Intest Res.  2017 Apr;15(2):228-235. 10.5217/ir.2017.15.2.228.

Current practices in endoscopic submucosal dissection for colorectal neoplasms: a survey of indications among Korean endoscopists

• Kim TJ
• Kim ER
• Hong SN
• Kim YH
• Chang DK

• KMID: 2425166
• DOI: http://doi.org/10.5217/ir.2017.15.2.228

Abstract

BACKGROUND/AIMS
The indications for colorectal endoscopic submucosal dissection (ESD) vary in clinical practice. To establish colorectal ESD as a standard treatment, standard indications are essential. For establishing standard indications for colorectal ESD, we surveyed the preferences and criteria of endoscopists for colorectal ESD in their practices.
METHODS
A multiple-choice questionnaire was sent to 27 members of the Korean Society of Gastrointestinal Endoscopy/ESD group. The indications of endoscopists for selecting ESD as a treatment for colorectal tumors ≥2 cm in diameter were surveyed.
RESULTS
On the basis of the preprocedural assessment of histology, adenoma with high-grade dysplasia, mucosal cancer, and shallow submucosa invasive cancer were included in the indication for ESD. Based on gross morphology, laterally spreading tumor (LST) granular nodular mixed type, LST-nongranular (LST-NG) flat elevated type, and LST-NG pseudodepressed type were included. On the basis of the pit pattern by Kudo classification, types III, IV, and V-I were included. Based on the narrow band imaging pattern by Sano classification, types II and III-a were included. Other lesions, such as sporadic localized tumors in chronic inflammation and local residual early carcinoma after endoscopic resection, were also included in the indication for ESD.
CONCLUSIONS
The indications of Korean endoscopists for colorectal ESD are broader than those in recent guidelines, and tend to include more benign-looking tumors. To find the appropriate indications for colorectal ESD, systematic data collection and analysis are required to reach a consensus in a timely manner.

Keyword

Endoscopic mucosal resection; Indication; Colorectal neoplasms

MeSH Terms

Adenoma
Classification
Colorectal Neoplasms*
Consensus
Data Collection
Inflammation
Narrow Band Imaging

Figure

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  Fig. 1 Approaches of endoscopists to the treatment of tumors ≥2 cm in diameter: preprocedural assessment of histology. SM, submucosa; EPMR, endoscopic piecemeal mucosal resection; ESD, endoscopic submucosal dissection.

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  Fig. 2 Approaches of endoscopists to the treatment of tumors ≥2 cm in diameter: preprocedural assessment of morphology. LST-G, laterally spreading tumor granular; LST-NG, LST-nongranular; EPMR, endoscopic piecemeal mucosal resection; ESD, endoscopic submucosal dissection.

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  Fig. 3 Approaches of endoscopists to the treatment of tumors ≥2 cm in diameter: preprocedural assessment of pit pattern. EPMR, endoscopic piecemeal mucosal resection; ESD, endoscopic submucosal dissection.

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  Fig. 4 Approaches of endoscopists to the treatment of tumors ≥2 cm in diameter: preprocedural assessment of narrow band imaging pattern. EPMR, endoscopic piecemeal mucosal resection; ESD, endoscopic submucosal dissection.

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  Fig. 5 Approaches of endoscopists to the treatment of tumors ≥2 cm in diameter: preprocedural assessment of the nonlifting sign. SM, submucosa; EPMR, endoscopic piecemeal mucosal resection; ESD, endoscopic submucosal dissection.

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  Fig. 6 Approaches of endoscopists to the treatment of tumors ≥2 cm in diameter: preprocedural assessment of special situations. EPMR, endoscopic piecemeal mucosal resection; ESD, endoscopic submucosal dissection.

Reference

1. Niimi K, Fujishiro M, Kodashima S, et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy. 2010; 42:723–729. PMID: 20806156.

2. Repici A, Hassan C, De Paula Pessoa D, et al. Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy. 2012; 44:137–150. PMID: 22271024.

3. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010; 72:1217–1225. PMID: 21030017.

4. Lee EJ, Lee JB, Lee SH, Youk EG. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc. 2012; 26:2220–2230. PMID: 22278105.

5. Saito Y, Uraoka T, Matsuda T, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007; 66:966–973. PMID: 17524403.

6. Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007; 66:100–107. PMID: 17591481.

7. Chang DK. Current status of colorectal endoscopic submucosal dissection in Korea. Clin Endosc. 2012; 45:288–289. PMID: 22977820.

8. Kiriyama S, Saito Y, Yamamoto S, et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis. Endoscopy. 2012; 44:1024–1030. PMID: 23012216.

9. Park SU, Min YW, Shin JU, et al. Endoscopic submucosal dissection or transanal endoscopic microsurgery for nonpolypoid rectal high grade dysplasia and submucosa-invading rectal cancer. Endoscopy. 2012; 44:1031–1036. PMID: 23012217.

10. Saito Y, Fukuzawa M, Matsuda T, et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc. 2010; 24:343–352. PMID: 19517168.

11. Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015; 27:417–434. PMID: 25652022.

12. Lee EJ, Lee JB, Lee SH, et al. Endoscopic submucosal dissection for colorectal tumors--1,000 colorectal ESD cases: one specialized institute's experiences. Surg Endosc. 2013; 27:31–39. PMID: 22729707.

13. Kudo S, Rubio CA, Teixeira CR, Kashida H, Kogure E. Pit pattern in colorectal neoplasia: endoscopic magnifying view. Endoscopy. 2001; 33:367–373. PMID: 11315901.

14. Tanaka S, Sano Y. Aim to unify the narrow band imaging (NBI) magnifying classification for colorectal tumors: current status in Japan from a summary of the consensus symposium in the 79th Annual Meeting of the Japan Gastroenterological Endoscopy Society. Dig Endosc. 2011; 23(Suppl 1):131–139. PMID: 21535219.

15. Gotoda T, Yamamoto H, Soetikno RM. Endoscopic submucosal dissection of early gastric cancer. J Gastroenterol. 2006; 41:929–942. PMID: 17096062.

16. Puli SR, Kakugawa Y, Saito Y, Antillon D, Gotoda T, Antillon MR. Successful complete cure en-bloc resection of large nonpedunculated colonic polyps by endoscopic submucosal dissection: a meta-analysis and systematic review. Ann Surg Oncol. 2009; 16:2147–2151. PMID: 19479308.

17. Kaltenbach T, Sano Y, Friedland S, Soetikno R. American Gastroenterological Association (AGA) Institute technology assessment on imageenhanced endoscopy. Gastroenterology. 2008; 134:327–340. PMID: 18061178.

18. Tanaka S, Kaltenbach T, Chayama K, Soetikno R. High-magnification colonoscopy (with videos). Gastrointest Endosc. 2006; 64:604–613. PMID: 16996357.

19. Ikematsu H, Saito Y, Tanaka S, et al. The impact of narrow band imaging for colon polyp detection: a multicenter randomized controlled trial by tandem colonoscopy. J Gastroenterol. 2012; 47:1099–1107. PMID: 22441532.

20. Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol. 2008; 43:641–651. PMID: 18807125.

21. Iizuka H, Okamura S, Onozato Y, Ishihara H, Kakizaki S, Mori M. Endoscopic submucosal dissection for colorectal tumors. Gastroenterol Clin Biol. 2009; 33:1004–1011. PMID: 19762190.

22. Tajika M, Niwa Y, Bhatia V, et al. Comparison of endoscopic submucosal dissection and endoscopic mucosal resection for large colorectal tumors. Eur J Gastroenterol Hepatol. 2011; 23:1042–1049. PMID: 21869682.

23. Kanao H, Tanaka S, Oka S, Hirata M, Yoshida S, Chayama K. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc. 2009; 69(3 Pt 2):631–636. PMID: 19251003.

24. Oba S, Tanaka S, Oka S, et al. Characterization of colorectal tumors using narrow-band imaging magnification: combined diagnosis with both pit pattern and microvessel features. Scand J Gastroenterol. 2010; 45:1084–1092. PMID: 20350257.

25. Uraoka T, Saito Y, Matsuda T, et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006; 55:1592–1597. PMID: 16682427.

26. Oka S, Tanaka S, Kanao H, Oba S, Chayama K. Therapeutic strategy for colorectal laterally spreading tumor. Dig Endosc. 2009; 21(Suppl 1):S43–S46. PMID: 19691733.

27. Kang SG, Lee SH, Chung SK, et al. Endoscopic treatment strategy for large laterally spreading tumor: endoscopic piecemeal mucosal resection or endoscopic submucosal dissection. Intest Res. 2011; 9:211–216.