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Standard Endoscopic Mucosal Resection vs Precutting Endoscopic Mucosal Resection Using Novel Disk-Tip Snare for Colorectal Lesions

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An Invited Commentary to this article was published on 07 March 2023

Abstract

Introduction

SOUTEN (KANEKA Co., Tokyo, Japan) is a unique snare with a disk tip. We analyzed the efficacy of precutting endoscopic mucosal resection with SOUTEN (PEMR-S) for colorectal lesions.

Methods

We retrospectively reviewed 57 lesions of 10–30 mm treated with PEMR-S at our institution from 2017 to 2022. The indications were lesions that were difficult for standard EMR due to size, morphology, and poor elevation by injection. Various therapeutic results of PEMR-S such as en bloc resection, procedure time, and perioperative hemorrhage were analyzed, and the results of 20 lesions of 20–30 mm with PEMR-S were compared to those of lesions with standard EMR (2012–2014) using propensity score matching. Additionally, the stability of the SOUTEN disk tip was analyzed in a laboratory experiment.

Results

The polyp size was 16.5 ± 4.2 mm and the non-polypoid morphology rate was 80.7%. Histopathological diagnosis included 10 sessile-serrated lesions, 43 low-grade and high-grade dysplasias, and 4 T1 cancers. After matching, the en bloc resection and histopathological complete resection rates of lesions of 20–30 mm between PEMR-S and standard EMR (90.0% vs. 58.1%, p = 0.03 and 70.0% vs. 45.0%, p = 0.11). The procedure time (min) was 14.8 ± 9.7 and 9.7 ± 8.3 (p < 0.01). The en bloc resection (%) and procedure time of expert/non-expert were 89.7/85.7 (p = 0.96) and 6.1 ± 2.2/18.5 ± 7.2 (p < 0.01). The perioperative bleeding and hemostasis success rates with SOUTEN were 43.9% and 96.0%. In the experiment, the SOUTEN disk tip was fixed stably compared to other EMR snares.

Conclusions

PEMR-S achieved high en bloc resection of colorectal lesions of 20–30 mm though it leaded to long procedure time.

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Acknowledgments

We thank all the members of the Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine for their help in this study. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hhirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Naohisa Yoshida, Ken Inoue, Hikaru Hashimoto, Reo Kobayashi, Yuri Tomita, Satoshi Sugino, Ryohei Hirose, Osamu Dohi & Yoshito Itoh

  2. Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Yukiko Morinaga

  3. Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan

    Yutaka Inada

  4. Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan

    Takaaki Murakami

Authors
  1. Naohisa Yoshida
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  2. Ken Inoue
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  3. Hikaru Hashimoto
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Contributions

NY designed the study, performed data collection and analysis, and prepared and reviewed the manuscript; KI, HH, RK, YT, SS, RH, OD, TM, and YI helped in the treatment of cases; YM performed histological assessments; and YI arranged the study plan and reviewed the manuscript.

Corresponding author

Correspondence to Naohisa Yoshida.

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Conflict of interest

N. Yoshida and O. Dohi received research grants from Fujifilm. N. Yoshida received technical supports of KANEKA Co. regarding the analysis of the desk experiment in this study. K. Inoue, H. Hashimoto, R. Kobayashi, Y. Tomita, S. Sugino, R. Hirose, Y. Morinaga, Y. Inada, T. Murakami, and Y. Itoh declare no conflicts of interest.

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An editorial commenting on this article is available at https://doi.org/10.1007/s10620-023-07851-2.

Supplementary Information

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Supplemental Video 1. Precutting endoscopic mucosal resection with SOUTEN. A non-polypoid lesion of 20 mm was found in the descending colon. A full circumferential incision was made after injection with SOUTEN, and en bloc resection was achieved. The procedure time was 5 min, and histopathology revealed high-grade dysplasia with a negative margin (MP4 68470 KB)

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Yoshida, N., Inoue, K., Hashimoto, H. et al. Standard Endoscopic Mucosal Resection vs Precutting Endoscopic Mucosal Resection Using Novel Disk-Tip Snare for Colorectal Lesions. Dig Dis Sci 68, 2030–2039 (2023). https://doi.org/10.1007/s10620-023-07833-4

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