Feasibility of endoscopic submucosal dissection for cecal tumors involving the ileocecal valve or appendiceal orifice.
appendix
colonoscopy
endoscopic mucosal dissection
ileocecal valve
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
revised:
02
04
2022
received:
27
12
2021
accepted:
18
04
2022
pubmed:
29
4
2022
medline:
6
8
2022
entrez:
28
4
2022
Statut:
ppublish
Résumé
Endoscopic resection of the ileocecal valve lesions (ICVL) and peri-appendiceal orifice lesions (PAOL), is challenging. This study aimed to evaluate the feasibility of endoscopic submucosal dissection (ESD) for ICVLs and PAOLs compared with other cecal lesions (OCEL). This was a multicenter, retrospective cohort study conducted at a cancer center hospital and two community hospitals. Non-pedunculated cecal lesions that were intended to be treated by ESD followed by at least one surveillance colonoscopy were included. The main outcome was curative resection defined as en-bloc resection and R0 resection without risk factors of metastases. The secondary outcome was co lon preservation. A total of 206 patients with 206 cecal lesions, including 37 ICVL, 27 PAOL, and 142 OCEL, who were to be treated with ESD were included in this study. Curative resection rates were 75.7% for ICVL, 70.4% for PAOL, and 77.5% for OCEL (P = 0.67). In the multivariate analysis of predictors of curative resection, tumor size (<40 mm) (odds ratio [OR] 2.40; 95% confidence intervals [CI], 1.14-5.04; P = 0.02) and a negative non-lifting sign (OR 6.12; 95% CI, 2.55-14.60; P < 0.01) were significant. Colon preservation was achieved for 91.9% of the ICVL, 92.6% of the PAOL, and 90.8% of the OCEL (P = 0.947). Based on curative resection and colon preservation rates, ESD was found to be feasible for ICVL and PAOL. Large tumor size (≥ 40 mm) and positive non-lifting signs were significant factors for non-curative resection.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Endoscopic resection of the ileocecal valve lesions (ICVL) and peri-appendiceal orifice lesions (PAOL), is challenging. This study aimed to evaluate the feasibility of endoscopic submucosal dissection (ESD) for ICVLs and PAOLs compared with other cecal lesions (OCEL).
METHODS
METHODS
This was a multicenter, retrospective cohort study conducted at a cancer center hospital and two community hospitals. Non-pedunculated cecal lesions that were intended to be treated by ESD followed by at least one surveillance colonoscopy were included. The main outcome was curative resection defined as en-bloc resection and R0 resection without risk factors of metastases. The secondary outcome was co lon preservation.
RESULTS
RESULTS
A total of 206 patients with 206 cecal lesions, including 37 ICVL, 27 PAOL, and 142 OCEL, who were to be treated with ESD were included in this study. Curative resection rates were 75.7% for ICVL, 70.4% for PAOL, and 77.5% for OCEL (P = 0.67). In the multivariate analysis of predictors of curative resection, tumor size (<40 mm) (odds ratio [OR] 2.40; 95% confidence intervals [CI], 1.14-5.04; P = 0.02) and a negative non-lifting sign (OR 6.12; 95% CI, 2.55-14.60; P < 0.01) were significant. Colon preservation was achieved for 91.9% of the ICVL, 92.6% of the PAOL, and 90.8% of the OCEL (P = 0.947).
CONCLUSIONS
CONCLUSIONS
Based on curative resection and colon preservation rates, ESD was found to be feasible for ICVL and PAOL. Large tumor size (≥ 40 mm) and positive non-lifting signs were significant factors for non-curative resection.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1517-1524Informations de copyright
© 2022 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
Références
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021; 71: 209-249. https://doi.org/10.3322/caac.21660
Ferlitsch M, Moss A, Hassan C et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297. https://doi.org/10.1055/s-0043-102569
Moss A, Williams SJ, Hourigan LF et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65. https://doi.org/10.1136/gutjnl-2013-305516
Nanda KS, Tutticci N, Burgess NG, Sonson R, Williams SJ, Bourke MJ. Endoscopic mucosal resection of laterally spreading lesions involving the ileocecal valve: technique, risk factors for failure, and outcomes. Endoscopy 2015; 47: 710-718. https://doi.org/10.1055/s-0034-1391732
Vosko S, Gupta S, Shahidi N et al. Impact of technical innovations in EMR in the treatment of large nonpedunculated polyps involving the ileocecal valve (with video). Gastrointest. Endosc. 2021; 94: 959-968.e2. https://doi.org/10.1016/j.gie.2021.05.011
Ponugoti PL, Broadley HM, Garcia J, Rex DK. Endoscopic management of large ileocecal valve lesions over an 18-year interval. Endosc. Int. Open. 2019; 7: E1646-E1651. https://doi.org/10.1055/a-0990-9035
Horimatsu T, Fu KI, Sano Y et al. Acute appendicitis as a rare complication after endoscopic mucosal resection. Dig. Dis. Sci. 2007; 52: 1741-1744. https://doi.org/10.1007/s10620-006-9467-8
Yoshizaki T, Toyonaga T, Tanaka S et al. Feasibility and safety of endoscopic submucosal dissection for lesions involving the ileocecal valve. Endoscopy 2016; 48: 639-645. https://doi.org/10.1055/s-0042-102783
Jacob H, Toyonaga T, Ohara Y et al. Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice. Endoscopy 2016; 48: 829-836. https://doi.org/10.1055/s-0042-110396
Tanaka S, Kashida H, Saito Y et al. Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig. Endosc. 2020; 32: 219-239. https://doi.org/10.1111/den.13545
Matsumoto A, Tanaka S, Oba S, Kanao H, Oka S, Yoshihara M, Chayama K. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand. J. Gastroenterol. 2010; 45: 1329-1337. https://doi.org/10.3109/00365521.2010.495416
Japanese Society for Cancer of the Colon and Rectum. Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma: the 3d English Edition [Secondary Publication]. J. Anus. Rectum Colon. 2019; 3: 175-195. https://doi.org/10.23922/jarc.2019-018
Ito S, Hotta K, Imai K et al. Risk factors of post-endoscopic submucosal dissection electrocoagulation syndrome for colorectal neoplasm. J. Gastroenterol. Hepatol. 2018; 33: 2001-2006. https://doi.org/10.1111/jgh.14302
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, for the STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann. Intern. Med. 2007; 147: 573-577. https://doi.org/10.7326/0003-4819-147-8-200710160-00010
Hotta K, Yamaguchi Y, Saito Y, Takao T, Ono H. Current opinions for endoscopic submucosal dissection for colorectal tumors from our experiences: indications, technical aspects and complications. Dig. Endosc. 2012; 24: 110-116. https://doi.org/10.1111/j.1443-1661.2012.01262.x
Hashiguchi Y, Muro K, Saito Y et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int. J. Clin. Oncol. 2020; 25: 1-42. https://doi.org/10.1007/s10147-019-01485-z
Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant. 2013; 48: 452-458. https://doi.org/10.1038/bmt.2012.244
Imai K, Hotta K, Yamaguchi Y et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest. Endosc. 2016; 83: 954-962. https://doi.org/10.1016/j.gie.2015.08.024
Andrisani G, Fukuchi T, Antonelli G et al. Superficial neoplasia involving the Ileocecal valve: Clinical outcomes of endoscopic submucosal dissection. Dig. Liver Dis. 2021; 53: 889-894. https://doi.org/10.1016/j.dld.2021.03.005
Hori K, Uraoka T, Harada K et al. Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum. Endoscopy 2014; 46: 862-870. https://doi.org/10.1055/s-0034-1377205
Li B, Shi Q, Xu EP et al. Prediction of technically difficult endoscopic submucosal dissection for large superficial colorectal tumors: a novel clinical score model. Gastrointest. Endosc. 2021; 94: 133, e3-144. https://doi.org/10.1016/j.gie.2020.11.012
Iwai T, Hotta K, Imai K et al. Early cecal cancer adjacent to the appendiceal orifice successfully treated by endoscopic submucosal dissection. Gastrointest. Endosc. 2016; 83: 260-261. https://doi.org/10.1016/j.gie.2015.07.007
Suzuki S, Fukunaga Y, Tamegai Y et al. The short-term outcomes of laparoscopic-endoscopic cooperative surgery for colorectal tumors (LECS-CR) in cases involving endoscopically unresectable colorectal tumors. Surg. Today 2019; 49: 1051-1057. https://doi.org/10.1007/s00595-019-01840-7
Ritsuno H, Sakamoto N, Osada T et al. Prospective clinical trial of traction device-assisted endoscopic submucosal dissection of large superficial colorectal tumors using the S-O clip. Surg. Endosc. 2014; 28: 3143-3149. https://doi.org/10.1007/s00464-014-3572-0
Yamashina T, Takeuchi Y, Nagai K et al. Scissor-type knife significantly improves self-completion rate of colorectal endoscopic submucosal dissection: Single-center prospective randomized trial. Dig. Endosc. 2017; 29: 322-329. https://doi.org/10.1111/den.12784
Yamashina T, Nemoto D, Hayashi Y et al. Prospective randomized trial comparing the pocket-creation method and conventional method of colorectal endoscopic submucosal dissection. Gastrointest. Endosc. 2020; 92: 368-379. https://doi.org/10.1016/j.gie.2020.02.034