Colorectal Endoscopic Mucosal Resection Research Articles

OC-015 Prognostic indicators for short and long-term outcomes of colorectal endoscopic mucosal resection (EMR): a multi-centre (CERT-n) study

IntroductionEMR is an established treatment for large colorectal polyps, yet the data regarding efficacy and outcome are principally limited to single centre experience. We present a multicentre study to determine...

Usefulness of sodium hyaluronate solution in colorectal endoscopic mucosal resection

In endoscopic mucosal resection (EMR), it is essential to inject submucosal fluid to prevent complications and ensure safe and complete en bloc resection of tumors. Sodium hyaluronate (SH) solution, which is effective in forming and maintaining a mucosal lift and is innocuous to mucosal tissue, is considered a useful injection solution for endoscopic submucosal dissection, a procedure associated with a high risk of perforation. This study was undertaken to assess the usefulness of this solution in EMR. Ninety-four patients with colorectal tumors of ≤20 mm in diameter were enrolled for this study and randomized to a SH solution group (0.2% two-fold diluted MucoUp) or to a normal saline group (control). Ease of EMR was primarily assessed based on ease of submucosal injection, ease of snaring and injection time. SH solution was superior to normal saline for ease of submucosal injection (57 ± 0.7 vs 50 ± 0.7; P < 0.05), and it showed better results for ease of snaring with less variability (63 ± 0.8 vs 51 ± 1.0; P < 0.05). The mean injection time was similar between the two groups (3.0 ± 9.0 s and 3.0 ± 2.7 s, respectively). Post-procedural hemorrhage occurred in 7% patients (3/46) injected with SH solution and in 6% of patients (3/48) in the control group; there was no significant difference between the groups. Use of two-fold diluted MucoUp facilitated colorectal EMR.

Tu1541 Heparin Replacement Significantly Increases the Risk of Late Bleeding After Endoscopic Mucosal Resection for Colorectal Polyp

Anti-coagulants or anti-platelets (antithrombogenic) therapy is commonly used to prevent cerebro-cardiovascular events, in particular for patients with high-risk of thrombosis. Heparin replacement (HR) is often used in case of high-risk group; such as atrial fibrillation associated with valvular heart disease, mechanical valve, or previous thromboembolic events, during endoscopic interventions. However bleeding risk and benefits of HR during endoscopic intervention is unclear. The aim of this study was to evaluate the bleeding risk associated HR during colorectal endoscopic mucosal resection (EMR).

Comparing Safety and Effectiveness of Glycerol and Sodium Hyaluronate Submucosal Injection Solutions for Colorectal Endoscopic Mucosal Resection - A Pilot Study

Background: Various submucosal (sm) injection solutions have been developed for colorectal endoscopic mucosal resection (EMR) to facilitate en-bloc resections and reduce the risk of perforations and bleeding. We previously reported on the superiority of a 10% glycerol solution compared to normal saline for colorectal EMR. Recently, 0.4% sodium hyaluronate (SH) has been approved for clinical use in Japan. Higher en-bloc resection and lower perforation rates for endoscopic submucosal dissection (ESD) using SH have been reported although one disadvantage is its high cost.

Advanced Colon Polypectomy

Advanced Colon Polypectomy

Meta-analysis and systematic review of colorectal endoscopic mucosal resection

To evaluate the proportion of successful complete cure en-bloc resections of large colorectal polyps achieved by endoscopic mucosal resection (EMR). Studies using the EMR technique to resect large colorectal polyps were selected. Successful complete cure en-bloc resection was defined as one piece margin-free polyp resection. Articles were searched for in Medline, Pubmed, and the Cochrane Control Trial Registry, among other sources. An initial search identified 2620 reference articles, from which 429 relevant articles were selected and reviewed. Data was extracted from 25 studies (n = 5221) which met the inclusion criteria. All the studies used snares to perform EMR. Pooled proportion of en-bloc resections using a random effect model was 62.85% (95% CI: 51.50-73.52). The pooled proportion for complete cure en-bloc resections using a random effect model was 58.66% (95% CI: 47.14-69.71). With higher patient load (> 200 patients), this complete cure en-bloc resection rate improves from 44.19% (95% CI: 24.31-65.09) to 69.17% (95% CI: 51.11-84.61). EMR is an effective technique for the resection of large colorectal polyps and offers an alternative to surgery.

The Detection of Flat and Depressed Colorectal Lesions: Which Endoscopic Imaging Approach?

The secondary prevention of colorectal cancer (CRC) assumes that early detection and resection of precursor lesions disrupts the adenoma– carcinoma sequence and halts progression to invasive neoplastic disease. The adenoma– carcinoma sequence has until now formed the rationale for endoscopic therapies directed at reducing the incidence of CRC. The fact that snare polypectomy of exophytic lesions fails to prevent progression to carcinoma in up to 24% of cases has prompted reevaluation of the prevalence and clinicopathologic significance of flat and depressed colorectal lesions in Western population cohorts. Such lesions, although well-described in the Japanese literature, have only recently been reported in Western population cohorts. Debate has continued regarding their prevalence, anatomic localization, histopathologic characteristics, and proposed imaging modality of choice. Within this perspective, we summarize the key data pertinent to recently described endoscopic diagnostic modalities and detail their clinical applicability both for the detection of flat neoplastic lesions occurring in the “sporadic” patient cohort, familial polyposis syndromes, and chronic ulcerative colitis.

Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesions

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique for the excision of rectal lesions, with lower morbidity and mortality rates than open surgery. Following advances in laparoscopic colorectal surgery and endoscopic mucosal resection, this study evaluated the safety and efficacy of TEM in the treatment of complex rectal lesions. All patients were entered into a prospective database. Complex lesions were identified as high (more than 15 cm from anorectal margin), large (maximum dimension over 8 cm), involving two or more rectal quadrants, or recurrent. Seventy-one lesions (13 carcinomas and 58 tubulovillous adenomas) were identified. The median duration of operation was 60 (interquartile range (i.q.r.) 30-80) min, with an estimated median blood loss of 0 (i.q.r. 0-10) ml. Median hospital stay was 2 (i.q.r. 1-3) days. One patient developed postoperative urinary retention and one returned with rectal bleeding that did not require further surgery. Two patients developed rectal strictures after operation that were dilated successfully. There was no recurrence of benign lesions during a median follow-up of 21 (i.q.r. 6.5-35) months. TEM is a safe technique with low associated morbidity, even when used to excise complex rectal lesions. As such it remains the treatment of choice for rectal lesions not requiring primary radical resection.

Nonpolypoid (Flat and Depressed) Colorectal Neoplasms

Nonpolypoid (Flat and Depressed) Colorectal Neoplasms

A novel approach to endoscopic colorectal mucosal resection using a three-channel outer tube and multiple forceps: an experimental assessment.

Colorectal endoscopic mucosal resection (EMR) has limitations both anatomically and technically when it is done using the conventional snare wire method. The aim of this study was to develop a new method and instrument for colorectal EMR. A total of 21 EMR procedures were done using ten surgical specimens. Saline was injected into the normal submucosa of freshly resected colorectal specimens to prepare a pseudotumor. EMR was performed experimentally by employing a three-channel outer tube with three forceps and a colonoscope with a needle-type precutting knife. This method was assessed in terms of safety and the size of the resected specimens. Perforation occurred only twice in the initial stage of this study. The size of the specimens resected by EMR was 28-39 mm (long diameter 34.8+/-3.11), by 22-28 mm (short diameter 25.8+/-2.07). This method can achieve safety and en bloc mucosal resection to the submucosal layer. This novel approach may be promising for clinical application as a new form of endoscopic surgery.