Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(12): E1437-E1446
DOI: 10.1055/a-2427-1948
Original article

Endoscopic submucosal dissection of colorectal pedunculated polyps

Johanna Katharina Jakobs
1   Gastroenterology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
,
Malte Zumblick
1   Gastroenterology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
,
Susanne von Gerlach
2   Pathology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
,
Petros Stathopoulos
1   Gastroenterology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
,
Sebastian Glas
1   Gastroenterology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
,
Carsten Denkert
2   Pathology, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany (Ringgold ID: RIN61061)
,
Ulrike Walburga Denzer
3   Division of Interdisciplinary Endoscopy, University Hospital of Giessen and Marburg Campus Marburg Clinic for Gastroenterology Endocrinology Metabolism and clinical Infectiology, Marburg, Germany (Ringgold ID: RIN569428)
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims For pedunculated colon polyps, en bloc resection with inclusion of the polyp stalk is necessary to yield an accurate histologic staging. This can be challenging in cases of a large polyp and/or broad stalk using conventional snare resection. We evaluated the feasibility of endoscopic submucosal dissection (ESD) for large pedunculated polyps with broad stalks.

Patients and methods Between February 2019 and November 2021 all patients with large pedunculated polyps defined as polyp diameter ≥ 20 mm and or a broad stalk > 5 mm were enrolled in the study. All polyps were resected in ESD technique with dissection of the polyp stalk at the base after injection.

Results Twenty-five patients (male = 18, age mean: 67 years) were included. En bloc resection was achieved in 100% of the patients (25/25 polyps). Polyps were mainly located in the sigmoid (n = 19) and rectum (n = 3). Median polyp size was 30×25×17 mm. Histologic examination revealed the following results: adenoma low-grade intraepithelial neoplasia (LG-IEN): nine; high-grade intraepithelial neoplasia (HG-IEN): seven; pTis: three; adenoarcinoma: five (G1, pT1, L0, V0, Haggitt 3: 2/G2, pT1, L0, V0, Haggitt 3:2/G3, pT1, Bd3, V1, Haggitt 4: 1); other: 1.

R0 resection rate was 100% and the curative resection rate yielded 96% (24/25) without severe adverse events.

Conclusions ESD achieved high en bloc and R0 resection rates for large pedunculated polyps. In our collective, up to 32% of polyps already had adenocarcinoma, resulting in a high curative resection rate due to complete resection and subsequently accurate risk classification.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - Colorectal cancer - Endoscopic resection (polypectomy, ESD, EMRc, ...) - CRC screening


Publication History

Received: 11 February 2024

Accepted after revision: 22 August 2024

Accepted Manuscript online:
30 September 2024

Article published online:
06 December 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 ASGE Technical Committee, Maple JT, Abu Dayyeh BK. et al. Endoscopic submucosal dissection. Gastrointest Endosc 2015; 81: 1311-1325
    CrossrefPubMedSearch in Google Scholar
  • 2 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
    CrossrefPubMedSearch in Google Scholar
  • 3 Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell 1990; 61: 759-767
    CrossrefPubMedSearch in Google Scholar
  • 4 Winawer SJ, Zauber AG, Ho MN. et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 1993; 329: 1977-1981
    CrossrefPubMedSearch in Google Scholar
  • 5 Schmiegel W, Buchberger B, Follmann M. et al. S3-Leitlinie – Kolorektales Karzinom. Z Gastroenterol 2017; 55: 1344-1498
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Denzer U, Beilenhoff U, Eickhoff A. et al. S2k guideline: quality requirements for gastrointestinal endoscopy, AWMF registry no. 021–022. Z Gastroenterol 2015; 53: E1-E227
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Shahidi N, Sidhu M, Vosko S. et al. Endoscopic mucosal resection is effective for laterally spreading lesions at the anorectal junction. Endoscopy 2019; 69: 673-680
    PubMedSearch in Google Scholar
  • 8 Ohata K, Kobayashi N, Sakai E. et al. Long-term outcomes after endoscopic submucosal dissection for large colorectal epithelial neoplasms: a prospective, multicenter, cohort trial from Japan. Gastroenterology 2022; 163: 1423-1434 e1422
    CrossrefPubMedSearch in Google Scholar
  • 9 Tidehag V, Tornqvist B, Pekkari K. et al. Endoscopic submucosal dissection for removal of large colorectal neoplasias in an outpatient setting: a single-center series of 660 procedures in Sweden. Gastrointest Endosc 2022; 96: 101-107
    CrossrefPubMedSearch in Google Scholar
  • 10 Margreiter C, Öfner D, Scheidel S. Management und Therapie des kolorektalen Frühkarzinoms. Coloproctology 2016;
    CrossrefPubMedSearch in Google Scholar
  • 11 Choi YS, Lee JB, Lee EJ. et al. Can endoscopic submucosal dissection technique be an alternative treatment option for a difficult giant (>/= 30 mm) pedunculated colorectal polyp?. Dis Colon Rectum 2013; 56: 660-666
    CrossrefPubMedSearch in Google Scholar
  • 12 Queneherve L, Grainville T, Arnachellum R. et al. Targeted coagulation of large stalk vessels in giant pedunculated colorectal polyp: is endoscopic submucosal dissection the new way to go?. Endoscopy 2023; 55: E924-E925
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Chiba H, Tachikawa J, Arimoto J. et al. Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study. Endoscopy 2021; 53: 77-80
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Inagaki K, Yamashita K, Oka S. et al. Clinical outcomes of endoscopic submucosal dissection for large pedunculated colorectal carcinoma: A retrospective multicenter study. DEN Open 2024; 4: e277
    CrossrefPubMedSearch in Google Scholar
  • 15 Jawaid S, Draganov PV, Yang D. Endoscopic resection of large pedunculated colon polyps using only a scissor-type knife: a case series. VideoGIE 2020; 5: 264-266
    CrossrefPubMedSearch in Google Scholar
  • 16 Pimentel-Nunes P, Libanio D, Bastiaansen BAJ. et al. Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2022. Endoscopy 2022; 54: 591-622
    Thieme ConnectPubMedSearch in Google Scholar
  • 17 Bogie RMM, Veldman MHJ, Snijders L. et al. Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis. Endoscopy 2018; 50: 263-282
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Kobayashi K, Tanaka S, Murakami Y. et al. Predictors of invasive cancer of large laterally spreading colorectal tumors: A multicenter study in Japan. JGH Open 2020; 4: 83-89
    CrossrefPubMedSearch in Google Scholar
  • 19 Rex DK, Risio M, Hassan C. Prioritizing an oncologic approach to endoscopic resection of pedunculated colorectal polyps. Gastrointest Endosc 2021; 94: 155-159
    CrossrefPubMedSearch in Google Scholar
  • 20 Belderbos TD, Leenders M, Moons LM. et al. Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: systematic review and meta-analysis. Endoscopy 2014; 46: 388-402
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Heldwein W, Dollhopf M, Rosch T. et al. The Munich Polypectomy Study (MUPS): prospective analysis of complications and risk factors in 4000 colonic snare polypectomies. Endoscopy 2005; 37: 1116-1122
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Dumoulin FL, Hildenbrand R. Endoscopic resection techniques for colorectal neoplasia: Current developments. World J Gastroenterol 2019; 25: 300-307
    CrossrefPubMedSearch in Google Scholar
  • 23 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
    CrossrefPubMedSearch in Google Scholar
  • 24 Ji JS, Lee SW, Kim TH. et al. Comparison of prophylactic clip and endoloop application for the prevention of postpolypectomy bleeding in pedunculated colonic polyps: a prospective, randomized, multicenter study. Endoscopy 2014; 46: 598-604
    Thieme ConnectPubMedSearch in Google Scholar
  • 25 Draganov PV, Wang AY, Othman MO. et al. AGA Institute Clinical Practice Update: Endoscopic Submucosal Dissection in the United States. Clin Gastroenterol Hepatol 2019; 17: 16-25 e11
    CrossrefPubMedSearch in Google Scholar
  • 26 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86 e17
    CrossrefPubMedSearch in Google Scholar
  • 27 De Ceglie A, Hassan C, Mangiavillano B. et al. Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: A systematic review. Crit Rev Oncol Hematol 2016; 104: 138-155
    CrossrefPubMedSearch in Google Scholar