Abstract
Purpose
A modified endoscopic mucosal resection (EMR) technique, Tip-in EMR, was recently introduced to enhance the complete resection of colorectal neoplasia (CRN). We aimed to evaluate the feasibility of Tip-in EMR for flat CRNs.
Methods
From January to September 2018, conventional or Tip-in EMR was consecutively performed for 112 flat CRNs ≥ 10 mm in diameter. Tip-in EMR was performed when en bloc snaring was impossible with conventional EMR or when a lesion was inadequately lifted owing to a previous forceps biopsy. We retrospectively collected the clinical, procedural, and histologic data of the conventional and Tip-in EMR groups and compared the en bloc resection rate, complete resection rate, and complications between the two groups.
Results
Among 112 flat CRNs of 80 patients, conventional EMR and Tip-in EMR were performed for 74 and 38 lesions, respectively. The median lesion size was 12 (10–27) mm. Tip-in EMR was superior to conventional EMR in terms of en bloc resection (94.7% vs. 77.0%, p = 0.018) and histologic complete resection (76.3% vs. 54.1%, p = 0.022). There was no difference in postprocedural bleeding between the two groups; however, overall adverse events, including bleeding and postpolypectomy electrocoagulation syndrome, were more frequent in the Tip-in EMR group.
Conclusions
Tip-in EMR is a feasible technique for flat colorectal lesions ≥ 10 mm and is superior to conventional EMR with respect to en bloc and complete resection rates. The safety profiles of Tip-in EMR and conventional EMR should be compared via large-scale prospective studies.
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References
Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF, Stewart ET, Waye JD (2012) Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 366(8):687–696. https://doi.org/10.1056/NEJMoa1100370
Singh S, Singh PP, Murad MH, Singh H, Samadder NJ (2014) Prevalence, risk factors, and outcomes of interval colorectal cancers: a systematic review and meta-analysis. Am J Gastroenterol 109(9):1375–1389. https://doi.org/10.1038/ajg.2014.171
Pohl H, Srivastava A, Bensen SP et al (2013) Incomplete polyp resection during colonoscopy-results of the complete adenoma resection (CARE) study. Gastroenterology 144(1):74–80.e71. https://doi.org/10.1053/j.gastro.2012.09.043
Tavakkoli A, Law RJ, Bedi AO, Prabhu A, Hiatt T, Anderson MA, Wamsteker EJ, Elmunzer BJ, Piraka CR, Scheiman JM, Elta GH, Kwon RS (2017) Specialist Endoscopists are associated with a decreased risk of incomplete polyp resection during endoscopic mucosal resection in the colon. Dig Dis Sci 62(9):2464–2471. https://doi.org/10.1007/s10620-017-4643-6
Yoshida N, Inoue K, Dohi O, Yasuda R, Hirose R, Naito Y, Murakami T, Ogiso K, Inada Y, Inagaki Y, Morinaga Y, Kishimoto M, Itoh Y (2019) Efficacy of precutting endoscopic mucosal resection with full or partial circumferential incision using a snare tip for difficult colorectal lesions. Endoscopy 51(9):871–876. https://doi.org/10.1055/a-0956-6879
Sakamoto T, Matsuda T, Nakajima T, Saito Y (2012) Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors. Clin Gastroenterol Hepatol 10(1):22–26. https://doi.org/10.1016/j.cgh.2011.10.007
Yang DH, Kwak MS, Park SH, Ye BD, Byeon JS, Myung SJ, Yang SK, Kim HG, Friedland S (2017) Endoscopic mucosal resection with circumferential mucosal incision for colorectal neoplasms: comparison with endoscopic submucosal dissection and between two endoscopists with different experiences. Clin Endosc 50(4):379–387. https://doi.org/10.5946/ce.2016.058
Jacques J, Legros R, Charissoux A et al (2017) Anchoring the snare tip by means of a small incision facilitates en bloc endoscopic mucosal resection and increases the specimen size. Endoscopy 49(S 01):E39–e41. https://doi.org/10.1055/s-0042-121009
Chien H, Imai K, Hotta K, Ito S, Yamaguchi Y, Kawata N, Tanaka M, Takizawa K, Kakushima N, Matsubayashi H, Ono H (2016) Tip-in EMR for R0 resection for a large flat colonic tumor. Gastrointest Endosc 84(4):743. https://doi.org/10.1016/j.gie.2016.05.017
Shumeiko O, Imai K, Hotta K (2020) Tip-in endoscopic mucosal resection for R0 resection of a poorly lifted colonic laterally spreading tumor with possible submucosal invasion. Dig Endosc 32(1):e15–e16. https://doi.org/10.1111/den.13543
Pioche M, Wallenhorst T, Lepetit H, Lépilliez V, Rivory J, Legros R, Rostain F, Bianchi L, Charissoux A, Hervieu V, Moreno-Garcia M, Robinson P, Saurin JC, Ponchon T, Viprey M, Roche L, Subtil F, Jacques J (2019) Endoscopic mucosal resection with anchoring of the snare tip: multicenter retrospective evaluation of effectiveness and safety. Endosc Int Open 7(11):E1496–E1502. https://doi.org/10.1055/a-0990-9068
Endoscopic Classification Review Group (2005) Update on the Paris classification of superficial neoplastic lesions in the digestive tract. Endoscopy 37(6):570–578. https://doi.org/10.1055/s-2005-861352
Barge W, Kumar D, Giusto D, Kramer J, Behara R, Jakate S, Bishehsari F, Losurdo J, Lee S, Singh S, Melson J (2018) Alternative approaches to polyp extraction in colonoscopy: a proof of principle study. Gastrointest Endosc 88(3):536–541. https://doi.org/10.1016/j.gie.2018.05.015
Lee CY, Chen MY, Lin HJ, Chien HY (2019) Safety and efficacy of tip-in endoscopic mucosal resection for large sessile colorectal polyps: a single-center experience in Taiwan. Adv Dig Med:1–5. https://doi.org/10.1002/aid2.13145
Tutticci NJ, Hewett DG (2018) Cold EMR of large sessile serrated polyps at colonoscopy (with video). Gastrointest Endosc 87(3):837–842. https://doi.org/10.1016/j.gie.2017.11.002
Agarwal A, Garimall S, Scott FI, Ahmad NA, Kochman ML, Ginsberg GG, Chandrasekhara V (2018) En bloc endoscopic mucosal resection is equally effective for sessile serrated polyps and conventional adenomas. Surg Endosc 32(4):1871–1878. https://doi.org/10.1007/s00464-017-5876-3
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Soo Min Noh: planning and conducting the study, collecting and analyzing data, drafting the manuscript, and approving the final draft.
Jin Yong Kim, Jae Cheol Park, Eun Hye Oh, Jeongseok Kim, Nam Seok Ham, Sung Wook Hwang: conducting the study, collecting data, interpreting the results, and approving the final draft.
Sang Hyoung Park, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang: conducting the study, interpreting the results, and approving the final draft.
Dong-Hoon Yang: planning and conducting the study, collecting and analyzing data, interpreting analyzed results, drafting the manuscript, and approving the final draft.
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The study protocol was approved by the institutional review board of Asan Medical Center.
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Noh, S.M., Kim, J.Y., Park, J.C. et al. Tip-in versus conventional endoscopic mucosal resection for flat colorectal neoplasia 10 mm or larger in size. Int J Colorectal Dis 35, 1283–1290 (2020). https://doi.org/10.1007/s00384-020-03604-z
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DOI: https://doi.org/10.1007/s00384-020-03604-z