#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Endoscopic submucosal dissection in the rectum – our experience


Authors: D. Polák 1;  K. Beráková 2;  J. Váňa 3;  A. Kalavská 4
Authors place of work: Gastroenterologické centrum, FNsP Žilina 1;  Martinské bioptické centrum, s. r. o., Žilina 2;  Chirurgické oddelenie, FNsP Žilina 3;  VŠZaSP sv. Alžbety a I. interná klinika SZU, Bratislava 4
Published in the journal: Gastroent Hepatol 2023; 77(3): 208-214
Category:
doi: https://doi.org/10.48095/ccgh2023208

Summary

Introduction: Endoscopic submucosal dissection (ESD) is an endoscopic treatment method for the removal of neoplastic lesions of the digestive tract. Thanks to this technique, we can achieve complete (en bloc) R0 endoscopic resection of even large lesions in one piece. We thereby obtain a valuable resection for further histopathological evaluation and, with a suitably chosen lesion, achieve a curative resection. Methods: Retrospective analysis of our file in the period 1/2020–01/2023. The primary objective was to determine how endoscopic evaluation and selection of included rectal lesions treated with the ESD technique correlates with histopathological results. The secondary objective was to determine the curability of the treatment we performed in our group of patients. We included lesions over 20 mm with the assumption of maximum invasion into the surface parts of the submucosa, i.e., JNET 2B. In addition, we included recurrent lesions in the scar after previous endoscopic or surgical treatment, submucosal lesions up to 20 mm and lesions smaller than 20 mm, especially in the lower rectum, which cannot be radically removed en bloc by loop-based techniques. Results: We included a total of 76 rectal lesions. JNET 2B lesions were 59 of them (77.6%). The most common histopathological diagnosis was high-grade dysplasia (HGD) in 35 (46%) cases. We achieved curative endoscopic resection in the majority (93.4%) of patients. Five patients (5.26%) required subsequent surgical or oncological therapy after ESD and further staging. Conclusion: The results of our work confirm the effectiveness of ESD as a therapeutic method suitable for achieving en bloc R0 resection of rectal lesions and thus their correct histopathological evaluation. However, the correct selection of patients remains crucial.

Keywords:

endoscopic submucosa dissection – rectal lesions – curative resection


Zdroje

1. Fukuzawa M, Gotoda T. History of endoscopic submucosal dissection and role for colorectal endoscopic submucosal dissection: A Japanese perspective. Gastrointestinal Intervention 2012; 1 (1): 30–35. doi: 10.1016/j.gii.2012.09.001.

2. Kakushima N, Yahagi N, Fujishiro M et al. Efficacy and safety of endoscopic submucosal dissection for tumors of the esophagogastric junction. Endoscopy 2006; 38 (2): 170–174. doi: 10.1055/s-2005-921039.

3. Ma MX, Bourke MJ. Endoscopic submucosal dissection in the West: Current status and future directions. Dig Endosc 2018; 30 (3): 310–320. doi: 10.1111/den.12960.

4. Symer M, Connolly J, Yeo H. Management of the malignant colorectal polyp. Curr Probl Surg 2022; 59 (5): 101124. doi: 10.1016/j.cpsurg.2022.101 124.

5. Urban O, Falt P, Fojtík P et al. Comparison of endoscopic mucosal resection and endoscopic submucosal dissection in the treatment of flat neoplastic lesions in the rectum. Gastroent Hepatol 2018; 72 (3): 193–198. doi: 10.14735/amgh 2018193.

6. Dyba T, Randi G, Bray F et al. The European cancer burden in 2020: Incidence and mortality estimates for 40 countries and 25 major cancers. Eur J Cancer 2021; 157: 308–347. doi: 10.1016/j.ejca.2021.07.039.

7. Tanaka S, Kashida H, Saito Y et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27 (4): 417–434. doi: 10.1111/den.12456.

8. Shichijo S, Takeuchi Y, Uedo N et al. Management of local recurrence after endoscopic resection of neoplastic colonic polyps. World J Gastrointest Endosc 2018; 10 (12): 378–382. doi: 10.4253/wjge.v10.i12.378.

9. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47 (9): 829–854. doi: 10.1055/s-0034-1392882.

10. Belderbos TD, Leenders M, Moons LM et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46 (5): 388–402. doi: 10.1055/s-0034- 1364970.

11. Urban O, Kijonkova B, Kajzrlikova IM et al. Local residual neoplasia after endoscopic treatment of laterally spreading tumors during 15 months of follow-up. Eur J Gastroenterol Hepatol 2013; 25 (6): 733–738. doi: 10.1097/MEG. 0b013e32835eda96.

12. Osuská D, Pekárek B, Orságh A et al. MRI prior to precise endoscopic evaluation of rectal lesions may lead to unnecessary radical treatment. Endoscopy 2022; 54 (1): S58. doi: 10.1055/s-0042-1744682.

13. Osuská D, Pekárek B, Kolníková G et al. Overstaging T štádia včasných neoplastických lézií konečníka magnetickou rezonanciou. Gastroenterol prax 2022; 21 (1): 50–52.

14. Kotzev AI, Yang D, Draganov PV. How to master endoscopic submucosal dissection in the USA. Dig Endosc 2019; 31 (1): 94–100. doi: 10.1111/den.13240.

15. Yang D, Aihara H, Perbtani YB et al. Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience. Endosc Int Open 2019; 7 (12): E1714–E1722. doi: 10.1055/a-1010- 5663.

16. Kim ER, Chang DK. Management of Complications of Colorectal Submucosal Dissection. Clin Endosc 2019; 52 (2): 114–119. doi: 10.5946/ ce.2019.063.

17. Wei R, Crook C, Bamford R. Abdominoperineal Resection. 2022 [online]. StatPearls Publishing 2022. Available from: https: //www. ncbi.nlm.nih.gov/books/NBK574568/?report= classic.

18. Babiš B, Johanes R, Váňa J et al. Laparoskopická resekcia karcinómu hrubého čreva a rekta, vyhodnotenie výsledkov na Chirurgickom oddelení FNsP v Žiline – 1. časť. Slovenská chirurgia 2012; 9 (1): 17–20.

19. Babiš B, Johanes R, Váňa J et al. Laparoskopická resekcia karcinómu hrubého čreva a rekta, vyhodnotenie výsledkov na Chirurgickom oddelení FNsP v Žiline – 2. časť. Slovenská chirurgia 2013; 10 (3): 109–110.

20. Pimentel-Nunes P, Pioche M, Albéniz E et al. Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2019; 51 (10): 980–992. doi: 10.1055/a-0996-0912.

Štítky
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Článok vyšiel v časopise

Gastroenterology and Hepatology

Číslo 3

2023 Číslo 3
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#