Novel Endoscopic Technique in Treating Colon Neoplasms with Improved Clinical Outcomes
Ismailov Saidmurad Ibragimovich1,2, Djumaniyazov Djavokhir Azatbaevich1, Yigitaliev Sardor Khusanboevich2, Yakubov Farkhod Radjabovich3, Sapaev Duschan Shukhratovich3
Journal of Angiotherapy 8(6) 1-6 https://doi.org/10.25163/angiotherapy.869748
Submitted: 16 April 2024 Revised: 08 July 2024 Published: 18 June 2024
Abstract
Background: Colorectal polyps are a significant concern due to their potential to develop into colorectal cancer (CRC), a leading cause of cancer mortality. While many polyps are benign, a subset is "complex" and challenging to resect endoscopically. Current methods for polyp removal include cold excision, electrocoagulation, endoscopic mucosal resection (EMR), and endoscopic submucosal dissection (ESD), with varying success and complication rates. This study evaluates a new endoscopic excision technique involving a gel injection and diode laser system. Methods: The study included 208 patients with superficial neoplastic lesions of the colon, divided into a comparison group (112 patients, 170 polyps) and a main group (96 patients, 152 polyps). The comparison group underwent conventional excision techniques, while the main group received the new gel injection and diode laser excision method. Outcomes measured included complete resection rates, complication rates, recurrence rates, and hospital stay duration. Results: The main group showed a higher complete resection rate (70.4% vs. 57.1%, p=0.014) and lower recurrence rates (5.0% vs. 24.2%, p<0.001) compared to the comparison group. Clinically significant bleeding during and after procedures was also reduced in the main group (0% intraoperative, 0.7% postoperative) compared to the comparison group (4.7% intraoperative, 2.4% postoperative, p=0.012). The average hospital stay was shorter in the main group (3.4±1.0 days) compared to the comparison group (4.0±1.2 days, p<0.05). Conclusion: The new endoscopic excision technique using gel injection and diode laser significantly improves the complete resection rate, reduces complications and recurrence rates, and shortens hospital stay for patients with superficial colonic neoplastic lesions. This method offers a promising alternative for the endoscopic treatment of complex colorectal polyps.
Keywords: Colon polyps, endoscopic resection, laser excision, recurrence, complications
References
Akilov, K. A., Rustamov, A. E., Sapaev, D. Sh. (2023). Evaluation of the effectiveness of a new method of surgical treatment of rectal prolapse. Grekov’s Bulletin of Surgery, 182(3), 47–53. https://doi.org/10.24884/0042-4625-2023-182-3-47-53
Ataullaevich, A. K., Khasanovich, B. A., Abrarovich, S. R., Eshmurodovich, R. A., Bazarbaevich, O. G., Sultanbaevich, B. A., Radjabovich, Y. F., & Shukhratovich, S. D. (2023). A new method of surgical treatment of rectal prolapse. Migration Letters, 20(S8), 1512–1519. https://doi.org/10.59670/ml.v20iS8.6111
Atkin, W., Wooldrage, K., Parkin, D. M., et al. (2017). Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up: The UK Flexible Sigmoidoscopy Screening randomised controlled trial. Lancet, 389(10076), 1299–1311.
Belderbos, T. D., Leenders, M., Moons, L. M., & Siersema, P. D. (2014). Local recurrence after endoscopic mucosal resection of nonpedunculated colorectal lesions: Systematic review and meta-analysis. Endoscopy, 46, 388–402.
Bettington, M., Walker, N., Rahman, T., et al. (2017). High prevalence of sessile serrated adenomas in contemporary outpatient colonoscopy practice. Intern Med J, 47(3), 318–323.
Choi, C. W., Kang, D. H., Kim, H. W., et al. (2012). Endoscopic submucosal dissection as a treatment for gastric adenomatous polyps: Predictive factors for early gastric cancer. Scand J Gastroenterol, 47(10), 1218-1225.
Evans, J. A., Chandrasekhara, V., Chathadi, K. V., Decker, G. A., Early, D. S., Fisher, D. A., et al. (2015). ASGE guideline: The role of endoscopy in the management of premalignant and malignant conditions of the stomach. Gastrointest Endosc, 82, 1–8. https://doi.org/10.1016/j.gie.2015.03.1967
Jiang, Q., Yan, X., Wang, D., Zhang, S., Zhang, Y., Feng, Y., ... Wu, D. (2023). Endoscopic mucosal resection using cold snare versus hot snare in treatment for 10-19 mm non-pedunculated colorectal polyps: Protocol of a non-inferiority randomised controlled study. BMJ Open, 13(5), e070321. https://doi.org/10.1136/bmjopen-2022-070321
Kang, D. H., Choi, C. W., Kim, H. W., et al. (2018). Predictors of upstage diagnosis after endoscopic resection of gastric low-grade dysplasia. Surg Endosc, 32(6), 2732-2738.
Kim, S. Y., Sung, J. K., Moon, H. S., et al. (2012). Is endoscopic mucosal resection a sufficient treatment for low-grade gastric epithelial dysplasia? Gut Liver, 6(4), 446-451.
Kim, S. Y., Sung, J. K., Moon, H. S., et al. (2012). Is endoscopic mucosal resection a sufficient treatment for low-grade gastric epithelial dysplasia? Gut Liver, 6(4), 446-451.
Kolb, J. M., Hu, J., DeSanto, K., et al. (2021). Early-age onset colorectal neoplasia in average-risk individuals undergoing screening colonoscopy: A systematic review and meta-analysis. Gastroenterology, 161(4), 1145–1155.
Li, X., Xu, J., & Niu, J. (2016). Clinicopathological characteristics and risk factors of postoperative recurrence of different types of gastric polyps. Journal of Gastro-enterology and Hepatology, 25(10), 1156-1160.
Mann, R., Gajendran, M., Umapathy, C., Perisetti, A., Goyal, H., Saligram, S., & Echavarria, J. (2021). Endoscopic management of complex colorectal polyps: Current insights and future trends. Front Med (Lausanne), 8, 728704.
Ngamruengphong, S., Pohl, H., Haito-Chavez, Y., & Khashab, M. A. (2016). Update on difficult polypectomy techniques. Curr Gastroenterol Rep, 18, 3.
Pattarajierapan, S., Takamaru, H., Khomvilai, S. (2023). Difficult colorectal polypectomy: Technical tips and recent advances. World J Gastroenterol, 29(17), 2600-2615. https://doi.org/10.3748/wjg.v29.i17.2600
Pimentel-Nunes, P., Libânio, D., Marcos-Pinto, R., et al. (2019). Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy, 51(4), 365-388.
QIN, S., & XU, Y. (2020). Progress in clinical diagnosis and treatment for gastric polyps. Journal of Central South University. Medical Science, 45(1), 74-78. https://doi.org/10.11817/j.issn.1672-7347.2020.180521
Qin, S., & Xu, Y. (2020). Progress in clinical diagnosis and treatment for gastric polyps. Journal of Central South University. Medical Science, 45(1), 74-78. https://doi.org/10.11817/j.issn.1672-7347.2020.180521
Schramm, C., Janhsen, K., Hofer, J. H., et al. (2018). Detection of clinically relevant serrated polyps during screening colonoscopy: Results from seven cooperating centers within the German colorectal screening program. Endoscopy, 50(10), 993–1000.
Sullivan, B. A., Noujaim, M., & Roper, J. (2022). Cause, epidemiology, and histology of polyps and pathways to colorectal cancer. Gastrointest Endosc Clin N Am, 32(2), 177-194. https://doi.org/10.1016/j.giec.2021.12.001
Sung, H., Ferlay, J., Siegel, R. L., et al. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 71(3), 209–249.
Surveillance, Epidemiology, and End Results (SEER) Program. (2021). SEERStat Database: Incidence - SEER Research Data.* National Cancer Institute, DCCPS, Surveillance Research Program. Retrieved from https://seer.cancer.gov
Tanaka, S., Kashida, H., Saito, Y., et al. (2020). Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Digestive Endoscopy, 32(3), 219-239. https://doi.org/10.1111/den.13545
Yacoub, H., Bibani, N., Sabbah, M., Bellil, N., Ouakaa, A., Trad, D., & Gargouri, D. (2022). Gastric polyps: A 10-year analysis of 18,496 upper endoscopies. BMC Gastroenterol, 22(1), 70. https://doi.org/10.1186/s12876-022-02154-8
Yanai, Y., Yokoi, C., Watanabe, K., Akazawa, N., & Akiyama, J. (2021). Endoscopic resection for gastrointestinal tumors (esophageal, gastric, colorectal tumors): Japanese standard and future prospects. Glob Health Med, 3(6), 365-370. https://doi.org/10.35772/ghm.2020.01116
Yilmaz, S., & Gorgun, E. (2023). Endoscopic mucosal resection and endoscopic submucosal dissection. Clinics in Colon and Rectal Surgery. https://doi.org/10.1055/s-0043-1770941
Zhong, X., & Xu, A. (2002). Endoscopic treatment and follow-up of adenomatous gastric polyps. Journal of Practical Medicine, 18(6), 635-636.
Zhu, M., Ning, S., Bu, X., et al. (2009). Clinicopathological features and endoscopic treatment of gastric polyps. Gastroenterology, 14(12), 751-753.
View Dimensions
View Altmetric
Save
Citation
View
Share