CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(12): E1714-E1722
DOI: 10.1055/a-1010-5663
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience

Dennis Yang
 1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Hiroyuki Aihara
 2   Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Boston, MA, USA
,
Yaseen B. Perbtani
 1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Andrew Y. Wang
 3   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
,
Abdul Aziz Aadam
 4   Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA
,
Yutaka Tomizawa
 5   Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
,
Joo Ha Hwang
 5   Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
,
Baiming Zou
 6   Department of Biostatistics, University of Florida, Gainesville, FL, USA
,
Nikola S. Natov
 3   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
,
Amanda Siegel
 4   Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA
,
Milad Pourmousavi Khoshknab
 7   Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
,
Mouen A. Khashab
 7   Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
,
Saowanee Ngamruengphong
 7   Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
,
Harshit S. Khara
 8   Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA
,
David L. Diehl
 8   Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA
,
Thibaut Maniere
 9   Division of Gastroenterology and Hepatology, Universite de Sherbrooke, Sherbrook, QC, Canada
,
Sherif Andrawes
10   Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA
,
Petros Benias
10   Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA
,
Nikhil A. Kumta
11   Division of Gastroenterology, Mount Sinai Hospital, New York, NY, USA
,
Fariha Ramay
12   Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
,
Raymond E. Kim
12   Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
,
Jason Samarasena
13   Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
,
Kenneth Chang
13   Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
,
Rintaro Hashimoto
13   Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
,
Benjamin Tharian
14   Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA
,
Sumant Inamdar
14   Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA
,
Gloria Lan
15   Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA
,
Amrita Sethi
15   Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA
,
Michael J. Nosler
16   UC Health Medical Group, Fort Collins, CO, USA
,
Abdalaziz Tabash
17   Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA
,
Mohamed O. Othman
17   Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA
,
Peter V. Draganov
 1   Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
› Author Affiliations
Further Information

Publication History

submitted 09 June 2019

accepted after revision 16 August 2019

Publication Date:
02 December 2019 (online)

Abstract

Background and aims Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America.

Methods This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection.

Results In total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8–88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4–81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19–76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection.

Conclusion Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease.

 
  • References

  • 1 Jayanna M, Burgess NG, Sing R. et al. Cost analysis of endoscopic mucosal resection vs surgery for large laterally spreading colorectal lesions. Clin Gastroenterol Hepatol 2016; 14: 271-278
  • 2 Ahlenstiel G, Hourigan LF, Brown G. et al. Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc 2014; 80: 668-676
  • 3 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
  • 4 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
  • 5 Draganov PV, Wang AY, Othman MO. et al. Clinical practice of endoscopic submucosal dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25
  • 6 Kotzev AI, Yang D, Draganov PV. How to master endoscopic submucosal dissection in the USA. Dig Endosc 2019; 31: 94-100
  • 7 Yang D, Othman M, Draganov PV. Endoscopic mucosal resection vs endoscopic submucosal dissection for Barrett’s esophagus and colorectal neoplasia. Clin Gastroenterol Hepatol 2019; 17: 1019-1028
  • 8 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86
  • 9 The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-S43
  • 10 Kudo S, Lamber R, Allen JI. et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 2008; 68: S3-S47
  • 11 Kim EK, Han DS, Ro Y. et al. The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection?. Intest Res 2016; 14: 358-364
  • 12 Hamilton SR, Bosman FT, Boffetta P. et al. Carcinoma of the colon and rectum. WHO classification of tumours of the digestive system. J Clin Ultrasound 2014; 1: 1-6
  • 13 Schlemper RJ, Riddel RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
  • 14 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 450-454
  • 15 Benson 3rd AB, Venook AP, Cederquist L. et al. Colon cancer, Version 1. 2017, NCC Clinical Practice Guideline in Oncology. J Natl Compr Canc Netw 2017; 15: 370-398
  • 16 Oka S, Tanaka S, Saito Y. et al. Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 2015; 110: 697-707
  • 17 Khashab M, Eid E, Rusche M. et al. Incidence and predictors of “late” recurrences after endoscopic piecemeal resection of large sessile adenomas. Gastrointest Endosc 2009; 70: 344-349
  • 18 Russo P, Barbeiro S, Awadie H. et al. Management of colorectal laterally spreading tumors: a systematic review and meta-analysis. Endosc Int Open 2019; 7: E239-E259
  • 19 Terasaki M, Tanaka S, Oka S. et al. Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 2012; 27: 734-740
  • 20 Pidala MJ, Cusick MV. The difficult colorectal polyp. Surg Clin North Am 2017; 97: 515-527
  • 21 Ngamruengphong S, Pohl H, Haito-Chavez Y. et al. Update on difficult polypectomy techniques. Curr Gastroenterol Rep 2016; 18: 3
  • 22 Hassan C, Repici A, Sharma P. et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65: 806-820
  • 23 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: 1909-1918
  • 24 Barendse R, Musters GD, de Graaf EJR. et al. Randomised controlled trial of transanal endoscopic microsurgery versus endoscopic mucosal resection for large rectal adenomas (TREND Study). Gut 2017; 67: 837-846
  • 25 Bronzwaer M, Musters GD, Barendse R. et al. The occurrence and characteristics of endoscopically unexpected malignant degeneration in large rectal adenomas. Gastrointest Endosc 2017; 87: 862-871
  • 26 Yang D, Draganov PV. Removing large rectal polyps: when the whole may be greater than the sum of its parts. Gastrointest Endosc 2018; 87: 872-874
  • 27 Yang D, Draganov PV. Endoscopic submucosal dissection (ESD) in 2018: A minimally invasive curative approach for select rectal lesions. Am J Gastroenterol 2019; 114: 687
  • 28 Kim JH, Kim YJ, An J. et al. Endoscopic features suggesting gastric cancer in biopsy-proven gastric adenoma with high-grade neoplasia. World J Gastroenterol 2014; 20: 12233-12240
  • 29 Yang MJ, Shin SJ, Lim SG. et al. Comparison of clinical and endoscopic characteristics among upgrade, concordance and downgrade pathology after ESD. Gastrointest Endosc 2014; 81: AB250