Recurrence after endoscopic resection of small rectal neuroendocrine tumors: a retrospective cohort study

Pattarajierapan, Sukit,Khomvilai, Supakij 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.3

Purpose: According to the European Neuroendocrine Tumor Society consensus guidelines, rectal neuroendocrine tumors (NETs) up to 10 mm in size and without poor prognostic factors could be safely removed with endoscopic resection, suggesting omitting surveillance colonoscopy after complete resection. However, the benefit of surveillance colonoscopy is still unknown. In this study, we aimed to report the outcomes after endoscopic resection of small rectal NETs using our surveillance protocol. Methods: This retrospective cohort study included patients who underwent endoscopic resection for rectal NETs sized up to 10 mm from January 2013 to December 2019 at our center. We excluded patients without surveillance colonoscopy and those lost to follow-up. We strictly performed surveillance colonoscopy 1 year after endoscopic resection, and every 2 to 3 years thereafter. The primary outcomes were tumor recurrence and occurrence of metachronous tumors during follow-up. Results: Of the 54 patients who underwent endoscopic resection for rectal NETs during the study period, 46 were enrolled in this study. The complete resection rates by endoscopic mucosal resection, precutting endoscopic mucosal resection, and endoscopic submucosal dissection were 92.3% (12 of 13), 100% (21 of 21), and 100% (12 of 12), respectively. There was no local or distant recurrence during the median follow-up of 39 months. However, we found that 8.7% (4 of 46) of patients developed metachronous NETs. All metachronous lesions were treated with precutting endoscopic mucosal resection. Conclusion: Surveillance colonoscopy is reasonable after endoscopic resection of small rectal NETs for timely detection and treatment of metachronous lesions. However, larger collaborative studies are needed to influence the guidelines.

위선종과 조기위암에서 내시경 점막절제술의 연구 -완전절제율에 영향을 미치는 인자와 점막 절제술 전후의 조직학적 차이-

고강훈 ( Kang Hun Koh ),정혜진 ( Hey Jin Jung ),김상욱 ( Sang Wook Kim ) 전북대학교 의과학연구소 2007 全北醫大論文集 Vol.31 No.1

Objectives: The endoscopic mucosal resection of gastric adenomas or early gastric cancers is now widely accepted as a useful radical treatment method. We studied that the rate of successful treatment by the endoscopic mucosal resection of gastric adenomas or early gastric cancers and the factors related to the rate of the complete resection. Methods: We analysed, retrospectively, 118 lesions in 114 patients diagnosed early gastric cancer or gastric adenoma at the Chonbuk National University Hospital from January, 2005 to June, 2006. Of the 118 lesions, there were 107 adenomas and 11 early gastric cancers. We tried to follow up the lesions of resection by the endoscopic biopsy later. Results: The lesions were diagnosed 107 adenomas, 6 early gastric cancers type IIa, 5 type IIb, and the rate of complete resection was 85%(91), 84%(5), 80%(4), each. The sites of the lesions were divided antrum, angle, body, pylorus and each 60 cases, 14 cases, 42 cases, 2cases was reported. The rate of complete resection for the site was each 83%(50), 85%(12), 81%(34), 100%(2). The size of the lesions was divided ≤10 mm, 11~15 mm, 16~20 mm, 21~25 mm, 26~30 mm, ≥31 mm and each 14 cases, 21 cases, 41 cases, 6 cases, 31 cases, 5 cases were reported. The rate of complete resection for the size was each 86%, 86%, 90%, 100%, 71%, 60%. Of the 14 cases which were diagnosed as high grade dysplastic adenoma, early gastric cancer was diagnosed in 4 cases after the biopsy by endoscopic mucosal resection. Conclusion : We concluded that the site, size and the other factors of the lesions were related to the rate of complete resection after endoscopic mucosal resection, and the abnormal gastric mucosal lesions should be diagnosed with the biopsy by endoscopic mucosal resection.

밴드결찰술 및 올가미를 이용하여 내시경 점막절제술을 시행한 직장 유암종 3예

조영화,노지훈,구동영,유재훈,김기수,신영민,김성훈,박지은 대한소화기내시경학회 2010 Clinical Endoscopy Vol.41 No.1

Many reports have shown that endoscopic polypectomy or endoscopic mucosal resection can successfully remove tumor less than 1.0 cm in size. However, most carcinoid tumors in the rectum occur in the submucosal layer so that the entire tumor cannot be completely removed via endoscopic polypectomy or endoscopic mucosal resection. Endoscopic mucosal resection can also cause perforation of the intestinal wall and bleeding. Due to these reasons, instead of these two conventional methods, endoscopic mucosal resection using a ligation device is currently being used for the treatment of rectal carcinoid tumor. Recent studies that used this method have reported that endoscopic mucosal resection of rectal carcinoid tumor by band ligation and the snare resection technique is safe with minimal complications and this is quite useful to completely remove rectal carcinoid tumor. 유암종은 위장관 및 기관지 등의 신경 내분비세포에서 발생하는 종양이며 전체 유암종에서 직장 유암종이 차지하는 비율은 10% 정도이다. 아직은 직장 유암종에 대한 표준 치료가 확립되어 있지는 않으나 최근 내시경 시행 빈도의 증가 및 술기의 발달로 내시경 치료가 빈번히 시행되고 있다. 종양의 크기와 침습의 깊이에 따라 치료 방법이 주로 결정되며 종양의 크기가 1 cm 미만인 경우 단순한 용종절제술이나 고전적 내시경 점막절제술을 시행하여 치료에 성공하였다는 보고가 있다. 그러나 대부분의 직장 유암종은 직장의 점막하층에 발생하는 경우가 많으므로 용종절제술이나 고전적 내시경 점막절제술로는 완전한 절제가 불가능한 경우가 있으며 깊은 절제를 위해 내시경 점막하박리술을 시행하는 경우 장벽의 천공 및 출혈 등과 같은 부작용이 발생할 가능성도 있다. 이 같은 이유로 고전적인 술기가 아닌 밴드결찰술 및 올가미를 이용한 직장 유암종의 절제(endoscopic submucosal resection with EVL device)가 시도되고 있다. 밴드결찰술 및 올가미를 이용한 직장 유암종의 절제는 비교적 안전하고 시술에 의한 합병증의 발생 빈도가 적으며 무엇보다도 직장 유암종의 완전한 절제에도 유리하다는 보고가 늘고 있다. 저자들은 직장 유암종으로 진단된 3예에서 밴드결찰술 및 올가미를 이용하여 합병증 없이 완전 절제하여서 문헌 고찰과 함께 보고한다.

위 점막 병변의 겸자 생검과 점막절제술 후의 조직 진단의 비교

김지연 ( Jee Yeon Kim ),이시원 ( See Won Lee ),박이천 ( Lee Chun Park ),신중광 ( Jung Kwang Shin ),박남영 ( Nam Young Park ),문원 ( Won Moon ),김규종 ( Kyu Jong Kim ),박무인 ( Moo In Park ),박선자 ( Seun Ja Park ),장희경 ( Hee Ky 대한내과학회 2006 대한내과학회지 Vol.71 No.6

Background: The correct histological diagnosis of a gastric adenoma is important, because an adenoma has been reported to be a precancerous lesion and is associated with focal gastric carcinoma. However, there is some discrepancy between the histology of a forceps biopsy and that of the endoscopic mucosal resection. This study compared the histological findings of a gastric mucosal lesion in the specimens of a forceps biopsy and an endoscopic mucosal resection. Methods: 88 cases of gastric mucosal lesions, which had been removed by the endoscopic mucosal resection, were reviewed retrospectively. All the patients had undergone a forceps biopsy before the endoscopic mucosal resection. The histological findings of the specimens by a forceps biopsy were compared with those by resection. Results: The histological findings were accordant at 52 of the 88 cases (59.1%). Among the 71 cases with adenoma or gastritis in the biopsied specimens. 13 cases (18.3%) were finally diagnosed with gastric cancer in the resected specimens. Among all the gastritis and adenomas determined by the forceps biopsy, the high-risk groups for adenocarcinomas were characterized by the following endoscopic findings: red-colored and depressed lesions. Conclusions: Biopsy specimens may not be representative of the entire lesion. Therefore, an endoscopic resection of a gastric mucosal lesion is needed for making an accurate histological diagnosis and treatment if adenomas such as red-colored or depressed lesions are suspected. (Korean J Med 71:600-608, 2006)

Endoscopic resection of gastric gastrointestinal stromal tumor using clip-and-cut endoscopic full-thickness resection: a single-center, retrospective cohort in Korea

Yuri Kim,Ji Yong Ahn,Hwoon-Yong Jung,Seokin Kang,Ho June Song,Kee Don Choi,Do Hoon Kim,Jeong Hoon Lee,Hee Kyong Na,Young Soo Park 대한소화기내시경학회 2024 Clinical Endoscopy Vol.57 No.3

Background/Aims: To overcome the technical limitations of classic endoscopic resection for gastric gastrointestinal stromal tumors (GISTs), various methods have been developed. In this study, we examined the role and feasibility of clip-and-cut procedures (clip-and-cut endoscopic full-thickness resection [cc-EFTR]) for gastric GISTs. Methods: Medical records of 83 patients diagnosed with GISTs after endoscopic resection between 2005 and 2021 were retrospectively reviewed. Moreover, clinical characteristics and outcomes were analyzed. Results: Endoscopic submucosal dissection (ESD) and cc-EFTR were performed in 51 and 32 patients, respectively. The GISTs were detected in the upper third of the stomach for ESD (52.9%) and cc-EFTR (90.6%). Within the cc-EFTR group, a majority of GISTs were located in the deep muscularis propria or serosal layer, accounting for 96.9%, as opposed to those in the ESD group (45.1%). The R0 resection rates were 51.0% and 84.4% in the ESD and cc-EFTR groups, respectively. Seven (8.4%) patients required surgical treatment (six patients underwent ESD and one underwent cc-EFTR,) due to residual tumor (n=5) and post-procedure adverse events (n=2). Patients undergoing R0 or R1 resection did not experience recurrence during a median 14-month follow-up period, except for one patient in the ESD group. Conclusions: cc-EFTR displayed a high R0 resection rate; therefore, it is a safe and effective therapeutic option for small gastric GISTs.

Local recurrence and subsequent endoscopic treatment after endoscopic piecemeal mucosal resection with or without precutting in the colorectum

( Myeongsook Seo ),( Eun Mi Song ),( Gwang Un Kim ),( Sung Wook Hwang ),( Sang Hyoung Park ),( Dong-hoon Yang ),( Kyung-jo Kim ),( Byong Duk Ye ),( Seung-jae Myung ),( Suk-kyun Yang ),( Jeong-sik Byeo 대한장연구학회 2017 Intestinal Research Vol.15 No.4

Background/Aims: Precutting before endoscopic piecemeal mucosal resection (EPMR) may increase colorectal polyp resection effectiveness. We aimed to identify risk factors for recurrence after conventional EPMR (CEPMR) and precut EPMR (PEPMR) and investigated endoscopic treatment outcomes for recurrent cases. Methods: The medical records of patients with colorectal polyps treated by EPMR were analyzed. Patients without follow-up surveillance colonoscopies were excluded. Results: Among 359 lesions, the local recurrence rate on the first surveillance colonoscopy was 5.8% (18/312) and 6.4% (3/47) after CEPMR and PEPMR, respectively. Among lesions without recurrence at the first surveillance colonoscopy, the rates of late recurrence on subsequent surveillance colonoscopy were 3.9% (6/152) and 0% after CEPMR and PEPMR, respectively. Larger tumor size was the only independent risk factor for recurrence (odds ratio, 7.93; 95% confidence interval, 1.95-32.30; P<0.001). Endoscopic treatment was performed for all 27 recurrences. A combination of ≥2 endoscopic treatment modalities was used in 19 of 27 recurrences (70.4%). Surveillance colonoscopies were performed in 20 of 27 recurrences after endoscopic treatment. One (5.0%) had a re-recurrence and was treated by surgical resection because recurrence occurred at the appendiceal orifice. Nineteen of 20 lesions (95.0%) could be cured endoscopically, although 3 of the 19 showed second or third recurrences and were treated by repeat endoscopic resection. Conclusions: The local recurrence rates after CEPMR and PEPMR were similar. Larger tumor size was an independent risk factor for local recurrence after EPMR. Endoscopic treatment of recurrences resulted in high cure rates, although combination methods were necessary in many cases. (Intest Res 2017;15:502-510)

The significance of tumor budding in T1 colorectal carcinoma: the most reliable predictor of lymph node metastasis especially in endoscopically resected T1 colorectal carcinoma

Lee, So Jeong,Kim, Ahrong,Kim, Young Keum,Park, Won Young,Kim, Hyun Sung,Jo, Hong-Jae,Oh, Nahmgun,Song, Geum Am,Park, Do Youn Elsevier 2018 Human pathology Vol.78 No.-

<P>Endoscopic resection is widely recognized as a first-line treatment for T1 colorectal cancers (CRC), although additional surgical intervention may be indicated based on the risk of lymph node (LN) metastasis. However, risk factors for LN metastasis in T1 CRC not fully established. We investigated the clinicopathological features of T1 CRC and evaluated their association with lymph node metastasis in 133 cases of T1 CRC, consisting of 87 cases with first-line endoscopic resection (EMR) followed by additional surgery and 46 cases with primary surgical resection. Among the total 133 cases, 16 cases (12.0%) showed LN metastasis; 13 cases (13/16, 81.25%) were included in endoscopic resection cohort. These were all of the non-pedunculated gross type and most of LN+ tumors invaded submucosa over 1000 mu m (surgical cohort versus endoscopic resection cohort; 3 versus 11). However, there was no statistical difference in the depth of submucosal invasion between the LN+ and LN in both surgical cohort (2799.42 mu m 401.56 versus 3000.00 mu m 721.69, P=.897) and endoscopic resection cohort (2066.55 mu m 142.96 versus 2305.77 mu m 345.62, P=.520). Conversely, presence of and a higher number of tumor budding foci were associated with an increase in the incidence of LN metastasis in both cohort (P<.0001). Positive resection margins as well as absence of adenoma component were also an independent predictive factor for lymph node metastasis in 87 cases with first-line endoscopic resection followed by additional surgery. We found that tumor budding was the most reliable LN metastasis predictor in T1 CRC in both surgically resected and endoscopic resection specimens.</P>

식도암의 내시경 치료

민양원 대한소화기학회 2018 대한소화기학회지 Vol.71 No.3

Esophageal cancer incidence rate per 100,000 is 4.7 in 2013, which accounts for 1.1% of the total cancer incidence in Korea. Superficial esophageal squamous cell carcinoma is frequently detected in persons undergoing upper endoscopy for gastrointestinal symptoms or for gastric cancer screening. Esophagectomy with lymph node dissection is the standard treatment for esophageal cancer. However, given the considerable morbidity and mortality of esophagectomy, endoscopic resection has become the standard of care for most cases of superficial esophageal squamous cell carcinoma without metastasis. In addition, endoscopic submucosal dissection has increased the cure rate, even when the tumor is large, compared to endoscopic mucosal resection. Thus, endoscopic submucosal dissection is the treatment of choice for superficial esophageal squamous cell carcinoma with a negligible risk of lymph node metastasis. Endoscopic resection is usually associated with a low risk of morbidity and no mortality, and has also shown favorable long-term outcomes. However, the long-term risk of metastasis remains after endoscopic resection, which varies according to the characteristics of tumor. This review describes the indication and outcomes of endoscopic resection, complications of endoscopic resection, and management after treatment.

내시경적 점막 절제술로 치료한 바터팽대주위 신경절세포 부신경절종 1예

박선영,송영아,진남철,조준호,주영은,김현수,최성규,류종선 대한소화기내시경학회 2009 Clinical Endoscopy Vol.39 No.2

Gangliocytic paraganglioma is a rare tumor that occurs nearly exclusively in the second portion of the duodenum. This tumor is usually considered to be benign. So, endoscopic resection may be the best procedure to facilitate the diagnosis and for treatment to avoid an unnecessary, invasive operation. To the best of our knowledge, this is the first report of a periampullary gangliocytic paraganglioma that was successfully treated by endoscopic mucosal resection in Korea. We report here a case of a 45-year-old man who was found to have a periampullary gangliocytic paraganglioma. This tumor was adequately treated by endoscopic mucosal resection. 신경절세포 부신경절종(gangliocytic paraganglioma)은 드문 종양으로 주로 십이지장 제 2부에서 발생한다. 다른 십이지장 종양과의 감별이 어려워 췌십이지장절제술을 포함한 수술적 절제술을 시행한 경우가 많다. 그러나, 대부분 양성 종양이므로 최근 시행되는 내시경 점막 절제술(endoscopic mucosal resection, EMR)이 진단과 치료에 도움이 되어 불필요한 광범위한 수술을 피할 수 있을 것으로 생각한다. 십이지장의 신경절세포 부신경절종은 국내에서 이미 4예가 보고된바 있으나 모두 수술로 제거한 증례로, 저자들은 무증상의 바터 팽대 주위의 신경절세포 부신경절종을 내시경 점막 절제술로 성공적으로 제거한 1예를 경험하여 보고한다.

Factors Affecting Endoscopic Curative Resection of Gastric Cancer in the Population-Based Screening Era

Mun, Yoon Gwon,Choi, Myung-Gyu,Lim, Chul-Hyun,Lee, Han Hee,Kang, Dong Hoon,Park, Jae Myung,Song, Kyo Young Korean Society of Gastrointestinal Endoscopy 2018 Clinical Endoscopy Vol.51 No.5

<P><B>Background/Aims</B></P><P>Since population-based screening for gastric cancer in Korea was implemented, endoscopic treatment of early gastric cancer has become increasingly popular. This study investigates factors affecting endoscopic curative resection of early gastric cancer in population-based screening for gastric cancer. </P><P><B>Methods</B></P><P>We retrospectively reviewed data of patients with newly diagnosed gastric cancer who underwent treatment at Seoul St. Mary’s Hospital. All patients completed questionnaires about clinical information, including interval between surveillance tests for gastric cancer. </P><P><B>Results</B></P><P>Of 469 gastric cancer patients, 147 (31.3%) had undergone curative endoscopic resection, 260 (55.4%) had undergone curative surgical resection, and 62 (13.3%) underwent non-curative resection or were in an inoperable state. Patients with curative endoscopic resection had fewer alarm symptoms/signs than other groups. In multivariate analysis, regular surveillance endoscopy was the only factor predicting curative endoscopic resection (odds ratio [OR], 6.099; 95% confidence interval [CI], 2.532–14.933). In addition, patients undergoing gastric cancer screening had a significantly higher rate of endoscopic curative resection compared with subjects who had never been screened. (1-year interval: OR, 49.969; 95% CI, 6.340–393.827, 2-year interval: OR, 15.283; 95% CI, 1.833–127.406, over 2-year interval: OR, 10.651; 95% CI, 1.248–90.871). Shorter screening test intervals were associated with higher rates of endoscopic curative resection. </P><P><B>Conclusions</B></P><P>Regular surveillance testing was the independent factor predicting curative endoscopic resection of gastric cancer. </P>