Endoscopy 2020; 52(S 01): S6
DOI: 10.1055/s-0040-1704027
ESGE Days 2020 oral presentations
Thursday, April 23, 2020 08:30 – 10:00 Large colonic polyps: Slice and dice Ecocem Room
© Georg Thieme Verlag KG Stuttgart · New York

COMPARISON BETWEEN UNDERWATER ENDOSCOPIC MUCOSAL RESECTION AND ENDOSCOPIC SUBMUCOSAL DISSECTION FOR RECURRENT COLORECTAL NEOPLASMS AFTER ENDOSCOPIC REMOVAL: A PROPENSITY SCORE-MATCHED STUDY

M Ohmori
1   Okayama University Hospital, Department of Gastroenterology, Okayama, Japan
,
Y Takeuchi
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
A Shoji
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
T Inoue
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
M Miyake
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
K Matsueda
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
K Waki
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
M Kono
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
Y Shimamoto
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
H Fukuda
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
H Iwagami
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
H Nakahira
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
N Matsuura
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
S Shichijo
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
A Maekawa
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
T Kanesaka
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
K Higashino
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
N Uedo
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
R Ishihara
2   Osaka International Cancer Institute, Department of Gastrointestinal Oncology, Osaka, Japan
,
Hiroyuki Okada
1   Okayama University Hospital, Department of Gastroenterology, Okayama, Japan
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Publikationsverlauf

Publikationsdatum:
23. April 2020 (online)

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Aims Locally recurrent colorectal neoplasms (LRCN) after endoscopic removal (ER) are difficult to treat with conventional ER because of severe fibrosis. Endoscopic submucosal dissection (ESD) and Underwater endoscopic mucosal resection (UEMR) are reportedly effective. We aimed to investigate appropriate indications of these procedures.

Methods This was a single-center retrospective observational study. Patients who underwent UEMR or ESD for LRCN after ER were enrolled. Data were systemically retrieved from October 2013 to February 2019. Propensity score matching (PSM) between the UEMR and ESD groups were performed. Clinical characteristics, treatment and long-term outcomes between the two procedures were compared.

Results 30 UEMR and 21 ESD were performed for LRCN after ER. Median (range) diameter of the lesion in UEMR was 8 (2-22) and 15 (2-58) mm in ESD. Median procedure time in UEMR was significantly shorter than that in ESD [4 (2-15) vs. 70 (17-193) min, p< 0.01]. En bloc and R0 resection rate in ESD were significantly higher than those in EMR (73% vs 100%, 41% vs 81%, respectively). Prevalence of cancer (intramucosal or more) was 13% in UEMR and 57% in ESD. No complication occurred in UEMR, but 2 (10%) delayed perforation in ESD. Median hospitalization period in UEMR was significantly shorter in that in ESD [3 (2-9) vs. 7(6-14) days, p< 0.01], and 12 cases (40%) in UEMR were performed without hospitalization but no in ESD . There was no recurrence after treatment in both groups during median follow-up of 12 and 24 months, respectively. After PSM extracting 11 cases in each group, both procedure time and hospitalization period were significantly shorter in UEMR than in ESD.

Conclusions Long-term outcomes were comparable between UEMR and ESD, although en bloc and R0 resection rate were better with ESD. According to the background difference, UEMR would be a useful procedure for small LCRN after ER.