Endoscopic full-thickness resection for the treatment of local residual neoplastia in the colon – an analysis of 19 cases

Czech version

Authors: Přemysl Falt ^1,2; T. Hucl ³; P. Fojtík ⁴; P. Drastich ³; J. Martínek ³; R. Andělová ⁵; L. Voska ⁶; J. Špičák ³; O. Urban ^1,2
Authors‘ workplace: II. interní klinika – gastroenterologie a geriatrie LF UP a FN Olomouc ¹; Katedra interních oborů, LF UK v Hradci Králové ²; Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha ³; Centrum péče o zažívací trakt, Vítkovická nemocnice a. s., Ostrava ⁴; Oddělení patologie, Nemocnice Nový Jičín a. s. ⁵; Pracoviště klinické a transplantační patologie, Transplantcentrum, IKEM, Praha ⁶
Published in: Gastroent Hepatol 2018; 72(3): 206-211
Category:
doi: https://doi.org/10.14735/amgh2018206

Overview

Introduction:
Endoscopic full-thickness resection (FTR) is a novel endoscopic technique that allows transmural resection of the colonic wall. Limited data suggest that FTR is efficacious and safe for the management of local residual neoplasia (LRN). Standard endoscopic treatment of LRN is usually complicated by scarring and non-lifting sign caused by a previous endoscopic resection.

Methods:
We prospectively evaluated patients treated with FTR for difficult LRN after at least one session of endoscopic treatment in two tertiary endoscopic centers between June 2016 and January 2018. Primary outcomes were technical success rate, R0, and curative resection rate and occurrence of complications.

Results:
Nineteen patients with LRN (age 69.2 ± 10.5 years; 79% males) were treated between June 2016 and January 2018. Six cases of LRN were localized in the rectum and 13 cases in the colon. Mean size of the lesions was 16 (8–25) mm. There were four cases of low-grade dysplasia adenoma, 13 cases of high-grade dysplasia adenoma, one intramucosal adenocarcinoma, and one adenocarcinoma with superficial submucosal invasion. FTR was technically successful in 90% (17/19) of cases. R0 and concurrently curative resection was achieved in 74% (14/19) of cases. In 2 patients with large LRNs, a combination of endoscopic mucosal resection and FTR was successfully used. Complications were noted in 11% (2/19) of cases, 1 patient suffered from delayed bleeding, and one patient from acute appendicitis, but both responded to conservative treatment. Conclusion: In our series of 19 patients with difficult LRN, FTR was technically feasible in 90% of cases. Both R0 and curative resection were achieved in 74% of cases. Mild complications not requiring surgery occurred in 11% of patients.

Key words:
local residual neoplasia – endoscopic full-thickness resection – endoscopic mucosal resection – colorectal cancer

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted: 16. 4. 2018

Accepted: 12. 5. 2018

Sources

1. Schmidt A, Meier B, Caca K. Endoscopic full-thickness resection: current status. World J Gastroenterol 2015; 21 (31): 9273–9285. doi: 10.3748/wjg.v21.i31.9273.

2. Schmidt A, Beyna T, Schumacher B et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2017. In press. doi: 10.1136/gutjnl-2016-313677.

3. Falt P, Urban O, Suchánek Š et al. Doporučené postupy České gastroenterologické společnosti JEP pro diagnostickou a terapeutickou koloskopii. Gastroent Hepatol 2016; 70 (6): 523–538. doi: 10.14735/amgh2016csgh.info19.

4. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58 (6 Suppl): S3–S43.

5. 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 (5): 806–820. doi: 10.1136/gutjnl-2014-308481.

6. Belderbos TD, Leenders M, Moons LM et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46 (5): 388–402. doi: 10.1055/s-0034-1364970.

7. Urban O, Kijonkova B, Kajzrlikova IM et al. Local residual neoplasia after endoscopic treatment of laterally spreading tumors during 15 months of follow-up. Eur J Gastroenterol Hepatol 2013; 25 (6): 733–738. doi: 10.1097/MEG.0b013e32835eda96.

8. Brogyuk N, Grega T, Voška M et al. Rizikové faktory lokální reziduální neoplazie po endoskopické mukózní resekci. Gastroenterol Hepatol 2017; 71 (5): 394–400. doi: 10.14735/amgh2017394

9. Moss A, Williams SJ, Hourigan LF et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64 (1): 57–65. doi: 10.1136/gutjnl-2013-305516.

10. Cottet V, Jooste V, Fournel I et al. Long-term risk of colorectal cancer after adenoma removal: a population-based cohort study. Gut 2012; 61 (8): 1180–1186. doi: 10.1136/gutjnl-2011-300295.

11. 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 (8): 1107–1115.

12. Urban O, Pipek B, Kajzrlikova IM et al. The efficacy of treatment of local residual neoplasia under standardized conditions. Vnitr Lek 2016; 62 (5): 365–369.

13. Le Roy F, Manfredi S, Hamonic S et al. Frequency of and risk factors for the surgical resection of nonmalignant colorectal polyps: a population-based study. Endoscopy 2016; 48 (3): 263–270. doi: 10.1055/s-0034-1392976.

14. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47 (9): 829–854. doi: 10.1055/s-0034-1392882.

15. Kuroki Y, Hoteya S, Mitani T et al. Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors. J Gastroenterol Hepatol 2010; 25 (11): 1747–1753. doi: 10.1111/j.1440-1746.2010.06331.x.

16. Falt P, Urban O, Hanousek M et al. “Full-thickness” endoskopická resekce lokální reziduální neoplazie v hepatální flexure – videokazuistika. Gastroenterol Hepatol 2016; 70 (5): 398–401. doi: 10.14735/amgh2016398

17. Falt P, Štěpán M, Andělová R et al. Kombinace endoskopické slizniční resekce a transmurální resekce v léčbě lokálních reziduálních neoplazií tračníku – popis dvou případů. Rozhl Chir 2017; 96 (9): 394–398.

18. Falt P, Andělová R, Urban O. Kombinace endoskopické slizniční resekce a „full-thickness“ resekce v léčbě adenomu ascendens s příznakem „non-liftingu“ – kazuistika. Gastroenterol Hepatol 2017; 72 (2): 148–151. doi: 10.14735/amgh2018csgh.info03.