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Fulltext Colonoscopic Polypectomy Preferences of Asian Endoscopists: Results of a Survey-Based Study

Yang DH, Luvsandagva B, Tran QT, Fauzi A, Piyachaturawat P, Soe T, et al.

Gut Liver, 2021 05 15;15(3):391-400.
PMID: 32839364 DOI: 10.5009/gnl20140

Background/Aims: The clinical practice pattern of polypectomy is not well-investigated in Asian countries. We aimed to survey Asian endoscopists about their preferred polypectomy techniques for given conditions and images of polyps.
Methods: A survey was performed using questionnaires composed of two parts: a scenario-based questionnaire using scenarios of polyps, which were adopted from the European Society of Gastrointestinal Endoscopy guidelines, and an image-based questionnaire using provided endoscopic images of polyps.
Results: A total of 154 endoscopists participated in this survey. The most preferred resection techniques for diminutive (≤5 mm), small (6-9 mm), and benign-looking intermediate (10-19 mm) nonpedunculated polyps were cold forceps polypectomy, hot snare polypectomy, and endoscopic mucosal resection (EMR), respectively, in both the scenario- and image-based questionnaires. For benign-looking large (≥20 mm) nonpedunculated polyps, EMR and endoscopic submucosal dissection (ESD) were preferred in the scenario- and image-based surveys, respectively. In case of malignant nonpedunculated polyps, EMR and ESD were preferred for intermediate-sized and large lesions, respectively, according to the scenario-based survey. However, ESD was preferred in both intermediate-sized and large malignant nonpedunculated polyps according to the image-based survey. Trainee endoscopists, endoscopists working in referral centers, and endoscopists in the colorectal cancer-prevalent countries were independently associated with preference of cold snare polypectomy for removing small polyps.
Conclusions: The polypectomy practice patterns of Asian endoscopists vary, and cold snare polypectomy was not the most preferred resection method for polyps <10 mm in size, in contrast to recent guidelines.

Matched MeSH terms: Endoscopic Mucosal Resection*
Endoscopic management of colorectal tumors less than 10 mm in size: Current status and future perspectives in Japan from a questionnaire survey

Uraoka T, Oka S, Ichihara S, Iwatate M, Tamai N, Kawamura T, et al.

Dig Endosc, 2018 04;30 Suppl 1:36-40.
PMID: 29658642 DOI: 10.1111/den.13060
Matched MeSH terms: Endoscopic Mucosal Resection/methods*; Endoscopic Mucosal Resection/trends
Safety and efficacy of endoscopic submucosal dissection of large (≥3 cm) subepithelial tumors located in the cardia

Li J, Tang J, Lua GW, Chen J, Shi X, Liu F, et al.

Surg Endosc, 2017 12;31(12):5183-5191.
PMID: 28597288 DOI: 10.1007/s00464-017-5585-y

BACKGROUND: Upper gastrointestinal subepithelial tumors (SETs) may harbor potential malignancy. Although it is well recognized that large SETs should be resected, the treatment strategy remains controversial. Compared to surgical resection, endoscopic resection has many advantages such as less invasive, shorter hospital stay, lower costs, and better quality of life. However, Endoscopic resection of large SETs in the cardia is challenging. The purpose of this study was to evaluate the safety and efficacy of endoscopic submucosal dissection (ESD) in the treatment of such SETs.
METHODS: A total of 41 patients with large SETs (≥3 cm in diameter) located in the cardia were involved in the study. All patients underwent ESD. Data on therapeutic outcomes and follow-up were collected, for analysis of risk factors of complication rates.
RESULTS: The average tumor size was 4.7 ± 1.7 cm. The average procedure time was 69.3 ± 32.7 min and the average postoperative hospital stay was 3.5 ± 1.1 days. A total of 41 tumors were removed successfully, in which 35 were leiomyomas, three were gastrointestinal stromal tumors, two were lipomas, and one was gastritis cystica profunda. The en bloc resection rate was 90.2%, and was significantly higher for tumors with a round or oval shape (100%) than for those with an irregular shape (75.0%) (P

Matched MeSH terms: Endoscopic Mucosal Resection*
Fulltext Off-label use of 0.4 % sodium hyaluronate teardrops: a safe and effective solution for submucosal injection in gastric endoscopic submucosal dissection

Aliaga Ramos J, Arantes V, Abdul Rani R, Yoshida N

Endosc Int Open, 2020 Dec;8(12):E1741-E1747.
PMID: 33269305 DOI: 10.1055/a-1265-6598

Background and study aims Submucosal (SM) injection is a critical step in endoscopic submucosal dissection (ESD). In Japan, use of viscous solutions such as sodium hyaluronate are recommended; the commercially product available is MucoUp (Seikagaku Co. and Boston Scientific Japan Co., Japan). Nevertheless, MucoUp is expensive and unavailable in many Western countries. For the past 8 years, we have been using low-cost sterile teardrops solution composed of 0.4 % sodium hyaluronate (Adaptis Fresh, Legrand Laboratory, Brazil). This solution is readily available in drugstores with a cost of approximately US$ 10.00 for each 10-cc bottle. The aim of this study was to present the clinical outcome with off-label sodium hyaluronate use for SM injection in gastric ESD. Patients and methods A single-center retrospective study of collected data investigating consecutive patients that underwent gastric ESD between 2012 and 2019. ESD was performed using 0.4 % sodium hyaluronate teardrop for SM injection and Flush Knife BT 2.5 (Fujifilm Co., Japan). The following data were analyzed: clinical-pathological features, en-bloc, R0 and curative resection rate, procedure duration, adverse events, and clinical outcome. Results ESD was performed with sodium hyaluronate for submucosal injection in 78 patients. The en-bloc resection rate and R0 resection rate were 96.1 % and 92.3 %, respectively. The curative resection rate for epithelial lesions was 83.8 %. Adverse events occurred in 5 cases (6.3 %): delayed bleeding (3.8 %, 3 cases) and perforation (2.5 %, 2 cases); all managed successfully by clipping and thermal coagulation. The mean volume of sodium hyaluronate solution used per patient was 10 cc (SD: ± 8 cc). During follow-up (mean: 17 months; SD: ± 14.5 months), two patients developed metachronous lesions (2.5 %). Conclusions Off-label use of teardrops with 0.4 % sodium hyaluronate for submucosal injection was demonstrated to be safe and able to provide an effective submucosal cushion that facilitates SM dissection in gastric ESD procedures.

Matched MeSH terms: Endoscopic Mucosal Resection
Fulltext A Diminutive T1 Cancer 4 mm in Size Resected by Cold Snare Polypectomy

Yoshida N, Naito Y, Murakami T, Ogiso K, Hirose R, Inada Y, et al.

Case Rep Gastroenterol, 2018 01 19;12(1):27-31.
PMID: 29515342 DOI: 10.1159/000486128

Cold snare polypectomy (CSP) should be performed for benign lesions, though an accurate diagnosis is sometimes difficult with only white light observation. Irregular findings by narrow-band imaging (NBI) are useful for differentiating malignant lesions from benign lesions, and cases with this finding are not expected for CSP. We present a diminutive T1 cancer resected by CSP as a reflection case. A 68-year-old man underwent colonoscopy for surveillance after polypectomy. A reddish polyp 4 mm in size was detected at the rectum. White light observation showed no depression, but a slight, heterogeneous color change. NBI magnification showed irregular vessel and surface patterns. The polyp was diagnosed as intramucosal cancer. Even though cancerous lesions are regularly resected by endoscopic mucosal resection (EMR), this polyp was resected by CSP in daycare surgery because the patient requested not to be treated by EMR but by CSP, which needed an admission to our institution. The surgeon thought the polyp could be completely resected by CSP. It was thoroughly resected, and a histological examination showed submucosal cancer with a positive vertical margin. Additional surgical resection was not accepted by the patient, since he had received total gastrectomy for gastric cancer and a right hemicolectomy for colonic cancer in the past 7 years. He underwent follow-up colonoscopy 2 months after the CSP. Although there were no recurrent endoscopic findings, endoscopic submucosal dissection was performed to the scar area. The histological examination showed no residual tumor. In conclusion, CSP should only be adopted for benign cases, as cancerous lesions have a possibility for invading the submucosa, like in our case.

Matched MeSH terms: Endoscopic Mucosal Resection