The role of endoscopic mucosal resection in gastrointestinal precancerous lesions

Year 2017, Volume: 30 Issue: 2, 92 - 100, 14.05.2017

Suleyman Orman Orhan Gultekın

https://doi.org/10.5472/marumj.344819

Abstract

Objectives: Endoscopic mucosal resection (EMR) has

been widely used in early gastrointestinal malignancies and

precancerous lesions. We aim to analyze the outcomes of EMR for

gastrointestinal precancerous lesions.

Materials and Methods: A total of 1,518 cases were

retrospectively analyzed. Of these, 59 patients had undergone

EMR for gastrointestinal lesions. The lesions were divided into

two subgroups according to size; smaller than 20 mm and equal or

larger than 20 mm. The mucosal aspect (Kudo pit pattern), Paris

classification of the resected lesions and recurrences that were

determined during close follow-up were recorded.

Results: A total of 94 polyps were resected in 59 patients.

En-block resection was performed in 42 (71.2%) patients and

piecemeal resection in 17 (28.8%). There was no significant

difference between two modalities; regarding age, gender,

histopathology, complications, recurrence or macroscopic type

(P>0.05). However, the occurrence of Kudo type 4 lesions and

adenomatous polyps (P=0.001) was significant in the >20 mm

group (P=0.03).

Conclusion: Endoscopic mucosal resection is a safe and

feasible procedure for precancerous lesions, with low complication

and acceptable recurrence rates. Additionally, the Kudo pit pattern

should be taken into consideration on a routine basis when

determining the risk of cancer.

Keywords

Endoscopic mucosal resection, Gastrointestinal precancerous lesion, Pit pattern, Recurrence

References

• Consolo P, Luigiano C, Strangio G, et al. Efficacy, risk factors and complications of endoscopic polypectomy: ten year experience at a single center. World J Gastroenterol 2008; 14: 2364-9.
• Alexander S, Bourke MJ, Williams SJ, et al. EMR of large, sessile, sporadic nonampullary duodenal adenomas: technical aspects and long-term outcome (with videos). Gastrointest Endosc 2009; 69: 66-73.
• Bergmann U, Beger HG. Endoscopic mucosal resection for advanced non-polypoid colorectal adenoma and early stage carcinoma. Surg Endosc 2003; 17: 475-9.
• Yokota T, Sugihara K, Yoshida S. Endoscopic mucosal resection for colorectal neoplastic lesions. Dis Colon Rectum 1994; 37: 1108-11.
• Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-81.
• Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-96. doi: 10.1056/ NEJMoa1100370
• Woodward TA, Heckman MG, Cleveland P, et al. Predictors of complete endoscopic mucosal resection of flat and depressed gastrointestinal neoplasia of the colon. Am J Gastroenterol 2012; 107: 650-4. doi: 10.1038/ajg.2011.473
• Buchner AM, Guarner-Argente C, Ginsberg GG. Outcomes of EMR of defiant colorectal lesions directed to an endoscopy referral center. Gastrointest Endosc 2012; 76: 255-63. doi: 10.1016/j.gie.2012.02.060
• Moss A, Bourke MJ, Williams SJ, et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-18. doi: 10.1053/j.gastro.2011.02.062
• Barendse RM, van den Broek FJ, Dekker E, et al. Systematic review of endoscopic mucosal resection versus transanal endoscopic microsurgery for large rectal adenomas. Endoscopy 2011; 43: 941-9.
• Cotton PB, Eisen G, Romagnuolo J, et al. Grading the complexity of endoscopic procedures: results of an ASGE working party. Gastrointest Endosc 2011; 73: 868-74. doi: 10.1016/j.gie.2010.12.036
• Ponchon T. Endoscopic mucosal resection. J Clin Gastroenterol 2001; 32: 6-10.
• Binmoeller KF, Bohnacker S, Seifert H, et al. Endoscopic snare excision of “giant” colorectal polyps. Gastrointest Endosc 1996; 43: 183-8.
• Regula J, Wronska E, Polkowski M, et al. Argon plasma coagulation after piecemeal polypectomy of sessile colorectal adenomas: long-term follow-up study. Endoscopy 2003; 35: 212-8.
• Stergiou N, Riphaus A, Lange P, et al. Endoscopic snare resection of large colonic polyps: how far can we go? Int J Colorectal Dis 2003; 18: 131-5.
• Bories E, Pesenti C, Monges G, et al. Endoscopic mucosal resectio for advanced sessile adenoma and early-stage colorectal carcinoma. Endoscopy 2006; 38: 231-5.
• Arebi N, Swain D, Suzuki N, et al. Endoscopic mucosal resection of 161 cases of large sessile or flat colorectal polyps. Scand J Gastroenterol 2007; 42: 859-66.
• Zlatanic J, Waye JD, Kim PS, et al. Large sessile colonic adenomas: use of argon plasma coagulator to supplement piecemeal snare polypectomy. Gastrointest Endosc 1999; 49: 731-5.
• Doniec JM, Löhnert MS, Schniewind B, et al. Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum 2003; 46: 340-8.
• Bedogni G, Bertoni G, Ricci E, et al. Colonoscopic excision of large and giant colorectal polyps. Technical implications and results over eight years. Dis Colon Rectum 1986; 29: 831-5.
• Kanao H, Tanaka S, Oka S, et al. Clinical significance of type V(I) pit pattern subclassification in determining the depth of invasion of colorectal neoplasms. World J Gastroenterol 2008;14:211-7.
• Facciorusso A, Antonino M, Di Maso M, et al. Non-polypoid colorectal neoplasms: Classification, therapy and follow-up. World J Gastroenterol 2015;21:5149-57. doi: 10.3748/wjg. v21.i17.5149
• Fenger C, Bak M, Kronborg O, Svanholm H. Observer reproducibility in grading dysplasia in colorectal adenomas: comparison between two different grading systems. J Clin Pathol 1990; 43: 320-4.
• Haggitt RC, Glotzbach RE, Soffer EE, Wruble LD. Prognostic factors in colorectal carcinomas arising in adenomas: implications for lesions removed by endoscopic polypectomy. Gastroenterology 1985; 89: 328-36.
• Kikuchi R, Takano M, Takagi K, et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995; 38: 1286-95.
• Lezoche E, Feliciotti F, Paganini AM, et al. Laparoscopic vs open hemicolectomy for colon cancer. Surg Endosc 2002; 16: 596-602.
• Song JH, Choi YY, An JY, et al. Short-Term Outcomes of Laparoscopic Total Gastrectomy Performed by a Single Surgeon Experienced in Open Gastrectomy: Review of Initial Experience. J Gastric Cancer 2015;15:159-66. doi: 10.5230/jgc.2015.15.3.159
• Su MY, Hsu CM, Ho YP, et al. Endoscopic mucosal resection for colonic non-polypoid neoplasms. Am J Gastroenterol 2005; 100: 2174-9.
• Kunihiro M, Tanaka S, Haruma K, et al. Electrocautery snare resection stimulates cellular proliferation of residual colorectal tumor: an increasing gene expression related to tumor growth. Dis Colon Rectum 2000; 43: 1107-15.
• Espinel J, Pinedo E, Ojeda V, Del Rio MG. Treatment modalities for early gastric cancer. World J Gastrointest Endosc 2015;7:1062-9. doi:10.4253/wjge.v7.i12.1062
• Alberts DS, Martinez ME, Roe DJ, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. Phoenix Colon Cancer Prevention Physicians’ Network. N Engl J Med 2000;342:1156-62.
• Bonithon-Kopp C, Piard F, Fenger C, et al. Colorectal adenoma characteristics as predictors of recurrence. Dis Colon Rectum 2004; 47: 323–33.
• Schatzkin A, Lanza E, Corle D, et al. Lack of effect of a lowfat, high-fiber diet on the recurrence of colorectal adenomas. Polyp Prevention Trial Study Group. N Engl J Med 2000; 342:1149–55.
• Wallace K, Baron JA, Cole BF, et al. Effect of calcium supplementation on the risk of large bowel polyps. J Natl Cancer Inst 2004; 96: 921–5.
• Brooker JC, Saunders BP, Shah SG, et al. Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: A randomized trial and recommendations. Gastrointest Endosc 2002; 55: 371–5.