Endoscopic resection techniques for colorectal neoplasia: Current developments

Franz Ludwig Dumoulin, Ralf Hildenbrand, Franz Ludwig Dumoulin, Ralf Hildenbrand

Abstract

Endoscopic polypectomy and endoscopic mucosal resection (EMR) are the established treatment standards for colorectal polyps. Current research aims at the reduction of both complication and recurrence rates as well as on shortening procedure times. Cold snare resection is the emerging standard for the treatment of smaller (< 5mm) polyps and is possibly also suitable for the removal of non-cancerous polyps up to 9 mm. The method avoids thermal damage, has reduced procedure times and probably also a lower risk for delayed bleeding. On the other end of the treatment spectrum, endoscopic submucosal dissection (ESD) offers en bloc resection of larger flat or sessile lesions. The technique has obvious advantages in the treatment of high-grade dysplasia and early cancer. Due to its minimal recurrence rate, it may also be an alternative to fractionated EMR of larger flat or sessile lesions. However, ESD is technically demanding and burdened by longer procedure times and higher costs. It should therefore be restricted to lesions suspicious for high-grade dysplasia or early invasive cancer. The latest addition to endoscopic resection techniques is endoscopic full-thickness resection with specifically developed devices for flexible endoscopy. This method is very useful for the treatment of smaller difficult-to-resect lesions, e.g., recurrence with scar formation after previous endoscopic resections.

Keywords: Adenoma recurrence rate; Cold snare resection; Colorectal cancer screening; Colorectal neoplasia; Endoscopic full-thickness resection; Endoscopic mucosal resection; Endoscopic polypectomy; Endoscopic submucosal dissection.

Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
Cold snare resection. A: Endoscopic appearance of a small polyp in the sigmoid colon. B: Positioning of a specifically dedicated snare for cold snare resection. C: Appearance of the resection field with mild bleeding. D: Histopathology showing tubular adenoma (hematoxylin/eosine, magnification: 80-fold).
Figure 2
Figure 2
Endoscopic submucosal dissection. A: Endoscopic aspect of a large sessile lesion (Paris 0-Is/0-IIa; lateral spreading tumor, granular type) in the cecum. B: Start of endoscopic submucosal dissection at the proximal site. C: Mucosal incision at the distal margin. D: Completed resection with resection bed in the cecum. E: Resected specimen on corkboard. F: Histopathology: tubulovillous adenoma with focal high-grade intraepithelial neoplasia (hematoxylin/eosine, magnification: 80-fold).
Figure 3
Figure 3
Endoscopic full-thickness resection with the full thickness resection device. A: Endoscopic aspect of a recurrence after piecemeal endoscopic mucosal resection in the ascending colon. B: The lesion is marked and retracted into the resection cap using a grasping forceps. C: Resection bed with over the scope clip in situ. Note the periluminal fat within the clip. D: Resected specimen on corkboard. E: Histopathology: full-thickness resection specimen with tubulovillous adenoma/low-grade intraepithelial neoplasia (hematoxylin/eosine, magnification 80-fold).

References

    1. Zauber AG, Winawer SJ, O'Brien MJ, Lansdorp-Vogelaar I, van Ballegooijen M, Hankey BF, Shi W, Bond JH, Schapiro M, Panish JF, Stewart ET, Waye JD. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.
    1. Bénard F, Barkun AN, Martel M, von Renteln D. Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations. World J Gastroenterol. 2018;24:124–138.
    1. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM American College of Gastroenterology. American College of Gastroenterology guidelines for colorectal cancer screening 2009 [corrected] Am J Gastroenterol. 2009;104:739–750.
    1. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Kudo SE, Tsuruta O, Sugihara K, Watanabe T, Saitoh Y, Igarashi M, Toyonaga T, Ajioka Y, Ichinose M, Matsui T, Sugita A, Sugano K, Fujimoto K, Tajiri H. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27:417–434.
    1. Schmiegel W, Buchberger B, Follmann M, Graeven U, Heinemann V, Langer T, Nothacker M, Porschen R, Rödel C, Rösch T, Schmitt W, Wesselmann S, Pox C. S3-Leitlinie – Kolorektales Karzinom. Z Gastroenterol. 2017;55:1344–1498.
    1. Ferlitsch M, Moss A, Hassan C, Bhandari P, Dumonceau JM, Paspatis G, Jover R, Langner C, Bronzwaer M, Nalankilli K, Fockens P, Hazzan R, Gralnek IM, Gschwantler M, Waldmann E, Jeschek P, Penz D, Heresbach D, Moons L, Lemmers A, Paraskeva K, Pohl J, Ponchon T, Regula J, Repici A, Rutter MD, Burgess NG, Bourke MJ. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2017;49:270–297.
    1. Gaglia A, Sarkar S. Evaluation and long-term outcomes of the different modalities used in colonic endoscopic mucosal resection. Ann Gastroenterol. 2017;30:145–151.
    1. Shinozaki S, Kobayashi Y, Hayashi Y, Sakamoto H, Lefor AK, Yamamoto H. Efficacy and safety of cold versus hot snare polypectomy for resecting small colorectal polyps: Systematic review and meta-analysis. Dig Endosc. 2018;30:592–599.
    1. Ito A, Suga T, Ota H, Tateiwa N, Matsumoto A, Tanaka E. Resection depth and layer of cold snare polypectomy versus endoscopic mucosal resection. J Gastroenterol. 2018;53:1171–1178.
    1. Piraka C, Saeed A, Waljee AK, Pillai A, Stidham R, Elmunzer BJ. Cold snare polypectomy for non-pedunculated colon polyps greater than 1 cm. Endosc Int Open. 2017;5:E184–E189.
    1. Tate DJ, Awadie H, Bahin FF, Desomer L, Lee R, Heitman SJ, Goodrick K, Bourke MJ. Wide-field piecemeal cold snare polypectomy of large sessile serrated polyps without a submucosal injection is safe. Endoscopy. 2018;50:248–252.
    1. Jung YS, Park CH, Nam E, Eun CS, Park DI, Han DS. Comparative efficacy of cold polypectomy techniques for diminutive colorectal polyps: a systematic review and network meta-analysis. Surg Endosc. 2018;32:1149–1159.
    1. Moss A, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, Zanati S, Burgess NG, Sonson R, Byth K, Bourke MJ. 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;64:57–65.
    1. Holmes I, Friedland S. Endoscopic Mucosal Resection versus Endoscopic Submucosal Dissection for Large Polyps: A Western Colonoscopist's View. Clin Endosc. 2016;49:454–456.
    1. Bahin FF, Rasouli KN, Byth K, Hourigan LF, Singh R, Brown GJ, Zanati SA, Moss A, Raftopoulos S, Williams SJ, Bourke MJ. Prediction of Clinically Significant Bleeding Following Wide-Field Endoscopic Resection of Large Sessile and Laterally Spreading Colorectal Lesions: A Clinical Risk Score. Am J Gastroenterol. 2016;111:1115–1122.
    1. Belderbos TD, Leenders M, Moons LM, Siersema PD. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy. 2014;46:388–402.
    1. Briedigkeit A, Sultanie O, Sido B, Dumoulin FL. Endoscopic mucosal resection of colorectal adenomas &gt; 20 mm: Risk factors for recurrence. World J Gastrointest Endosc. 2016;8:276–281.
    1. Knabe M, Pohl J, Gerges C, Ell C, Neuhaus H, Schumacher B. Standardized long-term follow-up after endoscopic resection of large, nonpedunculated colorectal lesions: a prospective two-center study. Am J Gastroenterol. 2014;109:183–189.
    1. Tate DJ, Desomer L, Klein A, Brown G, Hourigan LF, Lee EY, Moss A, Ormonde D, Raftopoulos S, Singh R, Williams SJ, Zanati S, Byth K, Bourke MJ. Adenoma recurrence after piecemeal colonic EMR is predictable: the Sydney EMR recurrence tool. Gastrointest Endosc. 2017;85:647–656.e6.
    1. Robertson DJ, Lieberman DA, Winawer SJ, Ahnen DJ, Baron JA, Schatzkin A, Cross AJ, Zauber AG, Church TR, Lance P, Greenberg ER, Martínez ME. Colorectal cancers soon after colonoscopy: a pooled multicohort analysis. Gut. 2014;63:949–956.
    1. Wang J, Zhang XH, Ge J, Yang CM, Liu JY, Zhao SL. Endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal tumors: a meta-analysis. World J Gastroenterol. 2014;20:8282–8287.
    1. Arezzo A, Passera R, Marchese N, Galloro G, Manta R, Cirocchi R. Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United European Gastroenterol J. 2016;4:18–29.
    1. Takeuchi Y, Iishi H, Tanaka S, Saito Y, Ikematsu H, Kudo SE, Sano Y, Hisabe T, Yahagi N, Saitoh Y, Igarashi M, Kobayashi K, Yamano H, Shimizu S, Tsuruta O, Inoue Y, Watanabe T, Nakamura H, Fujii T, Uedo N, Shimokawa T, Ishikawa H, Sugihara K. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis. 2014;29:1275–1284.
    1. Nishizawa T, Yahagi N. Endoscopic mucosal resection and endoscopic submucosal dissection: technique and new directions. Curr Opin Gastroenterol. 2017;33:315–319.
    1. Uraoka T, Parra-Blanco A, Yahagi N. Colorectal endoscopic submucosal dissection: is it suitable in western countries? J Gastroenterol Hepatol. 2013;28:406–414.
    1. Yang DH, Jeong GH, Song Y, Park SH, Park SK, Kim JW, Jung KW, Kim KJ, Ye BD, Myung SJ, Yang SK, Kim JH, Park YS, Byeon JS. The Feasibility of Performing Colorectal Endoscopic Submucosal Dissection Without Previous Experience in Performing Gastric Endoscopic Submucosal Dissection. Dig Dis Sci. 2015;60:3431–3441.
    1. Berr F, Wagner A, Kiesslich T, Friesenbichler P, Neureiter D. Untutored learning curve to establish endoscopic submucosal dissection on competence level. Digestion. 2014;89:184–193.
    1. Sauer M, Hildenbrand R, Oyama T, Sido B, Yahagi N, Dumoulin FL. Endoscopic submucosal dissection for flat or sessile colorectal neoplasia &gt; 20 mm: A European single-center series of 182 cases. Endosc Int Open. 2016;4:E895–E900.
    1. Probst A, Ebigbo A, Märkl B, Schaller T, Anthuber M, Fleischmann C, Messmann H. Endoscopic submucosal dissection for early rectal neoplasia: experience from a European center. Endoscopy. 2017;49:222–232.
    1. ASGE Technology Committee. Maple JT, Abu Dayyeh BK, Chauhan SS, Hwang JH, Komanduri S, Manfredi M, Konda V, Murad FM, Siddiqui UD, Banerjee S. Endoscopic submucosal dissection. Gastrointest Endosc. 2015;81:1311–1325.
    1. Bhatt A, Abe S, Kumaravel A, Vargo J, Saito Y. Indications and Techniques for Endoscopic Submucosal Dissection. Am J Gastroenterol. 2015;110:784–791.
    1. Bahin FF, Heitman SJ, Rasouli KN, Mahajan H, McLeod D, Lee EYT, Williams SJ, Bourke MJ. Wide-field endoscopic mucosal resection versus endoscopic submucosal dissection for laterally spreading colorectal lesions: a cost-effectiveness analysis. Gut. 2018;67:1965–1973.
    1. Kiriyama S, Saito Y, Yamamoto S, Soetikno R, Matsuda T, Nakajima T, Kuwano H. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis. Endoscopy. 2012;44:1024–1030.
    1. Ahlenstiel G, Hourigan LF, Brown G, Zanati S, Williams SJ, Singh R, Moss A, Sonson R, Bourke MJ Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group. Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointest Endosc. 2014;80:668–676.
    1. Nakamura F, Saito Y, Sakamoto T, Otake Y, Nakajima T, Yamamoto S, Murakami Y, Ishikawa H, Matsuda T. Potential perioperative advantage of colorectal endoscopic submucosal dissection versus laparoscopy-assisted colectomy. Surg Endosc. 2015;29:596–606.
    1. Jayanna M, Burgess NG, Singh R, Hourigan LF, Brown GJ, Zanati SA, Moss A, Lim J, Sonson R, Williams SJ, Bourke MJ. Cost Analysis of Endoscopic Mucosal Resection vs Surgery for Large Laterally Spreading Colorectal Lesions. Clin Gastroenterol Hepatol. 2016;14:271–278.e1-2.
    1. Schurr MO, Baur FE, Krautwald M, Fehlker M, Wehrmann M, Gottwald T, Prosst RL. Endoscopic full-thickness resection and clip defect closure in the colon with the new FTRD system: experimental study. Surg Endosc. 2015;29:2434–2441.
    1. Fähndrich M, Sandmann M. Endoscopic full-thickness resection for gastrointestinal lesions using the over-the-scope clip system: a case series. Endoscopy. 2015;47:76–79.
    1. Richter-Schrag HJ, Walker C, Thimme R, Fischer A. [Full thickness resection device (FTRD). Experience and outcome for benign neoplasms of the rectum and colon] Chirurg. 2016;87:316–325.
    1. Backes Y, Kappelle WFW, Berk L, Koch AD, Groen JN, de Vos Tot Nederveen Cappel WH, Schwartz MP, Kerkhof M, Siersema PD, Schröder R, Tan TG, Lacle MM, Vleggaar FP, Moons LMG T1 CRC Working Group. Colorectal endoscopic full-thickness resection using a novel, flat-base over-the-scope clip: a prospective study. Endoscopy. 2017;49:1092–1097.
    1. Al-Bawardy B, Rajan E, Wong Kee Song LM. Over-the-scope clip-assisted endoscopic full-thickness resection of epithelial and subepithelial GI lesions. Gastrointest Endosc. 2017;85:1087–1092.
    1. Schmidt A, Beyna T, Schumacher B, Meining A, Richter-Schrag HJ, Messmann H, Neuhaus H, Albers D, Birk M, Thimme R, Probst A, Faehndrich M, Frieling T, Goetz M, Riecken B, Caca K. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut. 2018;67:1280–1289.

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