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Objective To assess the efficacy and safety of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) in the treatment of larger (≥10-15 mm) non-ampullary duodenal lesions. Methods The data of 21 patients with larger (≥10-15 mm) non-ampullary duodenal lesions, who underwent EPMR or ESD in Beijing Friendship Hospital from February 2013 to August 2018 were retrospectively analyzed. According to the treatment plan, the patients were divided into the EPMR group ( n=13) and the ESD group ( n=8) . The operation time, pathological histological evaluation and complications of each group were summarized. Results In the EPMR group, all 13 lesions were originated from the mucosa. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 22±12 mm and 26±15 mm, respectively, the median operation time was 39. 0 (23. 0, 45. 0) min, and 12 lesions were closed with metal clips. For pathological assessment, there were 2 cases of ectopia gastric mucosa, 7 cases of low grade intraepithelial neoplasia, and 4 cases of high grade intraepithelial neoplasia. And 5 cases were horizontal margin positive ( low grade intraepithelial neoplasia ) in the 13 lesions. Complications occurred in 2 patients, including 1 case of perioperative bacteremia, which was cured after anti-infective treatment, and another case of intraoperative perforation, which was recovered after emergency surgery. In the ESD group, there were 6 mucosal lesions and 2 submucosal lesions. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 17 ± 5 mm and 20 ± 7 mm, respectively, the median operation time was 47. 5 ( 34. 0, 68. 0) min, and all 8 lesions were closed with metal clips. For pathological assessment, there were 3 cases of low grade intraepithelial neoplasia, 3 cases of high grade intraepithelial neoplasia, 1 case of submucosal cyst, and 1 case of lymphangioma. All 8 cases were horizontal margin negative, and low-grade intraepithelial neoplasia was suspected at the vertical margin of 1 case, which failed to achieve complete resection. Perioperative perforation occurred in 3 cases. One case recovered after endoscopic treatment, another case was unsatisfactory under endoscopy, and recovered after emergency surgery. The other case was recovered after laparoscopic treatment. Conclusion EPMR and ESD are both safe and effective for larger non-ampullary duodenal lesions, which is worthy of further clinical research.
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Objective@#To assess the efficacy and safety of endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) in the treatment of larger (≥10-15 mm) non-ampullary duodenal lesions.@*Methods@#The data of 21 patients with larger (≥10-15 mm) non-ampullary duodenal lesions, who underwent EPMR or ESD in Beijing Friendship Hospital from February 2013 to August 2018 were retrospectively analyzed. According to the treatment plan, the patients were divided into the EPMR group (n=13) and the ESD group (n=8). The operation time, pathological histological evaluation and complications of each group were summarized.@*Results@#In the EPMR group, all 13 lesions were originated from the mucosa. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 22±12 mm and 26±15 mm, respectively, the median operation time was 39.0 (23.0, 45.0) min, and 12 lesions were closed with metal clips. For pathological assessment, there were 2 cases of ectopia gastric mucosa, 7 cases of low grade intraepithelial neoplasia, and 4 cases of high grade intraepithelial neoplasia. And 5 cases were horizontal margin positive (low grade intraepithelial neoplasia) in the 13 lesions. Complications occurred in 2 patients, including 1 case of perioperative bacteremia, which was cured after anti-infective treatment, and another case of intraoperative perforation, which was recovered after emergency surgery. In the ESD group, there were 6 mucosal lesions and 2 submucosal lesions. The diameter of the lesion estimated by endoscopy and the size of the resected specimen were 17±5 mm and 20±7 mm, respectively, the median operation time was 47.5 (34.0, 68.0) min, and all 8 lesions were closed with metal clips. For pathological assessment, there were 3 cases of low grade intraepithelial neoplasia, 3 cases of high grade intraepithelial neoplasia, 1 case of submucosal cyst, and 1 case of lymphangioma. All 8 cases were horizontal margin negative, and low-grade intraepithelial neoplasia was suspected at the vertical margin of 1 case, which failed to achieve complete resection. Perioperative perforation occurred in 3 cases. One case recovered after endoscopic treatment, another case was unsatisfactory under endoscopy, and recovered after emergency surgery. The other case was recovered after laparoscopic treatment.@*Conclusion@#EPMR and ESD are both safe and effective for larger non-ampullary duodenal lesions, which is worthy of further clinical research.
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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). There were no significant difference in the rate of intraoperative complication and short-term postoperative complication, such as fever, chest pain, and postoperative bleeding, between the two groups ( 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]. During the follow-up of 3-63 months, 5 cases recurred in ESD group and 1 case in EPMR group, with no significant difference ( 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.
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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, P0.05) 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.
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Objective To investigate the technical feasibility and oncological safety of EPMR for early esophageal cancer and precancerous lesions. Methods Clinicopathological data, procedure quality and complications of 70 patients with early esophageal cancer or precancerous lesions were retrospectively ana?lysed. The technical safety and feasibility were assessed, and the complications were investigated through postoperative surveillance. The results were compared with published data from two high?quality meta?analysis studies on ESD. Results In a total of 70 patients who underwent EPMR, 35?7%( 25/70) were diagnosed as having early esophageal cancer and 64?3%( 45/70) atypical hyperplasia. And tumor size greater than 2 cm was 78?6%(55/70). The mean EPMR time was(28?31±9?49) minutes. The R0 resection rate of EPMR was 88?6%(62/70) and no perforation occurred. The bleeding rate was 21?4%(15/70). The esoph?ageal stricture rate was 1?4%( 1/70) . The recurrence rate was 2?9%( 2/70) . Compared with published ESD data from the two studies, EPMR showed shorter procedure time, lower curative rate and lower rates of stric?ture and perforation, but slightly higher rates of bleeding and recurrence. Conclusion Both EPMR and ESD are feasible and effective for early esophageal cancer and precancerous lesions. The curative results of EPMR are similar to ESD, with shorter procedure time, but higher bleeding and recurrence rates.
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Local recurrence after endoscopic piecemeal mucosal resection (EPMR) for colorectal tumors is a crucial issue. However, such recurrence is usually detected within one year and cured with additional endoscopic treatment, which makes EPMR acceptable. Herein, we report a rare case of repeatedly recurrent colon cancer involving the appendiceal orifice after EPMR, which was not cured with additional endoscopic treatments. A 67-year-old man was referred to us for endoscopic treatment of a 25 mm cecal tumor spreading to the appendiceal orifice in May 2002. The tumor was resected with EPMR, showing well differentiated intramucosal adenocarcinoma with a positive lateral cut margin of tubular adenoma. Endoscopic surveillance was conducted and the first local recurrence was detected in August 2006. Although we resected it endoscopically, the second local recurrence was found in September 2007 and we removed it with endoscopic resection again. However, the third local recurrence was detected in March 2008. Although endoscopic resection was performed also for the third recurrence, curative resection was not achieved. In February 2009, laparoscopic assisted colectomy was performed and histopathological examination showed well differentiated adenocarcinoma with deep submucosal invasion. This case is important in considering indication for endoscopic resection in colorectal tumors involving the appendiceal orifice.
Subject(s)
Aged , Humans , Male , Adenocarcinoma/diagnosis , Appendiceal Neoplasms/complications , Colectomy , Colonic Neoplasms/diagnosis , Colonoscopy , Intestinal Mucosa/pathology , Neoplasm Recurrence, Local , RecurrenceABSTRACT
2 cm) according to the size of lesions. Large wound sections were sutured with metal clips. Results Histopathologic investigation showed that among 54 lesions,there were 13 cases of adenoma,38 cases of adenoma with atypical hyperplasia (10 cases with mild dysplasia,23 with moderate dysplasia and 5 with severe dysplasia )and 3 cases of mucosal cancer. We followed forty cases,local recurrence was found in none of 29 cases after 6 months of EMR. However,the recurrence was found in 2 of 11 cases after 1 month of EPMR and 1 each after 3 and 6 month of EPMR. There was no recurrence after further endoscopic re-treatment. Among 3 cancer patients,2 patients shifted to surgery due to patient's preference and 1 patient was followed up for 6 months. All of them were found without local recurrence by endoscopic biopsies or surgical results. Conclusions Chromoscopy,magnifying colonoscopy and EUS have benefits in diagnosis of early large bowel tumors,and it is also helpful in selecting the proper treatment so as to reduce the complication and recurrence.
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PURPOSE: A laterally spreading tumor (LST) has its own characteristic features and growth pattern. Information about LST is scanty in Korea, therefore this study was designed in order to contribute to the literature. METHODS: In this study, 43 patients with LSTs were included. The diagnoses were made by colonoscopy in all cases. Treatment options included endoscopic resection, transanal excision, and surgical resection. In reviewing and analyzing the cases, we made a special emphasis on size, classification, histology, and treatment. RESULTS: The most frequent location was the rectum, followed by the sigmoid colon and the ascending colon in that order. Lesions smaller than 20 mm accounted for 69.8%. Granular homogeneous LSTs, 41.9%. Lesions larger than 20 mm, except granular homogeneous LSTs, showed an abrupt increase in malignancy rate. Tubular adenomas accounted for 65.1%. The overall malignancy rate was 20.9%, and the submucosal cancer rate, 9.3%. There were no malignancies in the granular homogeneous LSTs. The malignancy rate for the mixed-nodule type lesions was 33.3% (4/12), and the nongranular LSTs, 38.5% (5/13). Polypectomy was done in 37.2% of the lesions, endoscopic mucosal resection (EMR) in 16.3%, and endoscopic piecemeal mucosal resection (EPMR) in 16.3%. The overall endoscopic resection rate was 83.7% (36/43). EMR was applicable to lesions smaller than 20 mm, and EPMR to those larger than 20 mm. Transanal resection was done in 2 cases with lesions. Five cases were resected surgically. Four of them were submucosal invasive lesions, and one, a mucosal lesion which was wide and had initially been thought to be a submucosal cancer. There were two recurrences during the average 15-month follow-up period. The follow-up rate was 81.4% (35/43). Of these 2 recurring cases, one patient was treated endoscopically and the other, transanally. CONCLUSIONS: LSTs show different behavior depending on the endoscopic classification. Granular homogeneous LSTs are seldom larger than 30 mm and are good candidates for endoscopic treatment. The mixed-nodule type and the nongranular type show a marked predisposition to malignancy when they are over 20 mm, and nongranular-type LSTs have a higher rate of submucosal invasive cancers. Thus, in the cases of the mixed-nodule and nongranular types, careful consideration should be given for deciding between endoscopic treatment and surgical resection. Complete resection should be assured to prevent recurrence, and follow-up surveillance is required in all lesions for more than 3 to 5 years.
Subject(s)
Humans , Adenoma , Classification , Colon, Ascending , Colon, Sigmoid , Colonoscopy , Diagnosis , Follow-Up Studies , Korea , Rectum , RecurrenceABSTRACT
PURPOSE: Endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection (EPMR) is a useful method for treating benign neoplastic lesions and selected cases of early colorectal cancers, especially those cancers with flat or depressed shapes. However, clinical data concerning EMR or EPMR are still lacking. Accordingly, we designed this study to review and analyze our cases for more information and in order to achieve more adequate and prudential application. METHODS: We performed 2609 colonoscopic polypectomies from January 1997 to December 1998. Among those, 77 lesions (3.0%) were treated by using the EMR or the EPMR technique. We analyzed those 77 lesions with special reference to size, configuration, and histologic diagnosis. RESULTS: The most common age group was the 5th decade. The male-to-female ratio was 1.75:1. The most common sites of the lesions were the rectum and the sigmoid colon. Most of the lesions were equal to or smaller than 15 mm in size (97.4%). Flat, elevated lesions were the most common type (39%), followed by sessile (31.2%) and depressed (18.2%) lesions in order. Adenomas and adenocarcinomas accounted for 51.9% (40/77) of the lesions and the malignancy rate was 9.1% (7/77). Three were submucosal cancers. Seventy-one percent of the carcinomas were less than 10 mm in size, and the only submucosal cancer was below 5 mm in size and was a depressed lesion. Carcinoid tumors accounted for 15.6% of the lesions, and chronic nonspecific inflammation for 9.1%. An EPMR was performed on 4 lesions which were larger than 10 mm. There were no complications such as bleeding, perforation, or recurrence. CONCLUSIONS: EMR and EPMR are useful endoscopic resection techniques, especially for sessile, flat, and depressed neoplastic lesions. Lesions up to 15~20 mm in size are good candidates for EMR and those up to 40 mm for EPMR. At the same time, a carefully performed procedure is mandatory to prevent recurrence or complications such as bleeding or perforation.
Subject(s)
Humans , Adenocarcinoma , Adenoma , Carcinoid Tumor , Colon, Sigmoid , Colorectal Neoplasms , Diagnosis , Hemorrhage , Inflammation , Rectum , RecurrenceABSTRACT
BACKGROUND/AIMS: Many endoscopists in Korea lack an understanding of laterally spreading, or creeping tumors(LSTs) which characteristically grow laterally, as opposed to other polypoid lesions, and which show superficially elevated lesions. An LST is similar in color to the adjacent normal mucosa, so it is difficult to recognize, but it can be detected by chromoscopy. When it grows to over 2-3 cm in its largest diameter, it can have malignant foci. It is important not to overlook the lesion and to remove it in a timely manner. METHODS: The authors experienced 9 cases of LSTs from Jan. 1996 to Jan. 1997. We reviewed those 9 cases clinically, endoscopically, and pathologically, and tried to establish the diagnostic and therapeutic key points. RESULTS: The most common age group was the fifth decade. The male-to-female ratio was 5:4. Four cases were asymptomatic, and lower abdominal pain and rectal bleeding were seen in 2 cases respectively. The rectum and the sigmoid colon were the most commonly involved sites showing 88.9% (8/9). Granular-type(nodule-aggregating-type) LSTs were seen in 4 cases and nongranular types(non-noodule-aggregating type) in 5 cases. 66.7%(6/9) were larger than 2 cm in the largest diameter. A tubular adenoma was seen in each of 5 cases; among them, 1 case had cellular atypia and another case revealed a submucosal(sm) carcinoma. Two granular types with large nodules had mucosal carcinomas. The sm carcinoma was a nongranular type. Endoscopically, redness was observed in 66.7%(6/9) of the cases and depression in 33.3%(3/9). The sm carcinoma had both redness and depression. Three cases underwent endoscopic piecemeal mucosal resection(EPMR) and the other 3 cases underwent endoscopic mucosal resection (EMR). A low anterior resection was performed on one patient; there was no lymph node metastasis. CONCLUSIONS: The characteristics of LSTs are important in their diagnosis and management. Nongranular-type LSTs are not uncommon, despite the difficulty in recognizing them by endoscopy. Pathologically, LSTs, in general, are tubular or tubulovillous adenomas. When they are over 2 cm in their largest diameter, they are likely to have malignancies. Giant nodule, redness and depression are important features indicating malignancy, especially an sm carcinoma. An EPMR or an EMR is the main treatment option, but depending on the depth of invasion, surgical resection may need to be considered.