to successful en bloc resection of colonic laterally spreading tumor with submucosal fat. Gut Liver. 2008;2:209–212.
Yoshida N, Naito Y, Hirose R, et al. Risk of lens cloudiness during colorectal endoscopic submucosal dissection and ability of a novel lens cleaner to maintain and restore endoscopic view. Dig Endosc. 2015;27:609–617.
Matsumoto A, Tanaka S, Oka S, et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol. 2010;45:1329–1337.
Tajiri H, Kitano S. Complication associated with endoscopic mucosal resection: definition of bleeding that can be viewed as accidental. Dig Endosc. 2004;16:134–136.
Hayashi N, Tanaka S, Nishiyama S, et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc. 2014;79:427–435.
Tanaka S, Saito Y, Matsuda T, et al. Evidence-based clinical practice guidelines for management of colorectal polyps. J Gastroenterol. 2015;50:252–260.
Naganuma M, Yahagi N, Bessho R, et al. Evaluation of the severity of ulcerative colitis using endoscopic dual red imaging targeting deep vessels. Endosc Int Open. 2017;5:E76–E82.
Furuichi Y, Gotoda T, Moriyasu F, et al. Dual red imaging (novel advanced endoscopy) can increase visibility and can predict the depth in diagnosing esophageal varices. J Gastroenterol. 2017;52:568–576.
Furuichi Y, Gotoda T, Kasai Y, et al. Role of dual red imaging to guide intravariceal sclerotherapy injection of esophageal varices. Gastrointest Endosc. 2018;87:360–369.
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The endoscope (PCF-Y0044) equipped with DRI mode was provided by Olympus Corporation. However, there are no funding or other relationships that can be considered as conflicts of interest.
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Tanaka, H., Oka, S., Tanaka, S. et al. Dual Red Imaging Maintains Clear Visibility During Colorectal Endoscopic Submucosal Dissection. Dig Dis Sci 64, 224–231 (2019). https://doi.org/10.1007/s10620-018-5306-y
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DOI: https://doi.org/10.1007/s10620-018-5306-y