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Stenosis rates after endoscopic submucosal dissection of large rectal tumors involving greater than three quarters of the luminal circumference

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Abstract

Background

Endoscopic submucosal dissection (ESD) is a minimally invasive treatment option for large rectal tumors. There are limited data available on stenosis rates following ESD of large rectal lesions. We aimed to evaluate the stenosis rate following ESD of large rectal tumors with rectal mucosal defects greater than three quarters of the circumference.

Methods

We retrospectively identified patients who underwent rectal ESD between January 1998 and July 2014. Patients with rectal mucosal defects greater than three quarters the luminal circumference were included for analysis. Clinicopathologic characteristics, treatment outcomes and adverse events were assessed. Stenosis was defined as an inability to pass a pediatric colonoscope into the sigmoid colon. None of the patients underwent prophylactic balloon dilation.

Results

A total of 363 patients with 370 rectal lesions were treated by ESD. Among these, 26 patients had 26 lesions with rectal mucosal defects greater than three quarters of the luminal circumference. Median tumor size (range) was 80 (47–150) mm. Four lesions (15 %) required between 90 and <100 % circumferential dissection, while complete circumferential ESD was performed in two lesions (8 %). Dissection extended to the anal canal in six patients. The median procedure time was 220 min. En bloc resection and curative resection were achieved in 88.5 and 65.4 %, respectively. Delayed bleeding rates and perforation rates were 7.7 and 0 %, respectively. During a median follow-up period of 9.8 (0–59) months, there were no patients with complaints of constipation or fecal incontinence. One patient (4.2 %) was noted to have rectal stenosis, but was clinically asymptomatic. Endoscopic balloon dilation was not required in any patients.

Conclusions

Stenosis may rarely occur after ESD of large rectal lesions with rectal mucosal defects greater than three quarters of the circumference, even without prophylactic endoscopic balloon dilation.

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References

  1. Ono H, Kondo H, Gotoda T et al (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Fujishiro M, Yahagi N, Kakushima N et al (2006) Endoscopic submucosal dissection of esophageal squamous cell neoplasms. Clin Gastroenterol Hepatol 4:688–694

    Article  PubMed  Google Scholar 

  3. Saito Y, Uraoka T, Yamaguchi Y et al (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225

    Article  PubMed  Google Scholar 

  4. Nakajima T, Saito Y, Tanaka S et al (2013) Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 27:3262–3270

    Article  PubMed  Google Scholar 

  5. Kobayashi N, Yoshitake N, Hirahara Y et al (2012) Matched case control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors. J Gastroenterol Hepatol 27:728–733

    Article  PubMed  Google Scholar 

  6. Tajika M, Niwa Y, Bhatia V et al (2011) Comparison of endoscopic submucosal dissection and endoscopic mucosal resection for large colorectal tumors. Eur J Gastroenterol Hepatol 23:1042–1049

    PubMed  Google Scholar 

  7. Saito Y, Fukuzawa M, Matsuda T et al (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352

    Article  PubMed  Google Scholar 

  8. Antillon MR, Bartalos CR, Miller ML, Diaz-Arias AA, Ibdah JA, Marshall JB (2008) En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 67:332–337

    Article  PubMed  Google Scholar 

  9. Imai K, Hotta K, Yamaguchi Y et al (2015) Safety and efficacy of endoscopic submucosal dissection of rectal tumors extending to the dentate line. Endoscopy 47:529–532

    Article  PubMed  Google Scholar 

  10. Katada C, Muto M, Manabe T et al (2003) Esophageal stenosis after endoscopic mucosal resection of superficial esophageal lesions. Gastrointest Endosc 57:165–169

    Article  PubMed  Google Scholar 

  11. Ono S, Fujishiro M, Niimi K et al (2009) Predictors of postoperative stricture after esophageal endoscopic submucosal dissection for superficial esophageal squamous cell cneoplasms. Endoscopy 41:661–665

    Article  CAS  PubMed  Google Scholar 

  12. Coda S, Oda I, Gotoda T et al (2009) Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy 41:421–426

    Article  CAS  PubMed  Google Scholar 

  13. Aoki T, Nakajima T, Saito Y (2012) Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection. World J Gastroenterol 28:3721–3726

    Article  Google Scholar 

  14. Sano Y, Horimatsu T, Fu KI et al (2006) Magnifying observation of microvascular architecture of colorectal lesions using a narrow band imaging system. Digest Endosc 18:S44–S51

    Article  Google Scholar 

  15. Ikematsu H, Matsuda T, Emura F et al (2010) Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol 10:33

    Article  PubMed  PubMed Central  Google Scholar 

  16. Matsuda T, Fujii T, Saito Y et al (2008) Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 103:2700–2706

    Article  PubMed  Google Scholar 

  17. Tanaka S, Kashida H, Saito Y et al (2015) JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 27:417–434

    Article  PubMed  Google Scholar 

  18. Kishida Y, Kakushima N, Kawata N, Tanaka M, Takizawa K, Imai K, Hotta K, Matsubayashi H, Ono H (2015) Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer. Surg Endosc 29:2953–2959

    Article  PubMed  Google Scholar 

  19. Ohara Y, Toyonaga T, Tanaka S et al (2016) Risk of stricture after endoscopic submucosal dissection for large rectal neoplasms. Endoscopy 48:62–70

    PubMed  Google Scholar 

  20. Mori H, Rafiq K, Kobara H et al (2012) Local steroid injection into the artificial ulcer created by endoscopic submucosal dissection for gastric cancer: prevention of gastric deformity. Endoscopy 44:641–648

    Article  CAS  PubMed  Google Scholar 

  21. Hashimoto S, Kobayashi M, Takeuchi M et al (2011) The efficacy of endoscopic triamcinolone injection for the prevention of esophageal stricture after endoscopic submucosal dissection. Gastrointest Endosc 74:1389–1393

    Article  PubMed  Google Scholar 

  22. Yamaguchi N, Isomoto H, Nakayama T et al (2011) Usefulness of oral prednisolone in the treatment of esophageal stricture after endoscopic submucosal dissection for superficial esophageal squamous cell carcinoma. Gastrointest Endosc 73:1115–1121

    Article  PubMed  Google Scholar 

  23. Oka S, Tanaka S, Saito Y et al (2015) Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 110:697–707

    Article  PubMed  Google Scholar 

  24. Nakamura F, Saito Y, Sakamoto T et al (2015) Potential perioperative advantage of colorectal endoscopic submucosal dissection versus laparoscopy-assisted colectomy. Surg Endosc 29:596–606

    Article  PubMed  Google Scholar 

  25. Kiriyama S, Saito Y, Yamamoto S et al (2012) Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis. Endoscopy 44:1024–1030

    Article  CAS  PubMed  Google Scholar 

  26. Arezzo A, Arolfo S, Allaix ME et al (2016) Transanal endoscopic microsurgery for giant circumferential rectal adenomas. Colorectal Dis. (Epub ahead of print)

  27. Morino M, Allaix ME, Caldart M et al (2011) Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm. Surg Endosc 25:3683–3690

    Article  PubMed  Google Scholar 

  28. Sakamoto T, Saito Y, Fukunaga S, Nakajima T, Matsuda T (2011) Learning curve associated with colorectal endoscopic submucosal dissection for endoscopists experienced in gastric endoscopic submucosal dissection. Dis Colon Rectum 54:1307–1312

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by The National Cancer Center Research and Development Fund (25-A-12). The authors are grateful to A. Aziz Aadam, MD. (Northwestern University Feinberg School of Medicine, Division of Gastroenterology and Hepatology, USA) for his assistance in editing this manuscript.

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Authors and Affiliations

  1. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Seiichiro Abe, Taku Sakamoto, Hiroyuki Takamaru, Masayoshi Yamada, Takeshi Nakajima, Takahisa Matsuda & Yutaka Saito

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  1. Seiichiro Abe
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  2. Taku Sakamoto
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  3. Hiroyuki Takamaru
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  4. Masayoshi Yamada
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  5. Takeshi Nakajima
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  6. Takahisa Matsuda
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  7. Yutaka Saito
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Correspondence to Seiichiro Abe.

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Disclosures

Drs. Seiichiro Abe, Taku Sakamoto, Hiroyuki Takamaru, Masayoshi Yamada, Takeshi Nakajima, Takahisa Matsuda and Yutaka Saito have no conflicts of interest or financial ties to disclose.

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Abe, S., Sakamoto, T., Takamaru, H. et al. Stenosis rates after endoscopic submucosal dissection of large rectal tumors involving greater than three quarters of the luminal circumference. Surg Endosc 30, 5459–5464 (2016). https://doi.org/10.1007/s00464-016-4906-x

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  • DOI: https://doi.org/10.1007/s00464-016-4906-x

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