학술논문
Endoscopic resection of colorectal circumferential and near-circumferential laterally spreading lesions: outcomes and risk of stenosis
Original Article
Original Article
Document Type
Academic Journal
Author
Source
International Journal of Colorectal Disease. May 1, 2019, Vol. 34 Issue 5, p829, 8 p.
Subject
Language
English
ISSN
0179-1958
Abstract
Author(s): Andrew Emmanuel [sup.1] [sup.2], Anil Ghosh [sup.1], Christo Lapa [sup.1], Shraddha Gulati [sup.2], Margaret Burt [sup.1] [sup.2], Bu'Hussain Hayee [sup.2], Amyn Haji [sup.1] [sup.2] Author Affiliations: (1) 0000 0004 [...]
Purpose Almost any colorectal superficial neoplastic lesion can be treated by endoscopic resection (ER) but very little is known about outcomes of ER leaving circumferential or near-circumferential mucosal defects. We report the outcomes of ER leaving [greater than or equal to] 75% circumferential mucosal defects performed in a western expert centre. Methods Five hundred eighty-seven ERs of large colorectal lesions [greater than or equal to] 20 mm were grouped according to the extent of the mucosal defect and comparisons made between those with < 75% and [greater than or equal to] 75% defects. Independent predictors of stenosis were identified. Results Forty-seven patients had ER leaving [greater than or equal to] 75% circumference defect, most located at or distal to the rectosigmoid, with [greater than or equal to] 90% defects in 5 and 100% in 11. There were no significant colonic muscle injuries in patients with [greater than or equal to] 75% defect and no differences in post-procedure bleeding (OR 1.6, 95% CI 0.2-13.7, p = 0.64) between patients with [greater than or equal to] 75% and < 75% defects. Stenosis developed in 9 patients. [greater than or equal to] 90% circumference defect was the only independent risk factor for stenosis (OR 286, p < 0.001). Three of 4 patients with asymptomatic stenosis had successful expectant management. The remainder were treated with dilatation. Recurrence was more likely in those with [greater than or equal to] 75% defect (OR 7.9, 95% CI 3.8-16.4, p < 0.001) but was managed with further ER in all but 2 cases. Conclusion ER of colorectal lesions resulting in defects [greater than or equal to] 75% of the luminal circumference is challenging but safe and effective when performed in an expert centre. The only independent predictor of stenosis is [greater than or equal to] 90% circumference defect but some patients improve with expectant management; therefore, pre-emptive intervention may not be warranted.
Purpose Almost any colorectal superficial neoplastic lesion can be treated by endoscopic resection (ER) but very little is known about outcomes of ER leaving circumferential or near-circumferential mucosal defects. We report the outcomes of ER leaving [greater than or equal to] 75% circumferential mucosal defects performed in a western expert centre. Methods Five hundred eighty-seven ERs of large colorectal lesions [greater than or equal to] 20 mm were grouped according to the extent of the mucosal defect and comparisons made between those with < 75% and [greater than or equal to] 75% defects. Independent predictors of stenosis were identified. Results Forty-seven patients had ER leaving [greater than or equal to] 75% circumference defect, most located at or distal to the rectosigmoid, with [greater than or equal to] 90% defects in 5 and 100% in 11. There were no significant colonic muscle injuries in patients with [greater than or equal to] 75% defect and no differences in post-procedure bleeding (OR 1.6, 95% CI 0.2-13.7, p = 0.64) between patients with [greater than or equal to] 75% and < 75% defects. Stenosis developed in 9 patients. [greater than or equal to] 90% circumference defect was the only independent risk factor for stenosis (OR 286, p < 0.001). Three of 4 patients with asymptomatic stenosis had successful expectant management. The remainder were treated with dilatation. Recurrence was more likely in those with [greater than or equal to] 75% defect (OR 7.9, 95% CI 3.8-16.4, p < 0.001) but was managed with further ER in all but 2 cases. Conclusion ER of colorectal lesions resulting in defects [greater than or equal to] 75% of the luminal circumference is challenging but safe and effective when performed in an expert centre. The only independent predictor of stenosis is [greater than or equal to] 90% circumference defect but some patients improve with expectant management; therefore, pre-emptive intervention may not be warranted.