Endoscopy 2018; 50(03): 263-282
DOI: 10.1055/s-0043-121144
Review
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis

Roel M. M. Bogie
 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
 2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Manon H. J. Veldman*
 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Luc A. R. S. Snijders*
 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Bjorn Winkens
 3  Department of Methodology and Statistics, Maastricht University Medical Center, Maastricht, The Netherlands
 4  CAPHRI, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
,
Tonya Kaltenbach
 5  Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
 6  Stanford University School of Medicine, Stanford, California, USA
,
Ad A. M. Masclee
 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
 7  NUTRIM, School of Nutrition & Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
,
Takahisa Matsuda
 8  Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
,
Eveline J. A. Rondagh
 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
,
Roy Soetikno
 9  Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
10  National Cancer Center Singapore, Singapore
11  Duke – National University Singapore Graduate Medical School, Singapore
,
Shinji Tanaka
12  Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
,
Han-Mo Chiu
13  Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
,
Silvia Sanduleanu-Dascalescu
 1  Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
 2  GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
› Author Affiliations
Further Information

Publication History

submitted: 01 June 2017

accepted after revision: 14 September 2017

Publication Date:
27 November 2017 (eFirst)

Abstract

Background and study aims Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment.

Methods We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95 % confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes.

Results We identified 2949 studies, of which 48 were included. Overall, 8.5 % (95 %CI 6.5 % – 10.5 %) of LSTs contained SMI. The risk of SMI differed among the LST subtypes: 31.6 % in non-granular pseudodepressed LSTs (95 %CI 19.8 % – 43.4 %), 10.5 % in granular nodular mixed LSTs (95 %CI 5.9 % – 15.1 %), 4.9 % in non-granular flat elevated LSTs (95 %CI 2.1 % – 7.8 %), and 0.5 % in granular homogenous LSTs (95 %CI 0.1 % – 1.0 %). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95 %CI 1.24 – 5.02). The proportion of SMI increased with lesion size (10 – 19 mm, 4.6 %; 20 – 29 mm, 9.2 %; ≥ 30 mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8 % (95 %CI 0.6 % – 1.1 %).

Conclusion The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the preferred therapy.

* Both authors contributed equally


Appendix e1, Fig. e3, Fig. e5, Fig. e7, Fig. e9, Fig. e11–e13, Tab. e2

Appendix e1 Supplementary method