Piecemeal Endoscopic Mucosal Resection Research Articles

Optimal Endoscopic Treatment and Surveillance of Serrated Polyps.

Serrated polyps are considered precursor lesions that account for 15% to 30% of colorectal cancers, and they are overrepresented as a cause of interval cancers. They are difficult to detect and resect comprehensively; however, recent data suggest that high definition endoscopy, chromoendoscopy (via spray catheter, pump or orally), narrow band imaging, split-dose bowel preparation and a slower withdrawal (>6 minutes) can all improve detection. Cold snare resection is effective and safe for these lesions, including cold snare piecemeal endoscopic mucosal resection, which is likely to become the standard of care for lesions >10 mm in size. Sessile serrated lesions ≥10 mm in size, those exhbiting dysplasia, or traditional serrated adenomas increase the chance of future advanced neoplasia. Thus, a consensus is emerging: a surveillance examination at 3 years should be recommended if these lesions are detected. Serrated lesions likely carry equivalent risk to adenomas, so future guidelines may consider serrated class lesions and adenomas together for risk stratification. Patients with serrated polyposis syndrome should undergo surveillance every 1 to 2 years once the colon is cleared of larger lesions, and their first degree relatives should undergo screening every 5 years starting at age 40.

Tu1998 A NOVEL TECHNIQUE FOR ENDOSCOPIC ENBLOC RESECTION FOR LESIONS UP TO 30 MM (EMR+)

Endoscopic mucosal resection (EMR) is the most common technique for endoscopic resection (ER) of intestinal mucosal neoplasia. However, successful enbloc resection depends on tumor size and decreases lower 40 % for lesions > 20 mm. In consequence, piecemeal EMR usually is performed for lesions > 20 mm but associated with higher rates of recurrency after incomplete resection. Endoscopic submucosal dissection (ESD) allows enbloc resection for lesions > 20 mm but the technique is difficult, time-consuming and associated with higher risk for complications. Submucosal injection is well investigated and essential for both resection techniques. Standard agent used for injection is saline solution, but the created submucosal cushion disappears quickly as saline is absorbed by the adjacent mucosa. Frequent re-injections and prolonged procedure times are the consequences.

Mo1677 RECURRENCE AFTER ADVANCED COLORECTAL ENDOSCOPIC RESECTION RESULTS IN A SUBSTANTIAL COST BURDEN

Little is known about the cost of treating recurrence after colorectal endoscopic resection (ER). Endoscopic mucosal resection (EMR) and piecemeal EMR have proven efficacy and safety and are the procedures of choice for the majority of western endoscopists. However, recurrence is not infrequent. Endoscopic submucosal dissection (ESD) produces much lower recurrence rates but is technically challenging and difficult to learn. However, few if any studies examine the cost associate with ER taking into account treatment for recurrent adenomas. We evaluated the cost of ER of large colorectal tumours at a tertiary referral centre.

Mo1061 COLD SNARE PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION (CSP-EMR) OF LARGE SESSILE COLONIC POLYPS ≥20 MM IS FEASIBLE, SAFE AND EFFECTIVE

Endoscopic Mucosal Resection (EMR) is the standard of care for resection of large (≥20 mm) non-malignant sessile colonic polyps. Serious adverse events are mostly due to electrocautery. This could potentially be avoided by cold snare EMR. We hypothesized that aggressive wide field cold snare piecemeal EMR (CSP-EMR) could be as effective as conventional EMR, but with fewer adverse events. The study aimed to evaluate safety and efficacy of CSP-EMR of sessile colonic polyps sized ≥20mm.

Clinical outcomes of endoscopic resection for non-ampullary duodenal laterally spreading tumors.

Non-ampullary duodenal laterally spreading tumors (NAD-LSTs) mimic the morphological features and natural history of colorectal LSTs, even achieving a large size but lacking invasive behavior; thus, they are suited for endoscopic resection (ER). At present, the endoscopic therapeutic approach in NAD-LSTs has not been clearly established. The aim of this study was to evaluate the efficacy and safety of ER for NAD-LSTs and to evaluate the risk factors for delayed perforation after ER of NAD-LSTs. A total of 54 patients with 54 NAD-LSTs treated with ER at the Chinese PLA General Hospital between January 2007 and January 2018 were retrospectively analyzed. Data on patient demographic, clinicopathological characteristics of the lesions, outcomes of ER, and results of follow-up endoscopies were collected. The mean (SD) lesion size was 26.9mm (8.5). Endoscopic mucosal resection (EMR) was performed in 21 lesions, and endoscopic submucosal dissection (ESD) was performed in 33 lesions. R0 resection was achieved in 93.9% of the ESD group and 38.1% of the EMR group (p = 0.000). Delayed bleeding was noted in two patients. Delayed perforation was identified in four patients. The incidence of delayed perforation showed a significant association with post-ampullary tumor location (p = 0.030). Follow-up endoscopy was performed in all cases with a mean (SD) period of 22.1 months (8.2), and local recurrence was identified in four cases after piecemeal EMR. ER of NAD-LSTs is a feasible and less invasive treatment. However, ER of NAD-LSTs is associated with serious adverse events such as delayed perforation, especially in patients with lesions located distal to Vater's ampulla.

Efficiency and safety of endoscopic therapy for early esophageal cancer and precancerous lesions with length more than 5 cm

Objective To compare the effectiveness and safety of endoscopic submucosal dissection (ESD) with endoscopic piecemeal mucosal resection (EPMR) for early esophageal cancer and precancerous lesions with length more than 5 cm. Methods A retrospective analysis was performed on data of 85 patients diagnosed as early esophageal cancer and precancerous lesions with length more than 5 cm in Fujian Medical Association of Early Esophageal Carcinoma from January 2012 to July 2017. The patients were divided into ESD group (52 cases) and EPMR group (33 cases), and the effectiveness and safety between the two groups were compared. Results There was no significant difference on the complete resection rate between the two groups[86.5% (45/52) VS 87.9% (29/33), P>0.05]. The operative time (58.53±30.50 min VS 32.06±9.12 min), postoperative fasting time (4.18±1.30 d VS 3.67±0.96 d), postoperative hospital-stay time (7.45±2.44 d VS 6.54±1.73 d), and postoperative antibiotics using time (3.48±2.33 d VS 1.96±2.20 d) in ESD group were higher than those in EPMR group (all P 0.05). But the postoperative stricture rate of ESD group was higher than that of EPMR group[23.1% (12/52) VS 6.1% (2/33), P 0.05). Conclusion ESD and EPMR have equivalent efficacy and safety on the treatment of early esophageal cancer and precancerous lesion. EPMR has a shorter operative time, lower rate of post-operative stricture, and is easier to master. Key words: Esophageal neoplasms; Endoscopic piecemeal mucosal resection; Endoscopic submucosal dissection; Efficiency; Safety

Clinical Experience With a Double Balloon Interventional Endoscopic Platform to Facilitate Colonic Endoscopic Submucosal Dissection, Endoscopic Mucosal Resection and Endoscopic Suturing: First 137 Procedures: Presidential Poster Award

Introduction: Endoscopic submucosal dissection (ESD) is gaining popularity worldwide. Despite clinical advantages of ESD over piecemeal endoscopic mucosal resection (EMR), colonic ESD remains technically challenging, labor-intensive and time-consuming. New endolumenal interventional platform (Lumendi LLC, USA) consists of overtube with 2 manually inflatable balloons and compatible with most standard endoscopes. Methods: Colonoscope with preloaded device was advanced into colon. The “fore-balloon” was advanced beyond colonic lesion and then both balloons were inflated stabilizing the lesion inside “therapeutic zone” between balloons. ESD or EMR was performed. After lesion resection, colonoscope was removed and a double channel endoscope loaded with endoscopic suturing device (Apollo Endosurgery, USA) was inserted through the platform to perform endoscopic suturing closure of large mucosal defect post ESD/EMR. Results: From November 2017 till April 2018 the device was used in consecutive patients with large (mean size 35.0±19.7 mm) lesions located in cecum (38), ascending colon (58), hepatic flexure (13), transverse colon (10), descending colon (4), sigmoid (9) and rectum (2). Majority (126 lesions, 92%) were removed by ESD, and only 11 lesions (8%) were removed by EMR. En bloc resection rate in EMR group was only 18.2%. En bloc resection rate in ESD group was 87.1%. Advancement of colonoscope preloaded with the device to reach colonic lesion was successful in all cases, requiring 10.0±8.3 minutes. Stabilization of the lesions by the balloons facilitated endoscopic intervention (mean intervention time 45.0 ±40.6 minutes), enabled quick advancement and closure of the defect utilizing the suturing device (mean advancement time 2.5±2.9 minutes, mean closure time 13.3±8.7 minutes). Total procedure time was 70.6±24.9 minutes. There were no device or procedure related serious adverse events during the study. Conclusion: This new interventional platform appears safe, effective and easy to use. Stabilization of colonic lesions with deployed balloons markedly facilitated colonic ESD and EMR, simplified suturing closure of large mucosal defects post lesion removal and significantly shortened the total procedure time. Retrospective and prospective case matched studies will be performed to better quantify the time benefit. The device has the potential to expand the number of complex benign polyps that can be handled endoscopically vs. surgically.

Correction: Outcomes after endoscopic resection of large laterally spreading lesions of the papilla and conventional ampullary adenomas are equivalent

Background Endoscopic resection of ampullary adenomas is a safe and effective alternative to surgical resection. A subgroup of patients have large laterally spreading lesions of the papilla Vateri (LSL-P), which are frequently managed surgically. Data on endoscopic resection of LSL-P are limited and long-term outcomes are unknown. The aim of this study was to compare the outcomes of endoscopic resection of LSL-P with those of standard ampullary adenomas. Methods A retrospective analysis of a prospectively collected and maintained database was conducted. LSL-P was defined as extension of the lesion ≥ 10 mm from the edge of the ampullary mound. Piecemeal endoscopic mucosal resection of the laterally spreading component was followed by resection of the ampulla. Patient, lesion, and procedural data, as well as results of endoscopic follow-up, were collected. Results 125 lesions were resected. Complete endoscopic resection was achieved in 97.6 % at the index procedure (median lesion size 20 mm, interquartile range [IQR] 13 – 30 mm). Compared with ampullary adenomas, LSL-Ps were significantly larger (median 35 mm vs. 15 mm), contained a higher rate of advanced pathology (38.6 % vs. 18.5 %), and had higher rates of intraprocedural bleeding (50 % vs. 24.7 %) and delayed bleeding (25.0 % vs. 12.3 %). Both groups had similar rates of histologically proven recurrence at first surveillance (16.4 % vs. 17.9 %). Median follow-up for the entire cohort was 18.5 months. For patients with at least two surveillance endoscopies (n = 68; median follow-up 29 months, IQR 18 – 48 months), 95.6 % were clear of disease and considered cured. Conclusions LSL-P can be resected endoscopically with comparable outcomes to standard ampullectomy, albeit with a higher risk of bleeding. Endoscopic treatment should be considered as an alternative to surgical resection, even for large LSL-P.

Safe and Effective Endoscopic Resection of Massive Colorectal Adenomas ≥8 cm in a Tertiary Referral Center.

Endoscopic resection of large colorectal lesions is well reported and is the first line of treatment for all noninvasive colorectal neoplasms in many centers, but little is known about the outcomes of endoscopic resection of truly massive colorectal lesions ≥8 cm. We report on the outcomes of endoscopic resection for massive (≥8 cm) colorectal adenomas and compare the outcomes with resection of large (2.0-7.9 cm) lesions. This was a retrospective study. The study was conducted in a tertiary referral unit for interventional endoscopy. A total of 435 endoscopic resections of large colorectal polyps (≥2 cm) were included, of which 96 were ≥8 cm. Outcomes included initial successful resection, complications, recurrence, surgery, and hospital admission. Endoscopic resection was successful for 91 of 96 massive lesions (≥8 cm). Mean size was 10.1 cm (range, 8-16 cm). A total of 75% had previous attempts at resection or heavy manipulation before referral. Thirty two were resected using endoscopic submucosal dissection or hybrid endoscopic submucosal dissection and the rest using piecemeal endoscopic mucosal resection. No patients required surgery for a perforation. Five patients had postprocedural bleeding. There were 25 recurrences: 2 were treated with transanal endoscopic microsurgery, 2 with right hemicolectomy, and the rest with endoscopic resection. Compared with patients with large lesions, more patients with massive adenomas had complications (19.8% versus 3.3%), required admission (39.6% versus 11.0%), developed recurrence (30.8% versus 9.9%), or required surgery for recurrence (5.0% versus 0.8%). This was a retrospective study. Endoscopic resection of massive colorectal adenomas ≥8 cm is achievable with few significant complications, and the majority of patients avoid surgery. Systematic assessment is required to appropriately select patients for endoscopic resection, which should be performed in specialist units. See Video Abstract at http://links.lww.com/DCR/A653.

Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection.

We aimed to investigate the factors associated with piecemeal resection of colorectal neoplasia (CRN), in spite of endoscopic submucosal dissection (ESD). We analyzed the retrospective data for colorectal ESD cases from January 2005 to April 2014. We also reviewed the piecemeal endoscopic mucosal resection (EMR) for CRNs ≥20 mm, performed over the same period. En bloc resection was possible in 648 (85.7%) of 756 lesions in 740 patients. Multivariate analysis showed that hybrid ESD (odds ratio (OR), 29.07; 95% confidence interval (CI), 15.46-54.65; p<0.01) and mild or severe submucosal fibrosis (OR, 3.62; 95% CI, 1.94-6.76; p<0.01) were independently associated with piecemeal ESD. The en bloc ESD group showed higher histologic complete resection rate than the piecemeal ESD group (80.4% vs. 56.5%; p<0.01), and the piecemeal ESD group showed higher recurrence rate than in the en bloc ESD group (5.6% [4/72] vs. 0.7% [3/450]; p<0.01). Overall recurrence rate was 1.3% (7/522). Hybrid ESD and submucosal fibrosis are independently associated with piecemeal ESD. Piecemeal ESD cases recurred more frequently than en bloc ESD cases.

Management of Early-Stage Adenocarcinoma of the Esophagus: Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection.

Barrett's esophagus with high-grade dysplasia and early-stage adenocarcinoma is amenable to curative treatment by endoscopic resection. Histopathological correlation has established that mucosal cancer has minimal risk of nodal metastases and that long-term complete remission can be achieved. Although surgery is the gold-standard treatment once there is submucosal involvement, even T1sm1 (submucosal invasion ≤ 500μm) cases without additional risk factors for nodal metastases might also be cured with endoscopic resection. Endoscopic resection is foremost an initial diagnostic procedure, and once histopathological assessment confirms that curative criteria are met, it will be considered curative. Endoscopic resection may be achieved by endoscopic mucosal resection, which, although easy to perform with relatively low risk, is limited by an inability to achieve en bloc resection for lesions of size more than 1.5cm. Conversely, the technique of endoscopic submucosal dissection is more technically demanding with higher risk of complications but is able to achieve en bloc resection for lesions larger than 1.5cm. Endoscopic submucosal dissection would be particularly important in specific situations such as suspected submucosal invasion and lesion size more than 1.5cm. In other situations, since endoscopic resection would always be combined with radiofrequency ablation to ablate the remaining Barrett's epithelium, piecemeal endoscopic mucosal resection would suffice since any remnant superficial invisible dysplasia would be ablated.

Resection of large sessile serrated polyps by cold piecemeal endoscopic mucosal resection: Serrated COld Piecemeal Endoscopic mucosal resection (SCOPE).

Resection of large sessile serrated polyps by cold piecemeal endoscopic mucosal resection: Serrated COld Piecemeal Endoscopic mucosal resection (SCOPE).

Single-center implementation of endoscopic submucosal dissection (ESD) in the colorectum: Low recurrence rate after intention-to-treat ESD.

Colorectal endoscopic submucosal dissection (ESD) shows higher R0 resection and lower local recurrence rates than endoscopic mucosal resection (EMR) in Japan. In Europe, independent learning of ESD in the colorectum is feasible, but yet to be analyzed for curative resection and recurrence rates. After experimental training under supervision by Japanese experts (T.O., N.Y.), three endoscopists independently carried out 83 ESD procedures intention-to-treat for lesions in the entire colorectum of 67 patients in a prospective registry (November 2009 to June 2016). ESD was feasible in 80 (96%) colorectal neoplasias (mean diameter 33.6[±1.8]mm), and three more required conversion to piecemeal EMR. The lesions were adenomas in 66% with low-grade intraepithelial neoplasia (LGIN), 29% with high-grade intraepithelial neoplasia, and 5% with carcinomas (G2, pT1). ESD had to be facilitated by the final use of snaring (hybrid-ESD, n=45), especially in the initial learning period. En-bloc resection rate was 85%. Complications were microperforations (7%, conducive to one hemicolectomy), and delayed bleeding (1%) without mortality or long-term morbidity. Residual adenomas with LGIN (5%) after hybrid-ESD did not recur after endoscopic ablation. All malignant neoplasias (34%) were curatively resected without recurrence after a mean follow up of 19.5(±3.2) months. During independent ESD learning in the colorectum, ESD intention-to-treat showed a low recurrence rate after appropriate training, and hybrid-ESD showed acceptable complication and recurrence rates, justifying hybrid-ESD as a strategy for self-completion and rescue.

Correction: Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis

Background and study aims Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment. Methods We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95 % confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes. Results We identified 2949 studies, of which 48 were included. Overall, 8.5 % (95 %CI 6.5 % – 10.5 %) of LSTs contained SMI. The risk of SMI differed among the LST subtypes: 31.6 % in non-granular pseudodepressed LSTs (95 %CI 19.8 % – 43.4 %), 10.5 % in granular nodular mixed LSTs (95 %CI 5.9 % – 15.1 %), 4.9 % in non-granular flat elevated LSTs (95 %CI 2.1 % – 7.8 %), and 0.5 % in granular homogenous LSTs (95 %CI 0.1 % – 1.0 %). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95 %CI 1.24 – 5.02). The proportion of SMI increased with lesion size (10 – 19 mm, 4.6 %; 20 – 29 mm, 9.2 %; ≥ 30 mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8 % (95 %CI 0.6 % – 1.1 %). Conclusion The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the preferred therapy.

Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis.

Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment. We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95 % confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes. We identified 2949 studies, of which 48 were included. Overall, 8.5 % (95 %CI 6.5 % - 10.5 %) of LSTs contained SMI. The risk of SMI differed among the LST subtypes: 31.6 % in non-granular pseudodepressed LSTs (95 %CI 19.8 % - 43.4 %), 10.5 % in granular nodular mixed LSTs (95 %CI 5.9 % - 15.1 %), 4.9 % in non-granular flat elevated LSTs (95 %CI 2.1 % - 7.8 %), and 0.5 % in granular homogenous LSTs (95 %CI 0.1 % - 1.0 %). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95 %CI 1.24 - 5.02). The proportion of SMI increased with lesion size (10 - 19 mm, 4.6 %; 20 - 29 mm, 9.2 %; ≥ 30 mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8 % (95 %CI 0.6 % - 1.1 %). The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the preferred therapy.

Endoscopic Resection of Cecal Polyps Involving the Appendiceal Orifice: A KASID Multicenter Study.

Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed. We evaluated the feasibility and outcomes of endoscopic resection for cecal polyps involving AO. In this retrospective, multicenter study involving nine tertiary referral centers, we evaluated 131 patients who underwent endoscopic resection for cecal polyps involving AO. The median size of polyps resected was 10mm (range 3-60mm). Endoscopic mucosal resection, endoscopic piecemeal mucosal resection, and endoscopic submucosal dissection were performed in 75 (57.3%), 31 (23.7%), and 5 (3.8%) patients, respectively. The en bloc resection rate was 68.7%. Endoscopic complete resection was achieved in 123 lesions (93.9%). Intraprocedural and delayed bleeding occurred in 14 (10.7%) and three patients (2.3%), respectively, and perforation occurred in two patients (1.5%). Seven patients (5.3%) underwent additional surgery because of treatment failure or recurrence. Polyps of ≥20mm in size showed significantly higher rates of perforation and additional surgery (p<0.05), and a lower rate of en bloc resection (p<0.005). Patients with polyps involving ≥75% of AO circumference exhibited a significantly lower rate of en bloc resection (p<0.001), and significantly higher rates of surgery and recurrence (p<0.05). Recurrence during follow-up occurred in 12 patients (15.6%); polyps involving ≥75% of AO circumference were an independent risk factor for recurrence. Endoscopic resection of cecal polyps involving AO is safe and effective in select patients.

Iatrogenic Gastrointestinal Perforation Following Therapeutic Endoscopic Procedures: Management and Outcome.

The aim of this study was to analyze the location, the cause and treatment of iatrogenic gastrointestinal perforations following therapeutic endoscopic procedures. Perforation occurred in 12 patients out of 3,389, giving cases occurred intraoperatively or postoperatively. Among them, 6 cases were closed by titanium clipping and 1 case by purse string suture. In another case after cap-assisted endoscopic mucosal resection (EMRC), attempted titanium clipping failed, emergency surgery had to be performed. One each case, after Argon plasma coagulation (APC) and case after endoscopic piecemeal mucosal resection (EPMR), recovered well spontaneously. In two cases, titanium clips fell off endoscopic mucosal resection (EMR) resulting in delayed perforation, required surgery. Key factors for preventing and managing the perforation of endoscopic treatment, include the choice of endoscopic approach, processing method of perforation, detail processing in endoscopic therapy, proficient degree of operators and psychological quality.

Therapeutic value of endoscopic papillectomy for duodenal papilla lesion

Objective To investigate the therapeutic value of endoscopic papillectomy (EP) for duodenal papilla lesion. Methods Patients with duodenal papilla lesion treated with EP from June 2007 to December 2015 were enrolled. The clinical characteristics, EP technical features, complications, the treatment, postoperative recurrence were analyzed. Results A total of 43 patients were enrolled. The mean diameter of the lesion was 22.8±1.2 mm. Thirty-two patients (69.8%) received en bloc resection, and 11 (25.6%) received endoscopic piecemeal mucosal resection (EPMR). After the operation, duodenal papilla lesions recurred in 3 patients (7.0%), 5 patients (11.6%) had delayed bleeding, 4 (9.3%) had postoperative pancreatitis, 6 (14.0%) had long-term bile duct stricture. Intraoperative pancreatic stenting (OR=0.000, 95%CI: 0.000-) was the independent protective factor for postoperative pancreatitis. Pancreatic duct dilation (OR=13.500, 95%CI: 1.400-130.191) was the independent risk factor for postoperative bile duct stenosis. Conclusion EP is minimally invasive with rapid recovery and less cost, and could be recommended for duodenal papilla lesions. Key words: Duodenal diseases; Sphincterotomy, endoscopic; Postoperative complications; Risk factors

Comparison of endoscopic piecemeal mucosal resection and endoscopic submucosal dissection for treatment of esophageal mucosal lesion larger than 15 mm

Objective To evaluate the clinical value of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) for treatment of esophageal mucosal lesion with diameter larger than 15 mm. Methods The data of 261 patients with esophageal mucosal lesions ≥15 mm and undergoing ESD (n=198) or EPMR (n=63) in Endoscopy Center of Zhongshan Hospital from September 2009 to August 2011 were retrospectively analyzed. Therapeutic effect, complications, and local recurrence were compared between the two groups. Results The lesion size was significantly larger in the ESD group than that in the EPMR group (3.02±1.13 mm VS 2.66±0.95 mm, P 0.05) between the two groups. The rate of postoperative esophageal stricture was higher in the EPMR group than that of the ESD group [22.6% (14/62) VS 6.2% (12/194), P<0.05] except for 5 cases with further surgery treatment (4 cases in the ESD group and 1 case in the EPMR group). The local recurrence rate was also higher in the EPMR group than that of the ESD group [11.5% (7/61) VS 3.7% (7/190), P<0.05], except for 10 cases with positive margin. Conclusion The therapeutic effect of ESD is superior to that of EPMR for esophageal mucosal lesions with diameter larger than 15 mm due to lower rate of local recurrence and acceptable complications. Key words: Therapeutic endoscopy; Endoscopic submucosal dissection; Endoscopic piecemeal mucosal resection; Esophageal neoplasm

693 Cold Piecemeal Endoscopic Mucosal Resection (EMR) for Large Sessile Serrated Colonic Polyps

693 Cold Piecemeal Endoscopic Mucosal Resection (EMR) for Large Sessile Serrated Colonic Polyps