Feasibility of endoscopic submucosal dissection of lesions at anastomosis site post-colorectal surgery: a case series

Chonlada Krutsri; Takashi Toyonaga; Tsukasa Ishida; Namiko Hoshi; Shinichi Baba; Nelson Tomio Miyajima; Yuzo Kodama

doi:10.1055/a-0903-2403

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(08): E949-E954
DOI: 10.1055/a-0903-2403

Case report

Feasibility of endoscopic submucosal dissection of lesions at anastomosis site post-colorectal surgery: a case series

Chonlada Krutsri

¹Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan

²Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

,

Takashi Toyonaga

³Department of Endoscopy, Kobe University Hospital, Kobe, Japan

⁴Department of Gastroenterology, Kishiwada Tokushukai Hospital, Osaka, Japan

,

Tsukasa Ishida

¹Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan

⁵Department of Gastroenterology, Akashi Medical Center, Akashi, Japan

,

Namiko Hoshi

¹Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan

,

Shinichi Baba

⁴Department of Gastroenterology, Kishiwada Tokushukai Hospital, Osaka, Japan

,

Nelson Tomio Miyajima

⁶Endoscopia Digestiva no Serviço de Endoscopia Gastrointestinal e Broncoesofagoscopia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

,

Yuzo Kodama

¹Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan

› Author Affiliations

Abstract

Background and study aims Patients who have undergone colorectal surgery for resection of cancer and benign lesions are at risk for recurrent, residual, or metachronous lesions at the anastomosis site. Surgical resection of such lesions is difficult because of adhesions, and a stoma may be required as there are risks for leakage after resection. The feasibility and safety of endoscopic submucosal dissection (ESD) for these lesions remain unknown. Therefore, this case series aimed to examine the feasibility and safety of ESD by evaluating the clinical outcomes.

Patients and methods We retrospectively investigated five patients who underwent ESD by a single expert for superficial neoplastic lesions at the anastomosis site after previous colorectal surgery.

Results R0 resections were achieved for all lesions. Mean procedure time was 160.6 minutes. Mean dimensions of the resected specimen and tumor were 52.4 mm and 31.8mm, respectively. None of the patients had complications or recurrence after surveillance colonoscopy 1-year post-resection.

Conclusions In an expert’s hands, ESD at the anastomosis site might be feasible minimally invasive treatment for superficial neoplastic lesions.

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References

References
1 Watanabe T, Itabashi M, Shimada Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol 2015; 20: 207-239
2 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
3 Toyonaga T, Man-i M, East JE. et al. 1,635 endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc 2013; 27: 1000-1008
4 Toyonaga T, Nishino E, Man-i M. et al. Principles of quality controlled endoscopic submucosal dissection with appropriate dissection level and high quality resected specimen. Clin Endosc 2012; 45: 362-374
5 Nakajima T, Saito Y, Tanaka S. et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 2013; 27: 3262-3270
6 Watanabe D, Toyonaga T, Ooi M. et al. Clinical outcomes of deep invasive submucosal colorectal cancer after ESD. Surg Endosc 2017; 32: 2123-2130
7 Hellinger MD, Santiago CA. Reoperation for recurrent colorectal cancer. Clin Colon Rectal Surg 2006; 19: 228-236
8 Rojatkar P, Henderson CE, Hall S. et al. A novel powered circular stapler designed for creating secure anastomoses. Med Devices Diagn Eng 2017; 2: 94-100
9 Ishii N, Akiyama H, Suzuki K. et al. Endoscopic submucosal dissection for the complete resection of the rectal remnant mucosa in a patient with familial adenomatous polyposis. ACG Case Report J 2016; 3: 172-174
10 McKenna NP, Mathis KL, Pemberton JH. et al. The impact of age at time of ileal pouch anal anastomosis on short and long-term outcomes in adults. Inflamm Bowel Dis 2018; 24: 1857-1865
11 Takeuchi Y, Iishi H, Tanaka S. et al. 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
12 Kawaguti FS, Nahas CS, Marques CF. et al. Endoscopic submucosal dissection versus transanal endoscopic microsurgery for the treatment of early rectal cancer. Surg Endosc 2014; 28: 1173-1179
13 Bignell MB, Ramwell A, Evans JR. et al. Complications of transanal endoscopic microsurgery (TEMS): a prospective audit. Colorectal Dis 2010; 12: e99-e103
14 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289