Skip to main content
SpringerLink
Log in

Selection of EMR and ESD for Laterally Spreading Lesions of the Colon

Current Treatment Options in Gastroenterology volume 16, pages 376–385 (2018)Cite this article

Abstract

Introduction

Colonic laterally spreading lesions (LSL) are increasingly managed using endoscopic methods that comprise two main techniques: endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).

Purpose of Review

In this review, we aimed to review the most recent literature on selection of the best endoscopic technique in the management of colonic LSL.

Recent Findings

EMR and ESD are complimentary techniques in the management of patients with colonic LSL.

Summary

EMR is safe and effective in most patients with LSL, except for cancers with submucosal invasion in whom R0 resection is favored.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Abbreviations

EMR:

Endoscopic mucosal resection

ESD:

Endoscopic submucosal dissection

G-LSL:

Granular laterally spreading lesion

LSL:

Laterally spreading lesion

NG-LSL:

Non-granular laterally spreading lesion

SMIC:

Submucosa-invasive cancer

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Bourke MJ, Neuhaus H, Bergman JJ. Endoscopic submucosal dissection: indications and application in Western endoscopy practice. Gastroenterology. 2018;154:1887–900.

    Article  Google Scholar 

  2. Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Paspatis G, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy. 2017;49:270–97.

    Article  Google Scholar 

  3. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27:417–34.

    Article  Google Scholar 

  4. Rex DK, Hassan C, Bourke MJ. The colonoscopist’s guide to the vocabulary of colorectal neoplasia: histology, morphology, and management. Gastrointest Endosc. 2017;86:253–63.

    Article  Google Scholar 

  5. Moss A, Bourke MJ, Williams SJ, Hourigan LF, Brown G, Tam W, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology. 2011;140:1909–18.

    Article  Google Scholar 

  6. Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006;55:1592–7.

    Article  CAS  Google Scholar 

  7. • Burgess NG, Hourigan LF, Zanati SA, et al. Risk stratification for covert invasive cancer among patients referred for colonic endoscopic mucosal resection: a large multicenter cohort. Gastroenterology. 2017;153:732–742.e1. This study examines endoscopic features of colonic LSL associated with malignant lesions.

    Article  Google Scholar 

  8. Klein A, Bourke MJ. Advanced polypectomy and resection techniques. Gastrointest Endosc Clin N Am. 2015;25:303–33.

    Article  Google Scholar 

  9. Hassan C, Repici A, Sharma P, Correale L, Zullo A, Bretthauer M, et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut. 2016;65:806–20.

    Article  CAS  Google Scholar 

  10. Tate DJ, Bahin FF, Desomer L, Sidhu M, Gupta V, Bourke MJ. Cold-forceps avulsion with adjuvant snare-tip soft coagulation (CAST) is an effective and safe strategy for the management of non-lifting large laterally spreading colonic lesions. Endoscopy. 2018;50:52–62.

    Article  Google Scholar 

  11. Sidhu M, Tate DJ, Desomer L, Brown G, Hourigan LF, Lee EYT, et al. The size, morphology, site, and access score predicts critical outcomes of endoscopic mucosal resection in the colon. Endoscopy. 2018;50:684–92.

    Article  Google Scholar 

  12. Tate DJ, Desomer L, Klein A, et al. Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool. Gastrointest Endosc. 2017;85:647–656.e6.

    Article  Google Scholar 

  13. Klein A, Jayasekeran V, Hourigan LF, Tate DJ, Singh R, Brown GJ, et al. 812b a multi-center randomized control trial of thermal ablation of the margin of the post endoscopic mucosal resection (EMR) mucosal defect in the prevention of adenoma recurrence following EMR: preliminary results from the SCAR; study. Gastroenterology. 2016;150:S1266–7.

    Article  Google Scholar 

  14. Moss A, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut. 2015;64:57–65.

    Article  Google Scholar 

  15. Desomer L, Tutticci N, Tate DJ, Williams SJ, McLeod D, Bourke MJ. A standardized imaging protocol is accurate in detecting recurrence after EMR. Gastrointest Endosc. 2017;85:518–26.

    Article  Google Scholar 

  16. Fahrtash-Bahin F, Holt BA, Jayasekeran V, et al. Snare tip soft coagulation achieves effective and safe endoscopic hemostasis during wide-field endoscopic resection of large colonic lesions (with videos). Gastrointest Endosc. 2013;78:158–163.e1.

    Article  Google Scholar 

  17. Bahin FF, Rasouli KN, Byth K, Hourigan LF, Singh R, Brown GJ, et al. Prediction of clinically significant bleeding following wide-field endoscopic resection of large sessile and laterally spreading colorectal lesions: a clinical risk score. Am J Gastroenterol. 2016;111:1115–22.

    Article  Google Scholar 

  18. Albeniz E, Fraile M, Ibanez B, et al. A scoring system to determine risk of delayed bleeding after endoscopic mucosal resection of large colorectal lesions. Clin Gastroenterol Hepatol. 2016;14:1140–7.

    Article  Google Scholar 

  19. Bahin FF, Rasouli KN, Williams SJ, Lee EY, Bourke MJ. Prophylactic clipping for the prevention of bleeding following wide-field endoscopic mucosal resection of laterally spreading colorectal lesions: an economic modeling study. Endoscopy. 2016;48:754–61.

    Article  Google Scholar 

  20. Burgess NG, Bassan MS, McLeod D, Williams SJ, Byth K, Bourke MJ. Deep mural injury and perforation after colonic endoscopic mucosal resection: a new classification and analysis of risk factors. Gut. 2017;66:1779–89.

    Article  Google Scholar 

  21. Swan MP, Bourke MJ, Moss A, Williams SJ, Hopper A, Metz A. The target sign: an endoscopic marker for the resection of the muscularis propria and potential perforation during colonic endoscopic mucosal resection. Gastrointest Endosc. 2011;73:79–85.

    Article  Google Scholar 

  22. Fuccio L, Hassan C, Ponchon T, et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc. 2017;86:74–86.e17.

    Article  Google Scholar 

  23. Takamaru H, Saito Y, Yamada M, et al. Clinical impact of endoscopic clip closure of perforations during endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc. 2016;84:494–502.e1.

    Article  Google Scholar 

  24. • Fujiya M, Tanaka K, Dokoshi T, et al. 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. 2015;81:583–95. This meta-analysis summarized the efficacy and safety of EMR compared to ESD in the managmeent of colonic LSL.

    Article  Google Scholar 

  25. Bahin FF, Heitman SJ, Rasouli KN, Mahajan H, McLeod D, Lee EYT, et al. Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis. Gut. 2017. https://doi.org/10.1136/gutjnl-2017-313823. This study examines the cost-effectiveness of EMR and ESD in the management of colonic LSL.

    Article  Google Scholar 

  26. Schmidt A, Bauerfeind P, Gubler C, Damm M, Bauder M, Caca K. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy. 2015;47:719–25.

    Article  Google Scholar 

  27. Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag HJ, Messmann H, et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut. 2018;67:1280–9.

    Article  Google Scholar 

  28. Awadie H, Repici A, Bourke MJ. Endoscopic management of large nonpedunculated colorectal polyps: selective treatment algorithms are needed. Endoscopy. 2017;49:214–6.

    Article  Google Scholar 

  29. Heitman SJ, Bourke MJ. Endoscopic submucosal dissection and EMR for large colorectal polyps: “the perfect is the enemy of good”. Gastrointest Endosc. 2017;86:87–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Interventional Endoscopy, Florida Hospital, Orlando, FL, USA

    Ji Young Bang MD MPH

  2. Department of Gastroenterology and Hepatology, Westmead Hospital and Western Clinical School, University of Sydney, Sydney, New South Wales, Australia

    Michael J. Bourke MBBS FRACP

Authors
  1. Ji Young Bang MD MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael J. Bourke MBBS FRACP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael J. Bourke MBBS FRACP.

Ethics declarations

Conflict of Interest

Ji Young Bang declares that she has no conflict of interest. Michael Bourke declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Endoscopy

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bang, J.Y., Bourke, M.J. Selection of EMR and ESD for Laterally Spreading Lesions of the Colon. Curr Treat Options Gastro 16, 376–385 (2018). https://doi.org/10.1007/s11938-018-0198-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11938-018-0198-7

Keywords

search

Navigation