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Objective To analyze the accuracy and influencing factors of miniprobe ultrasonic endoscope in evaluating submucosal infiltration of colorectal laterally spreading tumor(LST).Method A retrospective analysis was conducted on the clinical data of 213 patients(268 lesions in total)with colorectal LST who underwent endoscopic submucosal dissection(ESD)treatment from June 2018 to August 2021.We summarized the clinical pathological characteristics and miniprobe ultrasonic endoscope examination results of LST,then analyzed the accuracy of miniprobe ultrasonic endoscope examination and the risk factors affecting the accuracy of miniprobe ultrasonic endoscope examination.Results The accuracy rate of miniprobe ultrasonic endoscope examination was 93.28%,and there was a statistically significant difference in the accuracy rate of miniprobe ultrasonic endoscope examination between different lesion surface morphologies(P = 0.000).Multivariate Logistic regression analysis showed that mix-ed nodule and false depression lesions were risk factors for inaccurate EUS assessment.Conclusion Colorectal LST is a special type of tumor,and miniprobe ultrasonic endoscope examination has a high accuracy in evaluating its infiltration depth.The surface morphology of the lesion is a risk factor that affects the accuracy of miniprobe ultrasonic endoscope examination.When the lesion is a nodule mixed type or pseudo depressed type,it can easily lead to inaccurate miniprobe ultrasonic endoscope examination.
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BACKGROUND AND AIMS: To date, western data on colorectal ESD are limited. This study aimed to assess the efficacy and safety of rectal ESD for superficial lesions ≥ 8 cm. METHODS: A total of 138 superficial rectal neoplasms treated by ESD were allocated in two groups: 25 in the "giant" ESD group and 113 in the control group. RESULTS: En bloc resection was achieved in 96% of cases in both groups. En bloc R0 resection rate was similar between the "giant" ESD group and the control group (84% vs 86%; p: 0.5) and curative resection was higher in the control group (81%) than in "giant" ESD group (68%) without reaching statistical significance (p: 0.2). Dissection time was significantly longer in the "giant" ESD group (251 vs 108 min; p <0.001), however, dissection speed was significantly higher (0.35 vs 0.17 cm2/min; p: 0.02).). Post-ESD stenosis was observed in 2 patients from the "giant" ESD group (8% vs 0% of control group, p: 0.03). No significant differences were found in delayed bleeding, perforation, local recurrences, and need for additional surgery. CONCLUSIONS: ESD for superficial rectal tumors ≥ 8 cm is a feasible, safe, and effective therapeutic option.
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Neoplasias Colorrectales , Resección Endoscópica de la Mucosa , Neoplasias del Recto , Humanos , Neoplasias Colorrectales/patología , Resección Endoscópica de la Mucosa/efectos adversos , Colonoscopía , Estudios Retrospectivos , Mucosa Intestinal/cirugía , Mucosa Intestinal/patología , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Resultado del TratamientoRESUMEN
Background: Endoscopic ultrasonography is an effective endoscopic examination method for determining the depth of colorectal cancer invasion. Narrow-band imaging (NBI) techniques increase the contrast of vascular structures and more clearly highlight subtle structures on mucosal surfaces, thereby improving the accuracy of endoscopic assessment. This study investigated the diagnostic efficacy of NBI in colorectal laterally spreading tumor (LST) and its submucosal invasion. Methods: A total of 224 patients with colorectal LST admitted to the Affiliated Hospital of Putian University from January 2015 to December 2021 were enrolled in this study. The patients were divided into NBI and endoscopic ultrasonography groups according to the different examination methods they received. Subsequently, the clinicopathological characteristics of the patients were collected, and the rates of submucosal invasion of the four subtypes (LST-G-H, LST-G-NM, LST-NG-F, LST-NG-PD) were compared between the two groups. Also, the accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of judging the depth of LST lesions of the two examination methods were compared, taking the results of pathological tissue examination as the gold standard. Results: This study enrolled 224 patients with LST (mean onset age: 57.98±6.48 years), including 123 males and 101 females. In terms of tumor location, 21 cases were located in the cecum, 22 cases in the ascending colon, 38 cases in the transverse colon, 11 cases in the descending colon, 12 cases in the descending sigmoid junction, 23 cases in the sigmoid colon, and 97 cases in the rectum. The sizes of the tumors ranged from 18.81 to 52.88 mm. Moreover, there were 21 cases of lesion infiltration into the submucosa, and the infiltration rate was 9.38%. Furthermore, the accuracy of NBI in diagnosing colorectal LST was significantly higher than that of endoscopic ultrasonography (87.05% vs. 57.14%); NBI was more accurate than endoscopic ultrasonography in the preoperative diagnosis of LST lesion depth in the rectal, non-rectal, granular (LST-G), non-granular (LST-NG), <40, and ≥40 mm groups. Conclusions: Gastrointestinal NBI has a superior accuracy rate and value than endoscopic ultrasonography in diagnosing colorectal LST, tumor lesion depth, and submucosal invasion. Therefore, gastrointestinal NBI deserves to be promoted in clinical work.
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BACKGROUND: Endoscopic submucosal dissection (ESD) is a standard method for treating selected colorectal laterally spreading tumors (LSTs). However, technical difficulty occurs with the increase in tumor size, and little is known about the efficacy of ESD treatment in colorectal LSTs ≥10 cm. The present study aimed to report the feasibility, safety, and efficacy of ESD for rectal-sigmoid LSTs ≥10 cm. METHODS: From May 2012 to December 2019, patients with rectal-sigmoid LSTs ≥10 cm and underwent colorectal ESD were enrolled retrospectively. Demographic features, procedure-related parameters (procedure time, adverse events, rate of en bloc resection and complete resection), and follow-up results were recorded and analyzed. RESULTS: A total of 10 patients successfully underwent ESD: nine patients received conventional ESD, while the other one underwent tunneling ESD. The median diameter of the LSTs was 11.5 cm, and the median procedure time was 210 minutes. The rates of en bloc and curative resection rates were 100% and 90%, respectively. Of the ten patients, four had developed adverse events, one had intraoperative bleeding, two patients had delayed bleeding, and the other one had postoperative fever and rectum stricture postoperatively. None of the patients experienced recurrence during a median follow-up of 62 months. CONCLUSIONS: ESD can be used as a feasible, safe and effective treatment modality for the management of rectal-sigmoid LSTs ≥10 cm.
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BACKGROUND: Laterally spreading tumor (LST) is a type of precancerous lesion of colorectal cancer with high malignant potential. The present study aimed to evaluate long-term outcomes of endoscopic treatment for LST in Chinese patients. METHODS: This study was a retrospective review of data collected from 653 included patients with LST from six regional representative hospitals in China between January 2007 and January 2017. Demographic characteristics, endoscopic features of LST, operation-related data, and follow-up results were collected and analyzed. RESULTS: LST-granular type (LST-G, 80.3%) was much more common than LST-non-grandular type (LST-NG, 19.7%). The overall submucosal invasion rate of all LSTs was 6.1% and the submucosal invasion rate of LST-NG was significantly higher than that of LST-G (6.79% vs. 3.87%, p = 0.000). The en bloc resection rate of ESD and EMR treatment was 96% and 93.7%, respectively, with pathologic R0 resection rate of 90.1% and 82.8%. After an average duration of follow-up about 34.52 ± 11.76 months, the recurrence rate of ESD was 3.47%, and the recurrence rate of EMR was 8.8% after an average follow-up of about 38.44 ± 4.42 months. However, the recurrence rate of ESD was much lower than piecemeal EMR for LST (3.47% vs. 8.62%, p = 0.017). Retroflexion-assisted technique applied for resection of rectal LST was associated with a significantly shortened operating time (85.40 min vs. 174.18 min, p = 0.002). CONCLUSION: Endoscopic resection is a safe and efficient modality for the treatment of colorectal LST with a relatively low recurrence rate and shortened operating time with the use of retroflexion.
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Neoplasias Colorrectales/cirugía , Endoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Neoplasias del Recto/patología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Since the endoscopic resection of laterally spreading tumors (LSTs) involving the appendiceal orifice remains technically difficult, such lesions are usually treated by surgical resection. However, with recent advances in endoscopic devices, endoscopic submucosal dissection (ESD) has become feasible and may be safely performed even for lesions involving the appendiceal orifice. Therefore, in order to assess the validity of endoscopic treatment for such lesions, we retrospectively evaluated the safety and efficacy of ESD. METHODS: A total of 30 patients with LSTs extending to within 10 mm of the appendiceal orifice (Group AO) and 122 patients with cecal LSTs located away from the appendiceal orifice (Group C) who were treated between December 2011 and September 2015 were retrospectively enrolled in the present study. The indications for ESD were determined by the preoperative endoscopic diagnosis made on the basis of Kudo's pit pattern classification. Based on these preoperative endoscopic diagnoses, 8 of the 30 enrolled patients underwent surgical resection as the initial treatment, because the tumor showed deep invasion beyond the orifice and/or a VN pit pattern was visible. The treatment outcomes (en bloc R0 resection rates, tumor size, procedure time, and complication rates) were compared between the two groups. RESULTS: The sensitivity and specificity for the cancer diagnosis were 81.8 and 94.7%, respectively. There was no significant difference in the en bloc R0 resection rate between Group AO and Group C (90.9 vs. 95.9%, P = 0.23). Furthermore, there were also no differences in the mean tumor size (30.0 ± 20.8 vs. 34.9 ± 14.5 mm, P = 0.17) or mean OR time (55.0 ± 39.2 vs. 58.9 ± 48.2 min P = 0.72) between the two groups. One case from Group AO (4.5%) was complicated by a perforation, which was successfully managed endoscopically. CONCLUSIONS: Although proficiency in endoscopic techniques is required, our results indicate that LSTs involving the appendiceal orifice can be successfully treated by ESD.
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Apéndice/patología , Neoplasias del Ciego/cirugía , Disección , Resección Endoscópica de la Mucosa , Endoscopía , Mucosa Intestinal/patología , Anciano , Neoplasias del Ciego/patología , Disección/métodos , Resección Endoscópica de la Mucosa/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Objective To investigate the relationship between the morphological features, pit pattern classification and pathological types of colorectal laterally spreading tumor (LST). To provide a basis for the selection of treatment modalities, and to explore the value of endoscopic treatment. Methods Retrospective analysis of 17 cases of LST from January 2015 to December 2016 detected by conventional endoscopy. 17 cases of LST first underwent dyeing magnifying endoscopy and pit pattern typing. Endoscopic submucosal dissection (ESD) or surgical treatment was performed in all patients with LST. Postoperative pathologic findings were analyzed retrospectively. Results Of the 17 cases, ESD was performed in 15 patients, and other 2 patients underwent surgical treatment. All of the 17 cases were treated successfully without complications such as bleeding or perforation. No recurrence was found under endoscopy in the 3-month to 2-year postoperative review. Conclusion The preoperative pit pattern classification can provide the basis for treatment. ESD has good curative effect, low recurrence rate and good safety in the treatment of colorectal LST.
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Objective To investigate the relationship between the morphological features, pit pattern classification and pathological types of colorectal laterally spreading tumor (LST). To provide a basis for the selection of treatment modalities, and to explore the value of endoscopic treatment. Methods Retrospective analysis of 17 cases of LST from January 2015 to December 2016 detected by conventional endoscopy. 17 cases of LST first underwent dyeing magnifying endoscopy and pit pattern typing. Endoscopic submucosal dissection (ESD) or surgical treatment was performed in all patients with LST. Postoperative pathologic findings were analyzed retrospectively. Results Of the 17 cases, ESD was performed in 15 patients, and other 2 patients underwent surgical treatment. All of the 17 cases were treated successfully without complications such as bleeding or perforation. No recurrence was found under endoscopy in the 3-month to 2-year postoperative review. Conclusion The preoperative pit pattern classification can provide the basis for treatment. ESD has good curative effect, low recurrence rate and good safety in the treatment of colorectal LST.
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Objective To investigate the incidence of electrocoagulation syndrome after endoscopic submucosal dissection (ESD) in the colorectal laterally spreading tumors (LST) and the risk factors. Methods Data of 51 patients with coloretral LST,treated with ESD from January 2010 to May 2014 at Shengjing hospital affiliated to China Medical University,were reviewed.The incidence of electrocoagulation syndrome was analyzed and logistic regression was used to evaluate risk.Results The incidence of electro-coagulation syndrome was 9.8%(5 /51).The incidence of tumors in the rectal area(7.1%,2 /28)was lower than that of the left half colon (12.5%,1 /8),and the right colon (13.3%,2 /15).Multivariable logistic regression analysis showed that the independent risk factors for the development of electrocoagulation syndrome were LST located in non-rectum area (OR =1.655,P <1.655),lesion size larger than 25 mm (OR =1.028, P <0.05),the operation time longer than 129 min (OR =1.016,P <0.05),age older than 62 year old (OR =0.987,P <0.05).Conclusion For the patients aged over 62 year old,lesion size larger than 25 mm,the operation time longer than 129 min and LST located outside the rectum,the mucous membrane should be separated from the muscularis propria in the ESD procedure to reduce electrocoagulation time as much as possible. In the postoperative period,patients need fasting,fluid replacement support,and prevention of post endoscopic submucosal dissection electrocoagulation syndrome (PEECS).
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Aberrant DNA methylation plays an important role in genesis of colorectal cancer (CRC). Previously, we identified Group 1 and Group 2 methylation markers through genome-wide DNA methylation analysis, and classified CRC and protruded adenoma into three distinct clusters: high-, intermediate- and low-methylation epigenotypes. High-methylation epigenotype strongly correlated with BRAF mutations and these aberrations were involved in the serrated pathway, whereas intermediate-methylation epigenotype strongly correlated with KRAS mutations. Here, we investigated laterally spreading tumors (LSTs), which are flat, early CRC lesions, through quantitative methylation analysis of six Group 1 and 14 Group 2 methylation markers using pyrosequencing. Gene mutations in BRAF, KRAS and PIK3CA, and immunostaining of TP53 and CTNNB1 as well as other clinicopathological factors were also evaluated. By hierarchical clustering using methylation information, LSTs were classified into two subtypes; intermediate-methylation epigenotype correlating with KRAS mutations (p = 9 × 10(-4)) and a granular morphology (LST-G) (p = 1 × 10(-7)), and low-methylation epigenotype correlating with CTNNB1 activation (p = 0.002) and a nongranular morphology (LST-NG) (p = 1 × 10(-7)). Group 1 marker methylation and BRAF mutations were barely detected, suggesting that high-methylation epigenotype was unlikely to be involved in LST development. TP53 mutations correlated significantly with malignant transformation, regardless of epigenotype or morphology type. Together, this may suggest that two molecular pathways, intermediate methylation associated with KRAS mutations and LST-G morphology, and low methylation associated with CTNNB1 activation and LST-NG morphology, might be involved in LST development, and that involvement of TP53 mutations could be important in both subtypes in the development from adenoma to cancer.
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Adenoma/genética , Neoplasias Colorrectales/genética , Metilación de ADN , Epigenómica , Mutación/genética , Adenoma/metabolismo , Adenoma/patología , Anciano , Fosfatidilinositol 3-Quinasa Clase I , Neoplasias Colorrectales/metabolismo , Neoplasias Colorrectales/patología , Femenino , Humanos , Técnicas para Inmunoenzimas , Masculino , Invasividad Neoplásica , Estadificación de Neoplasias , Fenotipo , Fosfatidilinositol 3-Quinasas/genética , Reacción en Cadena de la Polimerasa , Pronóstico , Proteínas Proto-Oncogénicas/genética , Proteínas Proto-Oncogénicas B-raf/genética , Proteínas Proto-Oncogénicas p21(ras) , Proteína p53 Supresora de Tumor/genética , Proteína p53 Supresora de Tumor/metabolismo , beta Catenina/genética , beta Catenina/metabolismo , Proteínas ras/genéticaRESUMEN
BACKGROUND: In recent years, endoscopic submucosal dissection (ESD) has often been used for the treatment of laterally spreading tumors (LST) of the rectum. The present study was carried out with the aim of clarifying the characteristics of each of the subtypes of LST in the rectum that are often treated by ESD. PATIENTS AND METHODS: This study involved 141 rectal LST that were initially treated at our hospital between March 2005 and December 2010 and whose endoscopic images and histopathological specimens could be re-examined. The LST were divided into LST-G-H (homogeneous type), LST-G-MIX (nodular mixed type), LST-NG-F (flat type) and LST-NG-PD (pseudo-depressed type) type lesions, and tumor diameter and depth of invasion of each of these tumor types were investigated. RESULTS: Regarding the depth of invasion, the proportion of submucosa-massive (SM-m) lesions was high in the LST-NG-PDtumors, even among tumors measuring <20 mm in diameter; both the rate of cancer and proportion of SM-m lesions were significantly higher in the LST-NG-PD tumors than in the LST-NG-F tumors (P < 0.05). In both LST-NG-MIX and LST-NG-PD tumors, the proportion of SM-m lesions was significantly higher in the lower rectum than in the upper rectum (P < 0.05). CONCLUSION: For LST of the rectum (particularly of the lower rectum), it is necessary to carefully select the treatment considering LST subclass and tumor diameter from the standpoint of the presence of malignancy, quality of life, and prognosis of patients.
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Adenoma/clasificación , Adenoma/cirugía , Colonoscopía/métodos , Mucosa Intestinal/patología , Invasividad Neoplásica/patología , Neoplasias del Recto/clasificación , Neoplasias del Recto/cirugía , Adenoma/patología , Disección/métodos , Humanos , Neoplasias del Recto/patología , Recto/patologíaRESUMEN
BACKGROUND/AIMS: Among colorectal neoplasms, laterally spreading tumors (LSTs) are defined as tumors over 10 mm in diameter that are low in height and grow superficially. We analyzed the clinicopathologic characteristics of LSTs in colorectum. METHODS: Forty six LSTs were analyzed according to their endoscopic and pathologic findings. RESULTS: Incidence of LSTs were 2.0% (46/2,276). Twenty two LSTs (47.8%) were less than 20 mm in diameter, 20 (43.5%) were 20-30 mm, 4 (8.7%) were larger than 30 mm. The most frequent location was rectosigmoid colon (54.3%), followed by ascending colon (21.7%). Morphplogic types were GH types 37.0% (17/46), MN types 30.4% (14/46) and F types 32.6% (15/46). Histologic types were tubular adenomas 65.2% (30/46), tubulovillous adenomas 26.1% (12/46) and villous adenomas 8.7% (4/46). The overall malignancy rate was 19.6% (9/46). Malignancy rates were 4.5% (1/22) in the lesions less than 20 mm, 30.0% (6/20) in 20-30 mm, 50.0% (2/4) in larger than 30 mm. Malignancy rates were 11.8% (2/17) in GH type, 21.4% (3/14) in NM type and 26.7% (4/15) in F type. Carcinoma invaded into the submucosa were present in one lesion of NM types and two of F type. CONCLUSIONS: LSTs larger than 20 mm had high malignant potential, more than 30%. Furthermore, LSTs showed different clinicopathologic characteristics depending on the morphologic classification. NM or F type had higher malignant potential than GH type.
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Adenoma , Adenoma Velloso , Clasificación , Colon , Colon Ascendente , Neoplasias Colorrectales , IncidenciaRESUMEN
PURPOSE: A laterally spreading tumor (LST) has its own characteristic features and growth pattern. Information about LST is scanty in Korea, therefore this study was designed in order to contribute to the literature. METHODS: In this study, 43 patients with LSTs were included. The diagnoses were made by colonoscopy in all cases. Treatment options included endoscopic resection, transanal excision, and surgical resection. In reviewing and analyzing the cases, we made a special emphasis on size, classification, histology, and treatment. RESULTS: The most frequent location was the rectum, followed by the sigmoid colon and the ascending colon in that order. Lesions smaller than 20 mm accounted for 69.8%. Granular homogeneous LSTs, 41.9%. Lesions larger than 20 mm, except granular homogeneous LSTs, showed an abrupt increase in malignancy rate. Tubular adenomas accounted for 65.1%. The overall malignancy rate was 20.9%, and the submucosal cancer rate, 9.3%. There were no malignancies in the granular homogeneous LSTs. The malignancy rate for the mixed-nodule type lesions was 33.3% (4/12), and the nongranular LSTs, 38.5% (5/13). Polypectomy was done in 37.2% of the lesions, endoscopic mucosal resection (EMR) in 16.3%, and endoscopic piecemeal mucosal resection (EPMR) in 16.3%. The overall endoscopic resection rate was 83.7% (36/43). EMR was applicable to lesions smaller than 20 mm, and EPMR to those larger than 20 mm. Transanal resection was done in 2 cases with lesions. Five cases were resected surgically. Four of them were submucosal invasive lesions, and one, a mucosal lesion which was wide and had initially been thought to be a submucosal cancer. There were two recurrences during the average 15-month follow-up period. The follow-up rate was 81.4% (35/43). Of these 2 recurring cases, one patient was treated endoscopically and the other, transanally. CONCLUSIONS: LSTs show different behavior depending on the endoscopic classification. Granular homogeneous LSTs are seldom larger than 30 mm and are good candidates for endoscopic treatment. The mixed-nodule type and the nongranular type show a marked predisposition to malignancy when they are over 20 mm, and nongranular-type LSTs have a higher rate of submucosal invasive cancers. Thus, in the cases of the mixed-nodule and nongranular types, careful consideration should be given for deciding between endoscopic treatment and surgical resection. Complete resection should be assured to prevent recurrence, and follow-up surveillance is required in all lesions for more than 3 to 5 years.