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Objective:To investigate the independent predictors of colorectal polyps complicating colorectal laterally spreading tumors (CLST) and the independent risk factors for malignancy in CLST coexisting with colorectal polyps.Methods:Clinical data of 260 patients with CLST who underwent endoscopy and received treatment in the Second Affiliated Hospital of Dalian Medical University from January 2016 to December 2021 were retrospectively collected. Patients were divided into the coexisting group ( n=135) and the non-coexisting group ( n=125) according to the presence or absence of polyps. Differences in clinicopathological characteristics between the two groups were compared and binary logistic regression was used to analyse the predictors of coexistence. Then the coexisting group was further divided into coexisting malignant group ( n=38) and coexisting non-malignant group ( n=97) according to the infiltration depth of CLST, and binary logistic regression was used to analyse the risk factors for malignancy in CLST coexisting with colorectal polyps. Results:Male ( P=0.002, OR=2.355, 95% CI:1.354-4.099), villous tubular adenoma ( P=0.022, OR=3.873, 95% CI: 1.214-12.355) and polyps history ( P=0.001, OR=2.738, 95% CI: 1.527-4.909) were independent predictors for colorectal polyps coexisting with CLST. Area under the curve (AUC) of the predictive model was 0.725 ( P<0.001, 95% CI: 0.664-0.786). Polyp diameter≥10 mm ( P=0.007, OR=6.266, 95% CI:1.634-24.034), CLST diameter≥20 mm ( P<0.001, OR=11.879, 95% CI:4.078-34.601), granular-mixed type CLST ( P=0.003, OR=8.584, 95% CI: 2.126-34.660), flat-elevated type CLST ( P=0.021, OR=4.399, 95% CI: 1.250-15.482) and pseudo-depressed type CLST ( P<0.001, OR=31.426, 95% CI: 4.975-198.509) were independent risk factors for malignancy in CLST coexisting with polyps. AUC of the predictive model was 0.854 ( P<0.001, 95% CI: 0.775-0.933). Conclusion:Male CLST patients with polyps history and a pathological type of villous tubular adenoma are more likely to develop coexistence. In patients with CLST which is granular-mixed type, flat-elevated type and pseudo-depressed type coexisting with colorectal polyps, the larger the diameter of the polyp and the diameter of the CLST, the more likely it is to be malignant.
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Objective:To analyze the clinical and pathological characteristics of colorectal laterally spreading tumor (CLST) and provide reference for clinical diagnosis and treatment of CLST.Methods:From January 1, 2016 to June 30, 2021, the clinical data of patients with CLST who underwent endoscopic resection at the Second Affiliated Hospital of Dalian Medical University were retrospectively collected. The clinical and pathological characteristics of CLST were analyzed in terms of lesion location (right colon, left colon, rectum) and morphological type (granular-homogeneous type, granular-mixed type, flat-elevated type, and pseudo-depressed type). One-way analysis of variance, Pearson′s chi-square test and Fisher′s exact test were used for statistical analysis.Results:A total of 266 patients with CLST and 296 CLST lesions were included. The most common maximum diameters of the lesions were 10 to 29 mm, accounting for 85.1% (252/296). The main morphological type was granular type, accounting for 81.4% (241/296), and the main pathological type was adenoma, accounting for 79.7% (236/296), and the most common histological type was low-grade intraepithelial neoplasia (LGIN), accounting for 81.1% (240/296). The maximum diameter of CLST lesion of rectum was larger than that of the right colon and the left colon ((24.20±16.97), (18.38±8.24) and (18.59±7.95) mm, respectively), and the difference was statistically significant ( F=6.62, P<0.001). The detection rate of granular-homogeneous type CLST in rectum was lower than that in the right colon and the left colon (22.0%, 11/50, 53.5%, 69/129 and 58.9%, 69/117, respectively), while the detection rate of granular-mixed type CLST in rectum was higher than that in the right colon and the left colon (50.0%, 25/50; 29.4%, 38/129 and 24.8%, 29/117, respectively), and the differences were statistically significant ( χ2=20.06 and 10.67, both P<0.01). The incidence of adenoma in CLST in the right colon was lower than that in the left colon and rectum (68.2%, 88/129; 87.2%, 102/117 and 92.0%, 46/50, respectively), while the incidence of serrated adenoma in CLST in the right colon was higher than that in the left colon and rectum (30.2%, 39/129; 12.8%, 15/117 and 4.0%, 2/50, respectively), and the differences were statistically significant ( χ2=19.25 and 20.85, both P<0.001). The CLST in left colon was mostly treated by endoscopic submucosa dissection (94.9%, 111/117), while the CLST in rectum was mostly treated by endoscopic mucosal resection (20.0%, 10/50), and the difference was statistically significant ( χ2=8.77, P=0.012). The maximum diameter of the pseudo-depressed type CLST was larger than that of the granular-homogeneous type, granular-mixed type and flat-elevated type ((24.18±14.07), (15.96±5.70), (23.49±13.80) and (21.21±8.02) mm), and the difference was statistically significant ( F=13.40, P<0.001). The incidence of adenoma in flat-elevated type CLST was higher than that of the granular-homogeneous type, granular-mixed type and pseudo-depressed type (92.1%, 35/38; 71.1%, 106/149; 86.9%, 80/92 and 15/17, respectively), and the difference was statistically significant ( χ2=14.13, P=0.003). The incidence of serrated adenoma in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (28.9%, 43/149; 10.9%, 10/92; 5.3%, 2/38 and 1/17, respectively), and the difference was statistically significant ( χ2=19.98, P<0.001). The incidence of adenocarcinoma in the pseudo-depressed type CLST was higher than that of the granular-homogeneous type, granular-mixed type and flat-elevated type (1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38, respectively), and the difference was statistically significant (Fisher′s exact test, P=0.049). The incidence of LGIN in the granular-homogeneous type CLST was higher than that of the granular-mixed type, flat-elevated type and pseudo-depressed type (90.6%, 135/149; 76.1%, 70/92; 65.8%, 25/38 and 10/17, respectively), while the incidences of high-grade intraepithelial neoplasia and carcinoma in the pseudo-depressed type CLST were higher than those of the granular-homogeneous type, granular-mixed type and flat-elevated type (6/17; 9.4%, 14/149; 21.7%, 20/92; 31.6%, 12/38 and 1/17; 0, 0/149; 2.2%, 2/92 and 2.6%, 1/38), and the differences were statistically significant( χ2=21.58 and 16.81 and Fisher′s exact test, all P<0.05). Conclusions:The clinicopathological characteristics of CLST have certain specificity. The maximum diameter and malignant potential of the rectal CLST are both larger and higher than those of the colonic CLST. Although the granular-mixed type CLST is the granular type, it shows a larger maximum diameter and a higher degree of malignancy.
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Objective To compare the diagnostic accuracy of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for preoperative endoscopic assessment of the invasion depth of colorectal laterally spreading tumour(LST).Methods Data of 104 cases of colorectal LST were included.With the final pathological diagnosis as the golden standard,the accuracies of MCE and EUS for preoperative assessment of the invasion depth of colorectal LST were compared.Results The diagnostic accuracies of MCE and EUS for evaluating the invasion depth of LST were 89.4％ (93/104) and 73.1％ (76/104),respectively(P＜0.05).The lesion size and the endoscopist could affect the accuracy of the EUS evaluation (P=0.017,OR=3.561;P=0.035,OR =1.399).The accuracy of EUS seemed to show a downward trend for colorectal LST of larger diameters.Conclusion Both MCE and EUS are effective for evaluating the invasion depth of colorectal LST,but the accuracy of MCE may be higher than that of EUS.Large diameter of the lesion and the doctor's experience inadequacy may be the risk factors for the accuracy of EUS.
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Objective@#To evaluate the diagnostic efficacy of Japan Narrow Band Imaging Expert Team(JNET) classification under narrow-band imaging (NBI) for colorectal laterally spreading tumors.@*Methods@#Data of 170 laterally spreading tumors (LST) detected by NBI and pigment dyeing were reviewed in the retrospective study. JNET classification under NBI was used for rediagnosis based on surface pattern and vessel pattern. Pit pattern(PP) was observed under pigment dyeing using PP classification. The results were compared with histologic results after endoscopic resection or surgery.@*Results@#The diagnostic sensitivity, specificity, positive predictive value, negative predictive value and accuracy of JNET classification and PP classification were 92.2% VS 70.3%, 82.3% VS 85.0%, 74.7% VS 72.6%, 94.9% VS 83.5%, 85.9% VS 79.7%, respectively (P=0.159). The consistency rates of JNET classification and PP classification in predicting shallow invasion depth of LST were 6.1% and 8.3% respectively and the consistency rates in predicting deep invasion were 30.8% and 4.8%, respectively.@*Conclusion@#JNET classification under NBI is effective in predicting malignant laterally spreading tumors, however, its efficacy in predicting tumor invasion depth is unsatisfied. PP classification can be used to improve the diagnostic accuracy for those with diagnostic difficulty.
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Objective To evaluate the diagnostic efficacy of Japan Narrow Band Imaging Expert Team(JNET)classification under narrow-band imaging (NBI)for colorectal laterally spreading tumors. Methods Data of 170 laterally spreading tumors (LST)detected by NBI and pigment dyeing were reviewed in the retrospective study. JNET classification under NBI was used for rediagnosis based on surface pattern and vessel pattern. Pit pattern(PP)was observed under pigment dyeing using PP classification. The results were compared with histologic results after endoscopic resection or surgery. Results The diagnostic sensitivity,specificity, positive predictive value, negative predictive value and accuracy of JNET classification and PP classification were 92. 2％ VS 70. 3％,82. 3％ VS 85. 0％,74. 7％ VS 72. 6％,94. 9％VS 83. 5％,85. 9％ VS 79. 7％,respectively (P= 0. 159). The consistency rates of JNET classification and PP classification in predicting shallow invasion depth of LST were 6. 1％ and 8. 3％ respectively and the consistency rates in predicting deep invasion were 30. 8％ and 4. 8％,respectively. Conclusion JNET classification under NBI is effective in predicting malignant laterally spreading tumors,however,its efficacy in predicting tumor invasion depth is unsatisfied. PP classification can be used to improve the diagnostic accuracy for those with diagnostic difficulty.
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Objective To explore the clinical and pathological features of laterally spreading tumor ( LST) in colon, and the efficacy and safety of endoscopic submucosal dissection ( ESD) . Methods A total of 376 cases with 403 lesions of LST were detected by colonoscopy in the First Hospital of China Medical University from April 2014 to December 2016. The site, size and classification of all lesions were recorded. One hundred and sixty lesions in 143 patients underwent endoscopic treatment, and Their pit pattern were observed. The resected lesions were sent for pathological examination. The patients were followed up regularly after treatment. Results Among 403 cases of LST, 168 lesions ( 41. 69％) were located at rectum, which was the main site. Lesions with diameter of 10-<20 mm were of the largest number (37. 22％, 150/403). Nodular mixed type was the main morphologic type with a total of 203 lesions ( 50. 37％) . The main pathologic type was low-grade adenoma ( 65. 51％, 264/403) . The malignant potential rose with the increase of diameter of LST lesion ( P<0. 05) . Compared with the LST granular type, LST non-granular type had a higher pathologic malignant potential (P<0. 05). Among 403 lesions in 376 patients, 145 lesions in 128 patients were treated by ESD. Intraoperative bleeding occurred in 12 patients, and no delayed bleeding or perforation occurred. Among the 160 treated LST cases,Ⅳ-type pit pattern was of the largest number, up to 70. 62％ (113/160). The canceration rate of Ⅴ-type pit pattern was the highest, up to 80. 00％ (8/10). Malignant degree of pathology ( P<0. 05) and penetration degree of cancer ( P>0. 05) showed an increasing trend with the upgrade of pit pattern of LST cases. Among the 128 patients who were treated by ESD, 113 cases were regularly reexamined, and 2 cases relapsed. Others whose wounds didn′t relapse healed well. Conclusion The clinical and pathological features of colorectal LST are unique. ESD is an effective and safe treatment for LST, which can achieve radical results.
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Objective:To investigate the clinicopathological differences in laterally spreading tumor (LST) from the rectum and colon.Methods:Clinicopathological records of 198 patients with LST (116 cases in rectum,82 cases in colon) from the Second Xiangya Hospital of Central South University between January 2012 and January 2017 were evaluated.Results:A total of 198 colorectal LST were included.According to the endoscopic classification,nodular mixed type (LST-GM),homogeneous type (LST-GH),flat elevated type(LST-FE) and pseudodepressed type (LST-PD) were 127(64.1％),13(6.6％),41(20.7％) and 17(8.6％),respectively.LST-GM was predominant in the rectum (71.7％),while LST-FE was predominant in the colon (78.0％),with significant difference (P＜0.01).The mean size of LST was (52.03±35.62) mm or (25.37±11.56) mm in the rectum or the colon,with significant difference between them (P＜0.01).High grade intraepithelial neoplasia frequency was higher in the rectum than that in the colon (31.0％ vs 18.3％),while the low grade intraepithelial neoplasia frequency was lower in the rectum than that in the colon (61.2％ vs 75.6％) (both P＜0.05).The mean size of LSTGM and LST-GH diameter were larger in the rectum than that in the colon,and the malignant potential of LST-GM was higher in the rectum than that in the colon.The percentage of high grade intraepithelial neoplasia + invasive carcinoma was 41.8％ and 22.2％,respectively (both P＜0.05).LST in colon was mostly treated with endoscopic mucosal resection,while LST in rectum was treated by endoscopic submucosal dissection predominantly.Conclu sion:LSTs from the rectum and colon show different clinicopathological characteristics to some extent.LST-GM is predominant in the rectum,while LST-FE is predominant in the colon.The malignant potential of LST-GM is higher in the rectum than that in the colon.
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Objective To investigate the relationship between the morphological features, pit pattern classification and pathological types of colorectal laterally spreading tumor (LST). To provide a basis for the selection of treatment modalities, and to explore the value of endoscopic treatment. Methods Retrospective analysis of 17 cases of LST from January 2015 to December 2016 detected by conventional endoscopy. 17 cases of LST first underwent dyeing magnifying endoscopy and pit pattern typing. Endoscopic submucosal dissection (ESD) or surgical treatment was performed in all patients with LST. Postoperative pathologic findings were analyzed retrospectively. Results Of the 17 cases, ESD was performed in 15 patients, and other 2 patients underwent surgical treatment. All of the 17 cases were treated successfully without complications such as bleeding or perforation. No recurrence was found under endoscopy in the 3-month to 2-year postoperative review. Conclusion The preoperative pit pattern classification can provide the basis for treatment. ESD has good curative effect, low recurrence rate and good safety in the treatment of colorectal LST.
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Objective To evaluate the efficacy and safety of endoscopic submucosal dissection for the treatment of colorectal large laterally spreading tumor. Methods ESD was applied to treat 150 cases of colorectal LST with diameter larger than 4 cm. The morphological features of LST, distribution, the clinicopathological data and the en-bloc resection rate, complete resection rate, complications were retrospectively evaluated. Results There were 87 patients with LST-granular lesions and 63 patients with LST-nongranular lesions. Colorectal LST mainly distributed in the rectum for 109 cases (72.7%), sigmoid colon for 13 cases (8.7%), descending colon for 5 cases (3.3%), transverse colon for 8 cases (5.3%), ascending colon for 13 cases (8.7%), cecum for 2 cases (1.3%). There were 23 patients with low-grade neoplasia, 104 patients with high-grade intraepithelial neoplasia, 7 with intramucosal carcinoma and 16 with submucosal carcinoma. The en-bloc resection rate and complete resection rate were 92.7% (139/150) and 89.3%(134/150). Adverse events were intra-operative bleeding in 12 patients (8.0%), postoperative bleeding in 2 patients (1.3%), perforation in 3 patients (2.0%), postoperative stenosis in 3 patients (2.0%). Conclusion Colorectal large LST-NG has higher potential for malignancy. ESD is a safe and effective method to provide en-bloc and complete resection of colorectal large LST.
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Objective To investigate the clinic effect of tunnel technique on endoscopic submucosal dissection(ESD)for massive colorectal laterally spreading tumor(LST). Methods A retrospective study was conducted on the data of patients with colorectal large area LST(the shortest diameter>4 cm) undergoing ESD by tunnel technique from January 2015 to June 2016 in Digestive Endoscopy Center of Jiangsu Province Hospital of Traditional Chinese Medicine. The size of resected specimens, operation time, complications, pathology results, the number of en bloc resection and curative resection were analyzed. Results A total of 14 cases were collected, including 7 males and 7 females. The longest diameters of resected specimens were from 4.0 to 7.0 cm with mean size of 5.18 ± 0.49 cm. The operation times were from 40 to 120 min with mean time of 63.57±12.95 min. Intraoperative perforation occurred in 2 cases but no delayed perforation and bleeding occurred. Postoperative pathology showed 1 patient with adenoma hyperplasia with crypt abscess,3 patients with low grade intraepithelial neoplasia,6 patients with high grade intraepithelial neophasia,1 patient with carcinoma in situ, 1 patient with carcinoma in M3, and 2 patients with carcinoma in SM1. The number of cases who received en bloc resection, complete resection, and curative resection were 13, 13, and 13, respectively. Conclusion ESD by tunnel technique is safe and effective in the treatment of colorectal large area LST,which is worth popularizing in clinics.
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Objective To investigate the relationship between the morphological features, pit pattern classification and pathological types of colorectal laterally spreading tumor (LST). To provide a basis for the selection of treatment modalities, and to explore the value of endoscopic treatment. Methods Retrospective analysis of 17 cases of LST from January 2015 to December 2016 detected by conventional endoscopy. 17 cases of LST first underwent dyeing magnifying endoscopy and pit pattern typing. Endoscopic submucosal dissection (ESD) or surgical treatment was performed in all patients with LST. Postoperative pathologic findings were analyzed retrospectively. Results Of the 17 cases, ESD was performed in 15 patients, and other 2 patients underwent surgical treatment. All of the 17 cases were treated successfully without complications such as bleeding or perforation. No recurrence was found under endoscopy in the 3-month to 2-year postoperative review. Conclusion The preoperative pit pattern classification can provide the basis for treatment. ESD has good curative effect, low recurrence rate and good safety in the treatment of colorectal LST.
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Objective To evaluate the effect of pre-cut-endoscopic mucosa resection of colorectal laterally spreading tumor. Methods 65 patients with LST were enrolled from January 2014 to February 2014. LST was detected by chromoendoscopy and NBI combined with magnifying endoscopy technique. The size, site, morphological features, were observed and the histopathological features of the specimen of LST was analyzed. All the 65 LSTs were resect by pre-cut-EMR. The clinical results including enbloc resection rate, all bloc resection rate, procedure time, complication and recurrence rates were retrospectively evaluated. Results All the 65 LSTs lesions ranged from 2.0 cm to 5.0 cm, with a mean diameter of (2.4 ± 1.7) cm. The site of 65 LSTs was in rectum 28 (43.1 %), 11 LSTs in sigmoid colon (16.9 %), 6 LSTs in descending colon (9.2 %), 2 LSTs in splenic flexure of colon (3.1 %), 9 LSTs in transverse colon (13.8 %), 4 LSTs in Hepatic flexure of colon (6.2 %), 2 LSTs in ascending colon(3.1 %), and 3 LSTs in cecum (4.6 %). Morphology of 23 LSTs were homogeneous granular type (35.4 %), 27 LSTs were mixed non-granular type (41.5 %), 13 LSTs were flat elevated type (20.0 %), and 2 LSTs were pseudo-depressed type (3.1 %). The histopathological diagnoses of LST included 12 tubular adenoma (18.5 %), 19 villous-tubular adenoma (29.2 %), 26 villous adenoma (40.0 %), 7 advanced intraepithelial tumor (10.7 %), 1 intramucosal carcinoma (1.5 %). Enbloc resection was achieved in 65 patients (100.0 %) with a mean operation time of (18.0 ± 11.7) min. 5 cases were bleeding during the operation (7.7 %), 1 case was bleeding 7 days after operation (1.5 %), no perforation was happened. 65 patients were followed up for 3 ~ 12 months, and no local recurrence was found. Conclusion Pre-cut-endoscopic mucosal resection an effective and safe therapy for colorectal LST larger than 2.0 cm.
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Objective To investigate the incidence of electrocoagulation syndrome after endoscopic submucosal dissection (ESD) in the colorectal laterally spreading tumors (LST) and the risk factors. Methods Data of 51 patients with coloretral LST,treated with ESD from January 2010 to May 2014 at Shengjing hospital affiliated to China Medical University,were reviewed.The incidence of electrocoagulation syndrome was analyzed and logistic regression was used to evaluate risk.Results The incidence of electro-coagulation syndrome was 9.8%(5 /51).The incidence of tumors in the rectal area(7.1%,2 /28)was lower than that of the left half colon (12.5%,1 /8),and the right colon (13.3%,2 /15).Multivariable logistic regression analysis showed that the independent risk factors for the development of electrocoagulation syndrome were LST located in non-rectum area (OR =1.655,P <1.655),lesion size larger than 25 mm (OR =1.028, P <0.05),the operation time longer than 129 min (OR =1.016,P <0.05),age older than 62 year old (OR =0.987,P <0.05).Conclusion For the patients aged over 62 year old,lesion size larger than 25 mm,the operation time longer than 129 min and LST located outside the rectum,the mucous membrane should be separated from the muscularis propria in the ESD procedure to reduce electrocoagulation time as much as possible. In the postoperative period,patients need fasting,fluid replacement support,and prevention of post endoscopic submucosal dissection electrocoagulation syndrome (PEECS).
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Due to the widespread acceptance of gastric and esophageal endoscopic submucosal dissections (ESDs), the number of medical facilities that perform colorectal ESDs has grown and the effectiveness of colorectal ESD has been increasingly reported in recent years. The clinical indications for colorectal ESD at the National Cancer Center Hospital, Tokyo, Japan include laterally spreading tumor (LST) nongranular type lesions >20 mm and LST granular type lesions >30 mm. In addition, 0-IIc lesions >20 mm, intramucosal tumors with nonlifting signs and large sessile lesions, all of which are difficult to resect en bloc by conventional endoscopic mucosal resection (EMR), represent potential candidates for colorectal ESD. Rectal carcinoid tumors less than 1 cm in diameter can be treated simply, safely, and effectively by endoscopic submucosal resection using a ligation device and are therefore not indications for ESD. The en bloc resection rate was 90%, and the curative resection rate was 87% for 806 ESDs. The median procedure time was 60 minutes, and the mean size for resected specimens was 40 mm (range, 15 to 150 mm). Perforations occurred in 23 (2.8%) cases, and postoperative bleeding occurred in 15 (1.9%) cases, but only two perforation cases required emergency surgery (0.25%). ESD was an effective procedure for treating colorectal tumors that are difficult to resect en bloc by conventional EMR. ESD resulted in a higher en bloc resection rate as well as decreased invasiveness in comparison to surgery. Based on the excellent clinical results of colorectal ESDs in Japan, the Japanese healthcare insurance system has approved colorectal ESD for coverage.
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Humans , Asian People , Carcinoid Tumor , Colorectal Neoplasms , Delivery of Health Care , Emergencies , Hemorrhage , Insurance , Japan , Ligation , TokyoABSTRACT
Objective To investigate the clinicopathological features of specific subtypes of laterally spreading tumor (LST) and assess the outcomes of endoscopic submucosal dissection (ESD) based upon differentiation status.Methods A total of 174 cases of colorectal LST,treated with ESD between January 2007 and April 2011,were divided into granular type (LST-G) and non-granular type ( LST-NG),and further divided into 4 subtypes,including homogeneous granular,nodular mixed,flat elevated and pseudo-depressed types.Clinicopathological data and ESD parameters were compared between the four subtypes.Results Nodular mixed tumors were larger than homogeneous tumors,needed longer operation time and were more frequently seen in malignant transformation,high grade intraepithelial neoplasm ( HGIN ) as well as submucosal invasive cancer.So were peeudo-depressed tumors compared with flat elevated ones ( P ＜0.01 ).There was no significant difference between LST-G and LST-NG in the parameters of ESD including en bloc resection rate,complete resection rate and complete cure resection rate.The complications tended to be more frequent in nodular mixed tumors (bleeding rate:4.6％; peroration rate:3.5％ ) and pseudo-depressed tumors ( bleeding rate:11.1％ ; perforation rate 11.1％ ),but there was no severe complication in either homogeneous tumors or fiat elevated tumors.One recurrent pseudo-depressed tumor was found 6 months after ESD treatment.Conclusion The degree of technical difficulty appears higher for nodular mixed and pseudo-depressed tumors than for homogeneous and flat elevated tumors,as is shown in procedure time and complication rate.ESD for these two subtypes should better be performed by experienced endoscopists.Accurate differentiation of the LST lesions is needed in basic and clinical research.
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ObjectiveTo evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of laterally spreading tumors (LST).MethodsESD was applied to remove 32 colorectal LSTs larger than 2 cm.The characteristics of the tumors and clinical results including en bloc resection rate,procedure time,complication and recttrrence rates were retrospectively evaluated.Results The lesions ranged from 2.5 cm to 8.0 cm,with a mean diameter of 4.1 ± 2.1 cm.En bloc resection wasachieved in 29 patients (90.6％ ) with a mean operation time of 75.7 ±66.0 min.Immediate arerial bleeding occurred in 5 ( 15.6％ ) cases but was stopped successfully by clips or coagulations.Late bleeding occurred in 2 ( 6.2％ ) and perforations in 3 (9.4％ ),which were closed successfully by clips without surgery.Pathological diagnosis revealed low-grade intraepithelial dysplasia in 19 (59.4％ ),high-grade intraepithelial dysplasia in 6 ( 18.8％ ),and carcinomas in 7 (21.9％).The lesions were restricted in mucosal layer in 25 (78.1％ ),infiltrating into sm1 layer in 5 ( 15.6％ ) and sm2 layer in 2 (6.2％ ),and the later 2 were referred to surgery.Twenty patients were followed up for 3-12 months,and no local recurrence was found..ConclusionESD was an effective and safe therapy for colorectal LST larger than 2 cm.
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BACKGROUND/AIMS: The therapeutic strategy between endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD) for large laterally spreading tumors (LSTs) has not been clearly defined. The aim of this study was to compare the clinical outcomes between EPMR and ESD in patients with large LST. METHODS: From July 2006 to September 2010, 106 patients who underwent endoscopic resection for large (>20 mm) LSTs were included in our retrospective analysis. RESULTS: Baseline characteristics of the patients and tumors were not different between two groups except for location (EPMR-right colon, ESD-rectum). The en bloc resection rate and complete resection rate were significantly higher in the ESD group than those in the EPMR group (EPMR vs. ESD, 53.5% vs. 88.6, P<0.01, 45.1% vs. 71.4%, P=0.01, respectively). However, total procedure time was significantly shorter in the EPMR group (21.3 min vs. 44.4 min, P<0.01). Furthermore, the rates of complication including perforation and bleeding were significantly lower in the EPMR group than those in the ESD group (perforation, 1.4% vs. 11.4%, P=0.02; bleeding, 4.2% vs. 17.1%, P=0.03, respectively). During 19.9 months of follow-up, no significant difference was observed in terms of recurrence (1.5% vs. 3.2%). Non-granular, pseudo-depressed type (LST-PD) showed a significantly higher presence of adenocarcinoma and deeper submucosal invasion than other types of LSTs. CONCLUSIONS: The therapeutic strategy for choosing between EPMR and ESD for large LST lesions should be determined based on the macroscopic findings of their subtype. En bloc resection with ESD should be applied to LST-PDs due to their higher rate of submucosal invasion.
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Humans , Adenocarcinoma , Colon , Follow-Up Studies , Hemorrhage , Recurrence , Retrospective StudiesABSTRACT
Acute lymphoblastic leukemia is a cancer of blood cells. It is known as lymphoblastic lymphoma when it involves lymph nodes rather than the blood and bone marrow. The gastrointestinal tract is a predominant site for extra-nodal lymphomas. But, B-lymphoblastic leukemia/lymphoma more frequently presents in the leukemic form than in the lymphomatous form. We herein report a case of B-lymphoblastic leukemia/lymphoma detected as a laterally spreading tumor in the colon. A 54-year-old man was referred to our hospital for removal of multiple colonic polyps. A colonoscopy revealed multiple colonic polyps and several colonic laterally spreading tumors. An esophagogastroduodenoscopy revealed several raised erosive lesions on the fundus and several variable sized sessile polypoid lesions on the duodenum. We diagnosed B-lymphoblastic leukemia/lymphoma following biopsies of the lesions.
Subject(s)
Humans , Middle Aged , Biopsy , Blood Cells , Bone Marrow , Colon , Colonic Polyps , Colonoscopy , Duodenum , Endoscopy, Digestive System , Gastrointestinal Tract , Lymph Nodes , Lymphoma , Precursor Cell Lymphoblastic Leukemia-LymphomaABSTRACT
BACKGROUND/AIMS: Laterally spreading tumors (LSTs) are similar in color to the adjacent mucosa, so they are difficult to recognize. This study aimed to investigate the features of LSTs by morphologic classification and find effective diagnoses and treatments. METHODS: This retrospective study was done between March 2006 and August 2008. We reviewed patients' medical records, endoscopic findings, and histological findings. RESULTS: A total of 151 patients met criteria for LSTs. Eighty-seven lesions (57.6%) were of the granular type. The most frequent location was ascending colon (37.1%), followed by rectum and sigmoid colon (36.4%). The cecum is a common site in the granular type, but the transverse colon is common in the nongranular type. The overall malignancy rate was 21.2%, and the malignant rate increased in proportion to size. Malignant rates were higher for the mixed nodular type (25.9%) and pseudo-depressed type (41.2%) than for the homogeneous granular type (3.0%) or flat elevated type (10.0%). CONCLUSIONS: LSTs showed different clinicopathologic characteristics according to their morphologic classification. The homogenous type has a lower malignant potential. Piecemeal resection for those with a large diameter is possible, while the pseudo-depressed and mixed nodular types have a higher malignant potential and should receive en-bloc resection as soon as possible.
Subject(s)
Humans , Cecum , Colon, Ascending , Colon, Sigmoid , Colon, Transverse , Colorectal Neoplasms , Medical Records , Mucous Membrane , Rectum , Retrospective StudiesABSTRACT
Because screening gastrointestinal endoscopies have been widely performed recently, diagnosis rates of early stage cancer have been increasing rapidly. This trend has also led to advances in therapeutic endoscopy, which is less invasive than surgery. The state-of-the-art technique, endoscopic submucosal dissection (ESD), allows more favorable outcomes than conventional endoscopic mucosal resection (EMR) regarding en-bloc resection of the lesion, irrespective of the size of the lesion. ESD has already been established as the standard therapeutic option for neoplastic lesions in the upper gastrointestinal tract. However, the use of ESD for colorectal lesions is not yet established because of the unique pathological, organ specific characteristics of colonic lesions. Moreover, endoscopists are required to have higher qualifications to perform ESD and tend to cause complications more frequently. Nevertheless, it is obvious that ESD has a therapeutic advantage for certain colonic lesions and enables endoscopists to achieve a higher en-bloc resection rate, resulting in enhanced curability and more accurate histopathological assessment. Recent development of a special colonoscope for ESD and refinement of devices such as surgical knives and traction systems are expected to overcome some limitations of ESD and a standard protocol will be available in the near future. In this review, we will discuss the current status and future prospects of colorectal ESD.