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Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review

In the last years, endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions. At the same time, the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged. The current unsolved dilemma about th...

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Autores principales: Shahini, Endrit, Libânio, Diogo, Lo Secco, Giacomo, Pisani, Antonio, Arezzo, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394186/
https://www.ncbi.nlm.nih.gov/pubmed/34512876
http://dx.doi.org/10.4253/wjge.v13.i8.275
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author Shahini, Endrit
Libânio, Diogo
Lo Secco, Giacomo
Pisani, Antonio
Arezzo, Alberto
author_facet Shahini, Endrit
Libânio, Diogo
Lo Secco, Giacomo
Pisani, Antonio
Arezzo, Alberto
author_sort Shahini, Endrit
collection PubMed
description In the last years, endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions. At the same time, the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged. The current unsolved dilemma about the endoscopic excision techniques concerns the necessity of a reliable submucosal invasive cancer assessment system that can stratify the risk of the post-procedural need for surgery. Accordingly, this narrative literature review aims to compare the available diagnostic strategies in predicting malignancy and to give a guide about the best techniques to employ. We performed a literature search using electronic databases (MEDLINE/PubMed, EMBASE, and Cochrane Library). We collected all articles about endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) registering the outcomes. Moreover, we analyzed all meta-analyses comparing EMR vs ESD outcomes for colorectal sessile or non-polypoid lesions of any size, preoperatively estimated as non-invasive. Seven meta-analysis studies, mainly Eastern, were included in the analysis comparing 124 studies and overall 22954 patients who underwent EMR and ESD procedures. Of these, eighty-two were retrospective, twenty-four perspective, nine case-control, and six cohorts, while three were randomized clinical trials. A total of 18118 EMR and 10379 ESD were completed for a whole of 28497 colorectal sessile or non-polypoid lesions > 5-10 mm in size. In conclusion, it is crucial to enhance the preoperative diagnostic workup, especially in deciding the most suitable endoscopic method for radical resection of flat colorectal lesions at risk of underlying malignancy. Additionally, the ESD necessitates further improvement because of the excessively time-consuming as well as the intraprocedural technical hindrances and related complications. We found a higher rate of en bloc resections and R0 for ESD than EMR for non-pedunculated colorectal lesions. Nevertheless, despite the lower local recurrence rates, ESD had greater perforation rates and needed lengthier procedural times. The prevailing risk for additional surgery in ESD rather than EMR for complications or oncologic reasons is still uncertain.
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spelling pubmed-83941862021-09-09 Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review Shahini, Endrit Libânio, Diogo Lo Secco, Giacomo Pisani, Antonio Arezzo, Alberto World J Gastrointest Endosc Review In the last years, endoscopic techniques gained a crucial role in the treatment of colorectal flat lesions. At the same time, the importance of a reliable assessment of such lesions to predict the malignancy and the depth of invasion of the colonic wall emerged. The current unsolved dilemma about the endoscopic excision techniques concerns the necessity of a reliable submucosal invasive cancer assessment system that can stratify the risk of the post-procedural need for surgery. Accordingly, this narrative literature review aims to compare the available diagnostic strategies in predicting malignancy and to give a guide about the best techniques to employ. We performed a literature search using electronic databases (MEDLINE/PubMed, EMBASE, and Cochrane Library). We collected all articles about endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) registering the outcomes. Moreover, we analyzed all meta-analyses comparing EMR vs ESD outcomes for colorectal sessile or non-polypoid lesions of any size, preoperatively estimated as non-invasive. Seven meta-analysis studies, mainly Eastern, were included in the analysis comparing 124 studies and overall 22954 patients who underwent EMR and ESD procedures. Of these, eighty-two were retrospective, twenty-four perspective, nine case-control, and six cohorts, while three were randomized clinical trials. A total of 18118 EMR and 10379 ESD were completed for a whole of 28497 colorectal sessile or non-polypoid lesions > 5-10 mm in size. In conclusion, it is crucial to enhance the preoperative diagnostic workup, especially in deciding the most suitable endoscopic method for radical resection of flat colorectal lesions at risk of underlying malignancy. Additionally, the ESD necessitates further improvement because of the excessively time-consuming as well as the intraprocedural technical hindrances and related complications. We found a higher rate of en bloc resections and R0 for ESD than EMR for non-pedunculated colorectal lesions. Nevertheless, despite the lower local recurrence rates, ESD had greater perforation rates and needed lengthier procedural times. The prevailing risk for additional surgery in ESD rather than EMR for complications or oncologic reasons is still uncertain. Baishideng Publishing Group Inc 2021-08-16 2021-08-16 /pmc/articles/PMC8394186/ /pubmed/34512876 http://dx.doi.org/10.4253/wjge.v13.i8.275 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Review
Shahini, Endrit
Libânio, Diogo
Lo Secco, Giacomo
Pisani, Antonio
Arezzo, Alberto
Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review
title Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review
title_full Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review
title_fullStr Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review
title_full_unstemmed Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review
title_short Indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: A narrative review
title_sort indications and outcomes of endoscopic resection for non-pedunculated colorectal lesions: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8394186/
https://www.ncbi.nlm.nih.gov/pubmed/34512876
http://dx.doi.org/10.4253/wjge.v13.i8.275
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