Can Advanced Endoscopic Imaging Help Us Avoid Surgery for Endoscopically Resectable Colorectal Neoplasms? A Proof-of-Concept Study.
Colorectal polyp
Narrowband imaging
Optical diagnosis
Submucosal invasive cancers
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
11
07
2019
accepted:
03
10
2019
pubmed:
21
10
2019
medline:
21
10
2020
entrez:
21
10
2019
Statut:
ppublish
Résumé
European guidelines recommend advanced endoscopic imaging (AEI) to guide therapeutic decisions; however, data are limited concerning its clinical effects on the management of colorectal polyps. The aim of this study was to investigate the effect of standard chromoendoscopic imaging (SCI) and AEI on decision-making regarding therapeutic techniques. We retrospectively analyzed prospectively collected endoscopic and pathological data on colorectal neoplasms ≥ 10 mm removed at a Japanese tertiary cancer center between January 2010 and December 2016. We assumed a virtual approach to manage the decisions for endoscopic resection or surgery for each lesion using the following test modalities: (1) endoscopic size measurement (ESM), (2) SCI, and (3) AEI. Virtual surgical management was indicated using the following criteria: (1) ESM: lesion ≥ 40 mm, (2) SCI: depression, excavation, or ulceration, (3) AEI: Japan NBI Expert Team type 3 (magnifying NBI), V A total of 3509 lesions from 2693 patients were analyzed, including 142 SM-S and 457 deep submucosal invasive cancer (SM-D). The incidence of hypothetical redundant surgery was 9.2% with ESM, 5.1% with SCI, and 2.9% with AEI. When compared with ESM, hypothetical redundant surgery was significantly reduced with SCI (relative risk 0.55; 95% confidence interval 0.44-0.69) and AEI (0.31; 0.23-0.41). Therapeutic decision-making according to SCI or AEI can reduce surgery for endoscopically resectable colorectal neoplasms.
Sections du résumé
BACKGROUND
European guidelines recommend advanced endoscopic imaging (AEI) to guide therapeutic decisions; however, data are limited concerning its clinical effects on the management of colorectal polyps. The aim of this study was to investigate the effect of standard chromoendoscopic imaging (SCI) and AEI on decision-making regarding therapeutic techniques.
METHODS
We retrospectively analyzed prospectively collected endoscopic and pathological data on colorectal neoplasms ≥ 10 mm removed at a Japanese tertiary cancer center between January 2010 and December 2016. We assumed a virtual approach to manage the decisions for endoscopic resection or surgery for each lesion using the following test modalities: (1) endoscopic size measurement (ESM), (2) SCI, and (3) AEI. Virtual surgical management was indicated using the following criteria: (1) ESM: lesion ≥ 40 mm, (2) SCI: depression, excavation, or ulceration, (3) AEI: Japan NBI Expert Team type 3 (magnifying NBI), V
RESULTS
A total of 3509 lesions from 2693 patients were analyzed, including 142 SM-S and 457 deep submucosal invasive cancer (SM-D). The incidence of hypothetical redundant surgery was 9.2% with ESM, 5.1% with SCI, and 2.9% with AEI. When compared with ESM, hypothetical redundant surgery was significantly reduced with SCI (relative risk 0.55; 95% confidence interval 0.44-0.69) and AEI (0.31; 0.23-0.41).
CONCLUSIONS
Therapeutic decision-making according to SCI or AEI can reduce surgery for endoscopically resectable colorectal neoplasms.
Identifiants
pubmed: 31630341
doi: 10.1007/s10620-019-05894-y
pii: 10.1007/s10620-019-05894-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM