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Can Advanced Endoscopic Imaging Help Us Avoid Surgery for Endoscopically Resectable Colorectal Neoplasms? A Proof-of-Concept Study.

Abstract

BACKGROUND

European guidelines recommend advanced endoscopic imaging (AEI) to guide therapeutic decisions; however, data are limited concerning its clinical effects on the management of colorectal polyps. The aim of this study was to investigate the effect of standard chromoendoscopic imaging (SCI) and AEI on decision-making regarding therapeutic techniques.

METHODS

We retrospectively analyzed prospectively collected endoscopic and pathological data on colorectal neoplasms ≥ 10 mm removed at a Japanese tertiary cancer center between January 2010 and December 2016. We assumed a virtual approach to manage the decisions for endoscopic resection or surgery for each lesion using the following test modalities: (1) endoscopic size measurement (ESM), (2) SCI, and (3) AEI. Virtual surgical management was indicated using the following criteria: (1) ESM: lesion ≥ 40 mm, (2) SCI: depression, excavation, or ulceration, (3) AEI: Japan NBI Expert Team type 3 (magnifying NBI), VI high-grade, or VN (magnifying chromoendoscopy). We compared the incidence of hypothetical redundant surgery, defined as virtual surgical management for cases of dysplasia or superficial submucosal invasive cancers (SM-S).

RESULTS

A total of 3509 lesions from 2693 patients were analyzed, including 142 SM-S and 457 deep submucosal invasive cancer (SM-D). The incidence of hypothetical redundant surgery was 9.2% with ESM, 5.1% with SCI, and 2.9% with AEI. When compared with ESM, hypothetical redundant surgery was significantly reduced with SCI (relative risk 0.55; 95% confidence interval 0.44-0.69) and AEI (0.31; 0.23-0.41).

CONCLUSIONS

Therapeutic decision-making according to SCI or AEI can reduce surgery for endoscopically resectable colorectal neoplasms.

Authors+Show Affiliations

Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan. k.imai1977@gmail.com.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.Division of Endoscopy, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Suntogun, Shizuoka, 411-8777, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31630341

Citation

Hosotani, Kazuya, et al. "Can Advanced Endoscopic Imaging Help Us Avoid Surgery for Endoscopically Resectable Colorectal Neoplasms? a Proof-of-Concept Study." Digestive Diseases and Sciences, 2019.
Hosotani K, Imai K, Hotta K, et al. Can Advanced Endoscopic Imaging Help Us Avoid Surgery for Endoscopically Resectable Colorectal Neoplasms? A Proof-of-Concept Study. Dig Dis Sci. 2019.
Hosotani, K., Imai, K., Hotta, K., Ito, S., Kishida, Y., Yoshida, M., ... Ono, H. (2019). Can Advanced Endoscopic Imaging Help Us Avoid Surgery for Endoscopically Resectable Colorectal Neoplasms? A Proof-of-Concept Study. Digestive Diseases and Sciences, doi:10.1007/s10620-019-05894-y.
Hosotani K, et al. Can Advanced Endoscopic Imaging Help Us Avoid Surgery for Endoscopically Resectable Colorectal Neoplasms? a Proof-of-Concept Study. Dig Dis Sci. 2019 Oct 19; PubMed PMID: 31630341.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can Advanced Endoscopic Imaging Help Us Avoid Surgery for Endoscopically Resectable Colorectal Neoplasms? A Proof-of-Concept Study. AU - Hosotani,Kazuya, AU - Imai,Kenichiro, AU - Hotta,Kinichi, AU - Ito,Sayo, AU - Kishida,Yoshihiro, AU - Yoshida,Masao, AU - Kawata,Noboru, AU - Kakushima,Naomi, AU - Takizawa,Kohei, AU - Ishiwatari,Hirotoshi, AU - Matsubayashi,Hiroyuki, AU - Ono,Hiroyuki, Y1 - 2019/10/19/ PY - 2019/07/11/received PY - 2019/10/03/accepted PY - 2019/10/21/entrez PY - 2019/10/21/pubmed PY - 2019/10/21/medline KW - Colorectal polyp KW - Narrowband imaging KW - Optical diagnosis KW - Submucosal invasive cancers JF - Digestive diseases and sciences JO - Dig. Dis. Sci. N2 - BACKGROUND: European guidelines recommend advanced endoscopic imaging (AEI) to guide therapeutic decisions; however, data are limited concerning its clinical effects on the management of colorectal polyps. The aim of this study was to investigate the effect of standard chromoendoscopic imaging (SCI) and AEI on decision-making regarding therapeutic techniques. METHODS: We retrospectively analyzed prospectively collected endoscopic and pathological data on colorectal neoplasms ≥ 10 mm removed at a Japanese tertiary cancer center between January 2010 and December 2016. We assumed a virtual approach to manage the decisions for endoscopic resection or surgery for each lesion using the following test modalities: (1) endoscopic size measurement (ESM), (2) SCI, and (3) AEI. Virtual surgical management was indicated using the following criteria: (1) ESM: lesion ≥ 40 mm, (2) SCI: depression, excavation, or ulceration, (3) AEI: Japan NBI Expert Team type 3 (magnifying NBI), VI high-grade, or VN (magnifying chromoendoscopy). We compared the incidence of hypothetical redundant surgery, defined as virtual surgical management for cases of dysplasia or superficial submucosal invasive cancers (SM-S). RESULTS: A total of 3509 lesions from 2693 patients were analyzed, including 142 SM-S and 457 deep submucosal invasive cancer (SM-D). The incidence of hypothetical redundant surgery was 9.2% with ESM, 5.1% with SCI, and 2.9% with AEI. When compared with ESM, hypothetical redundant surgery was significantly reduced with SCI (relative risk 0.55; 95% confidence interval 0.44-0.69) and AEI (0.31; 0.23-0.41). CONCLUSIONS: Therapeutic decision-making according to SCI or AEI can reduce surgery for endoscopically resectable colorectal neoplasms. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/31630341/Can_Advanced_Endoscopic_Imaging_Help_Us_Avoid_Surgery_for_Endoscopically_Resectable_Colorectal_Neoplasms_A_Proof-of-Concept_Study L2 - https://doi.org/10.1007/s10620-019-05894-y DB - PRIME DP - Unbound Medicine ER -