Abstract
Background
Endoscopic submucosal dissection (ESD) has emerged as one of the techniques to successfully resect large colonic polyps en bloc. Complete resection prevents the patient from going through transabdominal colonic resection. We sought to evaluate the proportion of successful en-bloc and complete cure en-bloc resection of large colonic polyps by ESD.
Methods
Studies that use ESD technique to resect large colonic polyps were selected. Successful en-bloc resection was defined as resection of the polyp in one piece. Successful complete cure en-bloc resection was defined as one piece with histologic disease-free-margin polyp resection. Articles were searched in Medline, PubMed, and Cochrane control trial registry. Pooled proportions were calculated by both fixed and random-effects model.
Results
The initial search identified 2,120 reference articles; 389 relevant articles were selected and reviewed. Data were extracted from 14 studies (n = 1,314) that met the inclusion criteria. The mean ± standard error size of the polyps was 30.65 ± 2.88 mm. Pooled proportion of en-bloc resection by the random-effects model was 84.91% (95% confidence interval, 77.82–90.82) and complete cure en-bloc resection was 75.39% (95% confidence interval, 66.69–82.21). The fixed-effects model was not used because of the heterogeneity of studies.
Conclusions
ESD should be considered the best minimally invasive endoscopic technique in the treatment of large (>2 cm) sessile and flat polyps because it allows full pathological evaluation and cure in most patients. ESD offers an important alternative to surgery in the therapy of large sessile and flat polyps.
Similar content being viewed by others
References
Antillon MR, Bartalos CR, Miller ML, et al. En bloc submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery. Gastrointest Endosc. 2008;67:332–7.
Hurlstone DP, Atkinson R, Sanders DS, et al. Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg. 2007;94:1536–42.
Saito Y, Uraoka T, Matsuda T, et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections. Gastrointest Endosc. 2007;66:966–73.
Church JM. Avoiding surgery in patients with colorectal polyps. Dis Colon Rectum. 2003;46:1513–6.
Conio M, Repici A, Demarquay JF, et al. EMR of large sessile colorectal polyps. Gastrointest Endosc. 2004:60:234–41.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–12.
Stuart A, Ord JK. Kendall’s advanced theory of statistics. 6th ed. London: Edward Arnold; 1994.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–88.
Deeks JJ. Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. London: BMJ Books; 2001.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50:1088–101.
Sterne JAC, Egger M, Davey-Smith G. Investigating and dealing with publication and other biases in meta-analysis. Br Med J. 2001;323:101–5.
Sterne JAC, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54:1046–55.
Fujishiro M, Yahagi N, Nakamura M, et al. Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy. 2006;38:493–7.
Fujishiro M, Yahagi N, Kakushima N, et al. Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol. 2007;5:678–83.
Fujishiro M, Yahagi N, Nakamura M, et al. Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc. 2006;63:243–9.
Sano Y, Machida Y, Fu KI, et al. Endoscopic mucosal resection and submucosal dissection method for large colorectal tumors. Dig Endosc. 2004;16(Suppl):S93–6.
Matsuda T, Saito Y, Uraoka T, et al. Therapeutic strategy for laterally spreading tumors (LSTs) in the colorectum. Syokaki Naisikyo. 2006;18:1151–7.
Odajima S, Fujishiro M, Kadoshima N, et al. ESD of lateral spreading polyps. Syokakino Rinsyo. 2007;10:60–5.
Yamamoto H, Sunada K, Kita H, et al. Reliable en-bloc resection by submucosal dissection EMR using sodium hyaluronate ard small-caliber tip transparent hood. Syokaki Naisikyo. 2003;7:933–8.
Nakajima K, Miyazaki S, Aoki T, et al. Result of endoscopic resection and treatment strategy including operation for colorectal adenoma and early cancer of 20 mm or more in diameter. Progr Dig Endosc. 2006;68:67–72.
Tanaka S, Oka S, Kaneko I, et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007;66:100–7.
Yahagi N, Fujishiro M, Omata M. Endoscopic submucosal dissection of colorectal lesion. Dig Endosc. 2004;16:S178–81.
Onozato Y, Kakizaki S, Ishihara H, et al. Endoscopic submucosal dissection for rectal tumors. Endoscopy. 2007;39:423–7.
Tamegai Y, Saito Y, Masaki N, et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy. 2007;39:418–22.
Byeon JS, Jo JY, Choi KD, et al. Combination of endoscopic submucosal dissection and snare resection in colorectal lesions. J Gastroenterol Hepatol. 2005;20(Suppl 2):A246–7.
Odom SR, Duffy SD, Barone JE, Ghevariya V, McClane SJ. The rate of adenocarcinoma in endoscopically removed colorectal polyps. Am Surg. 2005;71:1024–6.
Doniec JM, Lohnert MS, Schniewind B, et al. Endoscopic removal of large colorectal polyps: prevention of unnecessary surgery? Dis Colon Rectum. 2003;46:340–8.
Stergiou N, Riphaus A, Lange P, et al. Endoscopic snare resection of large colonic polyps: how far can we go? Int J Colorectal Dis. 2003;18:131–5.
Pokala N, Delaney CP, Kiran RP, Brady K, Senagore AJ. Outcome of laparoscopic colectomyfor polyps not suitable for endoscopic resection. Surg Endosc. 2007;21:400–3.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Puli, S.R., Kakugawa, Y., Saito, Y. et al. Successful Complete Cure En-Bloc Resection of Large Nonpedunculated Colonic Polyps by Endoscopic Submucosal Dissection: A Meta-Analysis and Systematic Review. Ann Surg Oncol 16, 2147–2151 (2009). https://doi.org/10.1245/s10434-009-0520-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-009-0520-7