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Feasibility of endoscopic resection and impact of endoscopic ultrasound-based surveillance on colorectal subepithelial tumors

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Abstract

Background

Owing to the rising number of screening endoscopies and instrumental advances in endoscopic ultrasound (EUS), colorectal subepithelial tumors (SETs) are being increasingly detected. We aimed to determine the feasibility of endoscopic resection (ER) and the impact of EUS-based surveillance on colorectal SETs.

Methods

The medical records of 984 patients with incidentally detected colorectal SETs between 2010 and 2019 were retrospectively reviewed. Overall, 577 colorectal SETs underwent ER, and 71 colorectal SETs underwent serial colonoscopy for > 12 months.

Results

The mean tumor size (± standard deviation) of 577 colorectal SETs for which ER was performed was 7.0 ± 5.7 (median, 55; range, 1–50) mm; 475 tumors were located in the rectum and 102, in the colon. En bloc resection was achieved in 560/577 treated lesions (97.1%), and complete resection was achieved in 516/577 (89.4%). ER-related adverse events occurred in 15/577 (2.6%) patients. SETs originating from the muscularis propria showed a higher risk of ER-related adverse events and perforation than SETs arising from the mucosal or submucosal layer (odds ratio [OR] 19.786, 95% confidence interval [CI] 4.556–85.919; P = 0.002 and OR 141.250, 95% CI 11.596–1720.492; P = 0.046, respectively). Seventy-one patients were followed up after EUS without any treatment for > 12 months, during which three showed progression; eight, regression; and sixty, no changes.

Conclusions

ER for colorectal SETs showed excellent efficacy and safety. Additionally, colorectal SETs without high-risk features in surveillance with colonoscopy showed an excellent prognosis.

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Acknowledgements

We thank the Department of Biostatistics, Clinical Trial Center, Biomedical Research Institute, Pusan National University Hospital for their excellent assistance in the statistical analysis, and Editage (www.editage.co.kr) for their English language editing.

Funding

This study was supported by a Biomedical Research Institute Grant (grant number: 20220031), Pusan National University Hospital.

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Authors and Affiliations

  1. Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-Ro, Seo-Gu, Busan, 49421, South Korea

    Eun Young Park, Dong Hoon Baek, Seung Min Hong, Bong Eun Lee, Moon Won Lee, Gwang Ha Kim & Geun Am Song

  2. Department of Internal Medicine, Dong-Eui Medical Center, Busan, South Korea

    Eun Young Park

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  1. Eun Young Park
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Contributions

EYP: Study concept, design, statistical analysis, interpretation of data, and manuscript drafting. DHB: Study concept, design, statistical analysis and interpretation of data, manuscript drafting and editing, supervision, and funding. SMH, BEL, MWL, and GHK: interpretation of data and supervision. DHB and EYP: Statistical analysis and interpretation of data, manuscript drafting, and editing. DHB: data acquisition, statistical analysis, and interpretation. GAS: supervision.

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Correspondence to Dong Hoon Baek.

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Eun Young Park, Dong Hoon Baek, Seung Min Hong, Bong Eun Lee, Moon Won Lee, Gwang Ha Kim, and Geun Am Song have no conflict of interest or financial ties to disclose.

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Park, E.Y., Baek, D.H., Hong, S.M. et al. Feasibility of endoscopic resection and impact of endoscopic ultrasound-based surveillance on colorectal subepithelial tumors. Surg Endosc 37, 6867–6876 (2023). https://doi.org/10.1007/s00464-023-10195-7

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