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Endoscopic submucosal tunnel dissection vs conventional endoscopic submucosal dissection for large colorectal neoplasms: a single-centre retrospective study

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Abstract

Background

Colorectal endoscopic submucosal dissection (ESD) is still not widely used due to its technical difficulty and the risk of complications. Several techniques, such as traction techniques, pocket techniques and others, have been proposed to facilitate it. One modified pocket technique especially suitable for large lesions is endoscopic submucosal tunnel dissection (ESTD). The aim of this study was to evaluate the safety and efficacy of ESTD and compare ESTD to the conventional ESD (CESD) for treating large colorectal lesions.

Methods

The charts of consecutive patients referred to the Arcispedale Santa Maria Nuova (Reggio Emilia, Italy) for colorectal ESD between January 2014 and February 2021 for colorectal neoplasms > 40 mm were retrospectively analysed. The primary outcome of the study was the en bloc resection rate. Secondary outcomes were complete and curative resection rates, procedure speed, the adverse events rate and the recurrence rate.

Results

There were 59 patients (M:F ratio 29:30, median age 70 years [range 50–93 years]). Of 59 colorectal lesions > 40 mm, 25 were removed by ESTD and 34 by CESD. The en bloc resection rate was 100% in both groups and the complete resection rate was similar (ESTD 92% vs CESD 97.1%, p = 0.569), while the curative resection rate was higher in the CESD group, but not significantly (94.1% vs 76%, p = 0.061). Procedure speed was significantly faster with ESTD (22 vs 17 mm2/min, p = 0.045), and the overall incidence of adverse events was low (6.8%). Eight patients were referred to surgery due to non-curative resection. During follow-up, no recurrence was observed in either treatment group.

Conclusion

ESTD achieves a very high en bloc resection rate and is faster than CESD.

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References

  1. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Kudo SE, Tsuruta O, Sugihara KI, Watanabe T, Saitoh Y, Igarashi M, Toyonaga T, Ajioka Y, Ichinose M, Matsui T, Sugita A, Sugano K, Fujimoto K, Tajiri H (2015) JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digest Endosc 27(4):417–434

    Article  Google Scholar 

  2. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, Yoshida S, Ikehara H, Otake Y, Nakajima T, Matsuda T, Saito D (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72(6):1217–1225

    Article  PubMed  Google Scholar 

  3. Fujiya M, Tanaka K, Dokoshi T, Tominaga M, Ueno N, Inaba Y, Ito T, Moriichi K, Kohgo Y (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81(3):583–595

    Article  PubMed  Google Scholar 

  4. Hayashi N, Tanaka S, Nishiyama S, Terasaki M, Nakadoi K, Oka S, Yoshihara M, Chayama K (2014) Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc 79:427–435

    Article  PubMed  Google Scholar 

  5. Sato K, Ito S, Kitagawa T, Kato M, Tominaga K, Suzuki T, Maetani I (2014) Factors affecting the technical difficulty and clinical outcome of endoscopic submucosal dissection for colorectal tumors. Surg Endosc 28:2959–2965

    Article  PubMed  Google Scholar 

  6. Sakamoto N, Osada T, Shibuya T, Beppu K, Matsumoto K, Mori H, Kawabe M, Nagahara A, Otaka M, Ogihara T, Watanabe S (2009) Endoscopic submucosal dissection of large colorectal tumors by using a novel spring-action S-O clip for traction (with video). Gastrointest Endosc 69(7):1370–1374

    Article  PubMed  Google Scholar 

  7. Uraoka T, Kato J, Ishikawa S, Harada K, Kuriyama M, Takemoto K, Kawahara Y, Saito Y, Okada H (2007) Thin endoscope-assisted endoscopic submucosal dissection for large colorectal tumors (with videos). Gastrointest Endosc 66(4):836–839

    Article  PubMed  Google Scholar 

  8. Ritsuno H, Sakamoto N, Osada T, Goto SP, Murakami T, Ueyama H, Mori H, Matsumoto K, Beppu K, Shibuya T, Nagahara A, Ogihara T, Watanabe S (2014) Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg Endosc 28(11):3143–3149

    Article  PubMed  Google Scholar 

  9. Abe S, Wu SYS, Ego M, Takamaru H, Sekiguchi M, Yamada M, Nonaka S, Sakamoto T, Suzuki H, Yoshinaga S, Matsuda T, Oda I, Saito Y (2020) Efficacy of current traction techniques for endoscopic submucosal dissection. Gut Liver 14(6):673–684

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bordillon P, Pioche M, Wallenhorst T, Rivory J, Legros R, Albouys J, Lepetit H, Rostain F, Dahan M, Ponchon T, Sautereau D, Loustaud-Ratti V, Geyl S, Jacques J (2021) Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 94(2):333–343

    Article  PubMed  Google Scholar 

  11. Sakamoto H, Hayashi Y, Miura Y, Shinozaki S, Takahashi H, Fukuda H, Okada M, Ino Y, Takezawa T, Sunada K, Lefor AK, Yamamoto H (2017) Pocket-creation method facilitates endoscopic submucosal dissection of colorectal laterally spreading tumors, non-granular type. Endosc Int Open 5(2):E123–E129

    Article  PubMed  PubMed Central  Google Scholar 

  12. Takezawa T, Hayashi Y, Shinozaki S, Sagara Y, Okada M, Kobayashi Y, Sakamoto H, Miura Y, Sunada K, Lefor AK, Yamamoto H (2019) The pocket-creation method facilitates colonic endoscopic submucosal dissection (with video). Gastrointest Endosc 89(5):1045–1053

    Article  PubMed  Google Scholar 

  13. Hayashi Y, Miura Y, Yamamoto H (2015) Pocket-creation method for the safe, reliable, and efficient endoscopic submucosal dissection of colorectal lateral spreading tumors. Dig Endosc 27(4):534–535

    Article  PubMed  Google Scholar 

  14. Linghu E, Feng X, Wang X, Meng J, Du H, Wang H (2013) Endoscopic submucosal tunnel dissection for large esophageal neoplastic lesions. Endoscopy 45(1):60–62

    CAS  PubMed  Google Scholar 

  15. Huang R, Cai H, Zhao X, Lu X, Liu M, Lv W, Liu Z, Wu K, Han Y (2017) Efficacy and safety of endoscopic submucosal tunnel dissection for superficial esophageal squamous cell carcinoma: a propensity score matching analysis. Gastrointest Endosc 86(5):831–838

    Article  PubMed  Google Scholar 

  16. Yang JL, Gan T, Zhu LL, Wang YP, Yang L, Wu JC (2017) Endoscopic submucosal tunnel dissection: a feasible solution for large superficial rectal neoplastic lesions. Dis Colon Rectum 60(8):866–871

    Article  PubMed  Google Scholar 

  17. Tan L, Tan Y, Wang H, Liu D (2020) Single tunnel-assisted endoscopic submucosal dissection for a 13-cm giant colorectal laterally spreading tumor. Rev Esp Enferm Dig 112(2):150–151

    PubMed  Google Scholar 

  18. Zou J, Chai N, Linghu E, Zhai Y, Wang Z, Li L (2021) Efficacy and safety of endoscopic submucosal tunnel dissection for rectal laterally spreading tumors. Surg Endosc 35(8):4356–4362

    Article  PubMed  Google Scholar 

  19. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002 (2003). Gastrointest Endosc 58(6 Suppl):S3–S43

  20. Se K, Lambert R, Allen JI, Fujii H, Fujii T, Kashida H, Matsuda T, Mori M, Saito H, Shimoda T, Tanaka S, Watanabe H, Sung JJ, Feld AD, Inadomi JM, O’Brien MJ, Lieberman DA, Ransohoff DF, Soetikno RM, Triadafilopoulos G, Zauber A, Teixeira CR, Rey JF, Jaramillo E, Rubio CA, Van Gossum A, Jung M, Vieth M, Jass JR, Hurlstone PD (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68(4 Suppl):S3-47

    Google Scholar 

  21. Matsumoto A, Tanaka S, Oba S, Kanao H, Oka S, Yoshihara M, Chayama K (2010) Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 45(11):1329–1337

    Article  PubMed  Google Scholar 

  22. Calderwood AH, Jacobson BC (2010) Comprehensive validation of the Boston bowel preparation scale. Gastrointest Endosc 72(4):686–692

    Article  PubMed  PubMed Central  Google Scholar 

  23. Burgess NG, Hourigan LF, Zanati SA, Brown GJ, Singh R, Williams SJ, Raftopoulos SC, Ormonde D, Moss A, Byth K, Mahajan H, McLeod D, Bourke MJ (2017) Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicenter cohort. Gastroenterology 153(3):732-742.e1

    Article  PubMed  Google Scholar 

  24. Takamaru H, Goto R, Yamada M, Sakamoto T, Matsuda T, Saito Y (2020) Predicting and managing complications following colonoscopy: risk factors and management of advanced interventional endoscopy with a focus on colorectal ESD. Expert Rev Med Dev 17(9):929–936

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Gastroenterology and Digestive Endoscopy Unit, Azienda USL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy

    P. Cecinato, M. Lucarini, F. Bassi & R. Sassatelli

  2. Digestive Endoscopy Unit, Vita Salute San Raffaele University, Milan, Italy

    F. Azzolini

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  1. P. Cecinato
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  2. M. Lucarini
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  3. F. Azzolini
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  4. F. Bassi
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  5. R. Sassatelli
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Correspondence to P. Cecinato.

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Conflict of interest

Paolo Cecinato, Matteo Lucarini, Francesco Azzolini, Fabio Bassi and Romano Sassatelli have no conflicts of interest or financial ties to disclose.

Informed consent

Informed consent was initially exempted due to the retrospective nature of the study but prospectively collected when possible.

Ethical approval

The study protocol was first approved by the institutional review board of the Arcispedale Santa Maria Nuova, then by the Area Vasta Nord Ethics Committee on 14 January 2021. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Cecinato, P., Lucarini, M., Azzolini, F. et al. Endoscopic submucosal tunnel dissection vs conventional endoscopic submucosal dissection for large colorectal neoplasms: a single-centre retrospective study. Tech Coloproctol 27, 317–323 (2023). https://doi.org/10.1007/s10151-022-02732-8

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  • DOI: https://doi.org/10.1007/s10151-022-02732-8

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