1Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
2Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
Copyright © 2023 Korean Society of Gastrointestinal Endoscopy
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of Interest
The authors have no potential conflicts of interest.
Funding
This study was supported in part by JSPS KAKENHI (grant number JP21K20881). All authors disclosed no financial relationships relevant to this publication.
Acknowledgments
The authors thank ThinkSCIENCE Inc. (Tokyo, Japan) for their English language assistance.
Author Contributions
Conceptualization: HY, MF; Data curation: HY; Formal analysis: HY; Funding acquisition: HY; Investigation: HY, TMu, TMa, KU, YK, AM, TMo, SK, SN; Methodology: HY, NN, MS; Project administration: MF; Supervision: MF, TK, TI; Validation: HY; Writing–original draft: HY; Writing–review & editing: all authors.
Values are presented as median (interquartile range) or number (%).
ESD, endoscopic submucosal dissection; C-ESD, conventional ESD; SH-ESD, scheduled hybrid ESD; RH-ESD, rescue hybrid ESD; LST-G, laterally spreading tumor–granular type; LST-NG, laterally spreading tumor–nongranular type; SSA/P, Sessile serrated adenoma/polyps; M, mucosa; SM, submucosa.
Study | Study design, period | Endoscopic procedure | n | Location | Histopathology | Tumor size (mm) | Lesion type | Procedure time (min) | En bloc resection (%) | Perforation (%) | Delayed bleeding (%) | Recurrence rate (%) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Byeon et al. (2011)20 | Retrospective, 2004–2011 | ESD | 163 | C−A/T/D/S/R; 27/19/6/25/86 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 86/41/14/20 | 32.9±16.8 | LST-G/LST-NG/polypoid/non-polypoid; 66/49/38/10 | 49±35 | 87 | 7 | 1 | ND |
Hybrid ESD | 74 | C−A/T/D/S/R; 12/5/4/15/38 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 39/12/17/7 | 23.8±9.3 | LST-G/LST-NG/polypoid/non-polypoid; 22/14/31/7 | 35±24 | 64 | 3 | 3 | ND | ||
Terasaki et al. (2012)19 | Retrospective, 2006–2009 | ESD | 61 | Colon/R; 30/31 | Adenoma/M or superficial SM cancer/deep SM cancer; 24/32/5 | 42.1±17.1 | ND | 85 (30–360) | ND | 0.0 | 11.5 | 0.0 |
Hybrid ESD | 28 | Colon/R; 20/9 | Adenoma/M or superficial SM cancer/deep SM cancer; 17/10/1 | 31.7±15.6 | ND | 57.5 (9–150) | ND | 7.1 | 0.0 | 0.0 | ||
Yoshida et al. (2013)21 | Retrospective, 2012 | ESD | 466 | ND | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 207/205/20/34 | 31.2 (12–130) | ND | 94 (10–420) | 92.2 | 3.8 | 2.5 | ND |
Hybrid ESD | 22 | ND | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 15/5/0/2 | 21.2 (10–40) | ND | 57 (18–85) | 77.3 | 4.5 | 4.5 | ND | ||
Toyonaga et al. (2014)11 | Retrospective, 2002–2008 | ESD | 468 | ND | Adenoma/M cancer/SM cancer/MP invasive cancer; 161/227/78/2 | 30 (6–158) | ND | 60 (11–335) | 98.9 | 1.5 | 1.5 | ND |
Hybrid ESD | 44 | ND | Adenoma/M cancer/SM cancer/MP invasive cancer; 22/17/5/0 | 17 (4–33) | ND | 27 (8–98) | 90.9 | 4.5 | 2.3 | ND | ||
Bae et al. (2016)17 | RCT, 2014 | ESD | 31 | Colon/R; 30/31 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 21/8/1/1 | 30.0 (20–68) | Polypoid/non-polypoid; 18/13 | 40.6±22.1 | 100.0 | 6.5 | 3.2 | ND |
Hybrid ESD | 34 | Colon/R; 20/8 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 18/12/2/2 | 27.0 (15–62) | Polypoid/non-polypoid; 17/17 | 27.4±12.7 | 94.1 | 8.8 | 2.9 | ND | ||
Okamoto et al. (2017)22 | Retrospective, 2008–2016 | ESD | 137 | Colon/R; 63/74 | ND | 34.9±15.0 | LST-G/LST-NG/protruded/superficial; 76/39/20/2 | 122±72.2 | 94.2 | 1.4 | 0.0 | 0 |
Hybrid ESD | 27 | Colon/R; 22/5 | ND | 26.9±7.0 | LST-G/LST-NG/protruded/superficial; 9/10/7/1 | 108±59.5 | 66.7 | 11.1 | 0.0 | 0 | ||
Milano et al. (2018)23 | Retrospective, 2013–2014 | ESD | 23 | C/A/H/T/D/S/R; 2/2/1/3/2/1/12 | Adenoma/carcinoma/SSA/P; 17/2/1 | 25.8±12.6 | Protruding/non-protruding; 6/17 | 120 (20–270) | 82.6 | 8.7 | 0.0 | 11.8 |
Hybrid ESD | 29 | C/A/H/T/D/S/R; 2/6/3/1/1/3/13 | Adenoma/carcinoma/SSA/P; 18/3/7 | 25.4±9.4 | Protruding/non-protruding; 11/18 | 60 (30–120) | 82.8 | 3.4 | 17.2 | 20.0 | ||
Kang et al. (2020)24 | Retrospective, 2005–2014 | ESD | 563 | C/A/T/D/S/R; 14/89/79/21/86/274 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 357/126/46/33 | 33.2±16.2 | Sessile/LST-G/LST-NG; 127/115/320 | 54.3±46.5 | 96.5 | 6.0 | 2.1 | 0.7 |
Hybrid ESD | 273 | C/A/T/D/S/R; 9/50/28/11/56/119 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 135/64/33/37 | 27.9±13.7 | Sessile/LST-G/LST-NG; 76/44/153 | 45.6±40.8 | 56.8 | 10.3 | 1.9 | 5.7 | ||
Wang et al. (2021)25 | Retrospective, 2008–2019 | ESD | 27 | C; 27 | Adenoma/M cancer/SM cancer 24/2/1 | 25 (20–62) | LST-G/LST-NG; 24/3 | 52.63±44.20 | 81.5 | 3.7 | 0.0 | ND |
Hybrid ESD | 35 | C; 35 | Adenoma/M cancer/SM cancer 32/1/2 | 23 (20–42) | LST-G/LST-NG; 27/8 | 27.60±17.21 | 77.1 | 0.0 | 2.9 | ND | ||
Papparella et al. (2022)26 | Retrospective, 2015–2019 | ESD | 45 | Right colon/T/left colon/R; 2/2/7/34 | Dysplasia/SM cancer; 39/6 | 47.1 (25–100) | Sessile/LST-G/LST-NG; 7/30/3 | 126 (20–360) | ND | 2.2 | 8.9 | 0 |
Hybrid ESD | 33 | Right colon/T/left colon/R; 1/0/4/28 | Dysplasia/SM cancer; 28/5 | 47.2 (20–115) | Sessile/LST-G/LST-NG; 2/17/8 | 139.5 (81–277) | ND | 0.0 | 12.1 | 0 |
Values are presented as mean±standard deviation or median (range).
ESD, endoscopic submucosal dissection; A, ascending; C, cecum; D, descending; H, hepatic flexure; LST-G, laterally spreading tumor–granular type; LST-NG, laterally spreading tumor–nongranular type; M, mucosa; MP, muscularis propria; ND, not described; R, rectum; S, sigmoid; SM, submucosa; T, transverse.
Variable | C-ESD (A) | SH-ESD (B) | RH-ESD (C) | p-value |
---|---|---|---|---|
Procedures | 260 | 69 | 35 | |
Age (yr) | 71 (62–77) | 74 (67–79) | 73 (63–81) | 0.057 |
Sex, male/female | 141/119 | 41/28 | 17/18 | 0.567 |
Tumor location, left/right colon | 137/123 | 18/51 | 12/23 | <0.001 (B>A) |
Tumor size (mm) | 30 (20–40) | 22 (20–25) | 25 (20–30) | <0.001 (A>B, A>C) |
Tumor morphology | ||||
LST-G | 145 (55.8) | 33 (47.8) | 17 (48.6) | 0.431 |
LST-NG | 93 (35.8) | 33 (47.8) | 14 (40.0) | 0.183 |
Protruded type (0–I) | 22 (8.5) | 3 (4.3) | 4 (11.4) | 0.350 |
Pathological findings | ||||
Adenoma | 83 (31.9) | 25 (36.2) | 18 (51.4) | 0.075 |
SSA/P | 5 (1.9) | 6 (8.7) | 0 (0.0) | 0.018 (B>A) |
Adenocarcinoma | 172 (66.2) | 38 (55.1) | 17 (48.6) | 0.051 |
Depth of tumor invasion (M/SM) | 238/22 | 59/10 | 34/1 | 0.150 |
Vascular invasion | 6 (2.3) | 3 (4.3) | 2 (5.7) | 0.293 |
Lymphatic invasion | 6 (2.3) | 5 (7.2) | 1 (2.9) | 0.105 |
Characteristic | C-ESD (A) | SH-ESD (B) | RH-ESD (C) | p-value |
---|---|---|---|---|
Procedures | 260 | 69 | 35 | |
Procedure time (min) | 90 (60–140) | 52 (29–80) | 149 (90–197) | <0.001 (C>A>B) |
Resected specimen size (mm2) | 727 (446–1241) | 377 (254–528) | 467 (245–692) | <0.001 (A>B, A>C) |
Horizontal margin positive | 14 (5.4) | 2 (2.9) | 1 (2.9) | 0.777 |
Vertical margin positive | 8 (3.1) | 0 (0.0) | 1 (2.9) | 0.319 |
En bloc resection | 254 (97.7) | 54 (78.3) | 17 (48.6) | <0.001 (A>B>C) |
Experience of endoscopist, non-expert (<100 ESD surgeries)/expert (≥100 ESD surgeries) | 195/65 (75.0/25.0) | 58/11 (84.1/15.9) | 31/4 (88.6/11.4) | 0.085 |
Adverse events | ||||
Perforation | 10 (3.8) | 2 (2.9) | 7 (25.0) | 0.002 (C>A, C>B) |
Delayed bleeding | 10 (3.8) | 5 (7.2) | 2 (5.7) | 0.397 |
Local recurrence rate | 1 (0.4) | 1 (1.4) | 1 (2.9) | 0.222 |
Surgery due to local recurrence | 0 (0) | 0 (0) | 0 (0) | (incalculable) |
Surgery due to piecemeal resection | 1 (0.4) | 2 (2.9) | 3 (8.6) | >0.999 |
Predictive factor | En bloc resection | Piecemeal resection | p-value |
---|---|---|---|
Procedures | 17 | 18 | |
Age (yr) | 73 (69–81) | 72 (62–81) | 0.487 |
Sex, male/female | 9/8 | 8/10 | 0.615 |
Tumor location, left/right colon | 7/10 | 5/13 | 0.404 |
Tumor size (mm) | 25 (20–30) | 25 (20–30) | 0.697 |
Tumor morphology | |||
LST-G | 6 (35.3) | 11 (61.1) | 0.127 |
LST-NG | 9 (52.9) | 5 (27.8) | 0.129 |
Protruded type (0–I) | 2 (11.8) | 2 (11.1) | 0.677 |
Pathological findings adenoma/adenocarcinoma | 8/9 | 10/8 | 0.615 |
Depth of tumor invasion (M/SM) | 14/3 | 15/3 | 0.642 |
Vascular invasion | 0 (0) | 2 (11.1) | 0.257 |
Lymphatic invasion | 0 (0) | 1 (5.6) | 0.514 |
Procedure time (min) | 150 (110–193) | 120 (65–197) | 0.715 |
Resected specimen size (mm2) | 487 (280–825) | 437 (217–596) | 0.080 |
Submucosal dissection rate (%) | 40 (20–60) | 25 (20–30) | 0.037 |
Experience of endoscopist, non-expert (<100 ESD surgeries)/expert (≥100 ESD surgeries) | 16/1 | 16/2 | 0.552 |
Study | Study design, period | Endoscopic procedure | n | Location | Histopathology | Tumor size (mm) | Lesion type | Procedure time (min) | En bloc resection (%) | Perforation (%) | Delayed bleeding (%) | Recurrence rate (%) |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Byeon et al. (2011)20 | Retrospective, 2004–2011 | ESD | 163 | C−A/T/D/S/R; 27/19/6/25/86 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 86/41/14/20 | 32.9±16.8 | LST-G/LST-NG/polypoid/non-polypoid; 66/49/38/10 | 49±35 | 87 | 7 | 1 | ND |
Hybrid ESD | 74 | C−A/T/D/S/R; 12/5/4/15/38 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 39/12/17/7 | 23.8±9.3 | LST-G/LST-NG/polypoid/non-polypoid; 22/14/31/7 | 35±24 | 64 | 3 | 3 | ND | ||
Terasaki et al. (2012)19 | Retrospective, 2006–2009 | ESD | 61 | Colon/R; 30/31 | Adenoma/M or superficial SM cancer/deep SM cancer; 24/32/5 | 42.1±17.1 | ND | 85 (30–360) | ND | 0.0 | 11.5 | 0.0 |
Hybrid ESD | 28 | Colon/R; 20/9 | Adenoma/M or superficial SM cancer/deep SM cancer; 17/10/1 | 31.7±15.6 | ND | 57.5 (9–150) | ND | 7.1 | 0.0 | 0.0 | ||
Yoshida et al. (2013)21 | Retrospective, 2012 | ESD | 466 | ND | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 207/205/20/34 | 31.2 (12–130) | ND | 94 (10–420) | 92.2 | 3.8 | 2.5 | ND |
Hybrid ESD | 22 | ND | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 15/5/0/2 | 21.2 (10–40) | ND | 57 (18–85) | 77.3 | 4.5 | 4.5 | ND | ||
Toyonaga et al. (2014)11 | Retrospective, 2002–2008 | ESD | 468 | ND | Adenoma/M cancer/SM cancer/MP invasive cancer; 161/227/78/2 | 30 (6–158) | ND | 60 (11–335) | 98.9 | 1.5 | 1.5 | ND |
Hybrid ESD | 44 | ND | Adenoma/M cancer/SM cancer/MP invasive cancer; 22/17/5/0 | 17 (4–33) | ND | 27 (8–98) | 90.9 | 4.5 | 2.3 | ND | ||
Bae et al. (2016)17 | RCT, 2014 | ESD | 31 | Colon/R; 30/31 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 21/8/1/1 | 30.0 (20–68) | Polypoid/non-polypoid; 18/13 | 40.6±22.1 | 100.0 | 6.5 | 3.2 | ND |
Hybrid ESD | 34 | Colon/R; 20/8 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 18/12/2/2 | 27.0 (15–62) | Polypoid/non-polypoid; 17/17 | 27.4±12.7 | 94.1 | 8.8 | 2.9 | ND | ||
Okamoto et al. (2017)22 | Retrospective, 2008–2016 | ESD | 137 | Colon/R; 63/74 | ND | 34.9±15.0 | LST-G/LST-NG/protruded/superficial; 76/39/20/2 | 122±72.2 | 94.2 | 1.4 | 0.0 | 0 |
Hybrid ESD | 27 | Colon/R; 22/5 | ND | 26.9±7.0 | LST-G/LST-NG/protruded/superficial; 9/10/7/1 | 108±59.5 | 66.7 | 11.1 | 0.0 | 0 | ||
Milano et al. (2018)23 | Retrospective, 2013–2014 | ESD | 23 | C/A/H/T/D/S/R; 2/2/1/3/2/1/12 | Adenoma/carcinoma/SSA/P; 17/2/1 | 25.8±12.6 | Protruding/non-protruding; 6/17 | 120 (20–270) | 82.6 | 8.7 | 0.0 | 11.8 |
Hybrid ESD | 29 | C/A/H/T/D/S/R; 2/6/3/1/1/3/13 | Adenoma/carcinoma/SSA/P; 18/3/7 | 25.4±9.4 | Protruding/non-protruding; 11/18 | 60 (30–120) | 82.8 | 3.4 | 17.2 | 20.0 | ||
Kang et al. (2020)24 | Retrospective, 2005–2014 | ESD | 563 | C/A/T/D/S/R; 14/89/79/21/86/274 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 357/126/46/33 | 33.2±16.2 | Sessile/LST-G/LST-NG; 127/115/320 | 54.3±46.5 | 96.5 | 6.0 | 2.1 | 0.7 |
Hybrid ESD | 273 | C/A/T/D/S/R; 9/50/28/11/56/119 | Adenoma/M cancer/superficial SM cancer/deep SM cancer; 135/64/33/37 | 27.9±13.7 | Sessile/LST-G/LST-NG; 76/44/153 | 45.6±40.8 | 56.8 | 10.3 | 1.9 | 5.7 | ||
Wang et al. (2021)25 | Retrospective, 2008–2019 | ESD | 27 | C; 27 | Adenoma/M cancer/SM cancer 24/2/1 | 25 (20–62) | LST-G/LST-NG; 24/3 | 52.63±44.20 | 81.5 | 3.7 | 0.0 | ND |
Hybrid ESD | 35 | C; 35 | Adenoma/M cancer/SM cancer 32/1/2 | 23 (20–42) | LST-G/LST-NG; 27/8 | 27.60±17.21 | 77.1 | 0.0 | 2.9 | ND | ||
Papparella et al. (2022)26 | Retrospective, 2015–2019 | ESD | 45 | Right colon/T/left colon/R; 2/2/7/34 | Dysplasia/SM cancer; 39/6 | 47.1 (25–100) | Sessile/LST-G/LST-NG; 7/30/3 | 126 (20–360) | ND | 2.2 | 8.9 | 0 |
Hybrid ESD | 33 | Right colon/T/left colon/R; 1/0/4/28 | Dysplasia/SM cancer; 28/5 | 47.2 (20–115) | Sessile/LST-G/LST-NG; 2/17/8 | 139.5 (81–277) | ND | 0.0 | 12.1 | 0 |
Values are presented as median (interquartile range) or number (%). ESD, endoscopic submucosal dissection; C-ESD, conventional ESD; SH-ESD, scheduled hybrid ESD; RH-ESD, rescue hybrid ESD; LST-G, laterally spreading tumor–granular type; LST-NG, laterally spreading tumor–nongranular type; SSA/P, Sessile serrated adenoma/polyps; M, mucosa; SM, submucosa.
Values are presented as median (interquartile range) or number (%). ESD, endoscopic submucosal dissection; C-ESD, conventional ESD; SH-ESD, scheduled hybrid ESD; RH-ESD, rescue hybrid ESD.
Values are presented as median (interquartile range) or number (%). LST-G, laterally spreading tumor–granular type; LST-NG, laterally spreading tumor–nongranular type; M, mucosa; SM, submucosa; ESD, endoscopic submucosal dissection.
Values are presented as mean±standard deviation or median (range). ESD, endoscopic submucosal dissection; A, ascending; C, cecum; D, descending; H, hepatic flexure; LST-G, laterally spreading tumor–granular type; LST-NG, laterally spreading tumor–nongranular type; M, mucosa; MP, muscularis propria; ND, not described; R, rectum; S, sigmoid; SM, submucosa; T, transverse.