Search

Background and Aims: The therapeutic outcome of endoscopic submucosal dissection (ESD) for large protruding tumors has not yet been evaluated. We aimed to compare the outcomes of ESD in protruding tumors with those of laterally spreading tumors (LSTs).Methods: Endoscopic submucosal dissection was attempted in 218 patients with 220 colorectal tumors ≥30 mm in diameter (67, protruding tumors; 153, LSTs) from July 2007 to June 2014. We retrospectively reviewed patient medical records, therapeutic outcomes, and procedure-related adverse events. This study defined lesions with a height of 10 mm or more as protruding tumors and those with a height under 10 mm as LSTs.Results: The mean lesion diameter, height, and volume were 43.8, 9.5 mm, and 13.6 cm(3), respectively. The mean procedure time was 75.5 min. Deep submucosal cancer was more frequent in protruding tumors than in LSTs (11.9 vs. 2.6%, P = 0.005). Severe fibrosis was more common in protruding tumors than in LSTs (19.4 vs. 3.9%, P < 0.001). En bloc resection and complete resection rates were lower in protruding tumors than in LSTs (en bloc resection, 76.1 vs. 92.8%, P = 0.001; complete resection, 64.2 vs. 79.1%, P = 0.020). Intra- and post-procedural bleeding were more frequent in protruding tumors than in LSTs (22.4 vs. 2.6%, P < 0.001; 6.0 vs. 0.7%, P = 0.031, respectively). By multivariate analysis, protruding tumor morphology (odds ratio 1.919, P = 0.048) and tumor size ≥60 mm (odds ratio 2.490, P = 0.030) were associated with incomplete resection.Conclusions: Endoscopic submucosal dissection for protruding tumors is less effective than ESD for LSTs, with lower rate of complete resection occurring with protruding tumors. [ABSTRACT FROM AUTHOR]

Background: Experience in gastric endoscopic submucosal dissection (ESD) has been suggested as a prerequisite for performing colorectal ESD by some experts.Aims: To evaluate the feasibility of performing colorectal ESD without experience in gastric ESD.Methods: Between November 2009 and December 2013, ESD was attempted for 250 colorectal lesions by an endoscopist having extensive colonoscopy experience but no prior experience of gastric ESD. All attempts were categorized according to the chronological order of procedures: group 1, attempts 1-50; group 2, attempts 51-100; group 3, attempts 101-150; group 4, attempts 151-200; and group 5, attempts 201-250. Procedure-related outcomes were analyzed.Results: En bloc resection rate ≥80% was achieved after initial ten ESD attempts. The ESD success rate (72, 80, 90, 90, and 94% in group 1-5, respectively; p for trend = 0.001), perforation rate (14, 14, 6, 6, and 0% in group 1-5, respectively; p for trend = 0.003), and macroperforation rate (6, 6, 2, 2, and 0% in group 1-5, respectively; p for trend = 0.042) improved as experience accumulated. Performing >100 ESDs, rectal location, and absence of submucosal fibrosis were independent predictors of successful procedure.Conclusion: Colorectal ESD can be safely and effectively performed by an endoscopist having extensive experience in colonoscopy-related procedures even without previous experience of gastric ESD. Meticulous case selection for ESD novice and active supervision by expert endoscopists during the initial learning period may minimize the risk of perforation. [ABSTRACT FROM AUTHOR]

Background: Few studies have compared the costs of colorectal endoscopic submucosal dissection (ESD) and endoscopic piecemeal mucosal resection (EPMR).Aims: Here, we aimed to investigate the cost-effectiveness of these approaches by analyzing clinical outcomes and costs.Methods: Data from patients undergoing colorectal ESD and EPMR were retrospectively reviewed. Clinical outcomes (procedure time, complete resection, and recurrence) were compared, and total direct costs (procedural and follow-up) were assessed.Results: Data from 429 ESD and 115 EPMR patients were included in the analysis. The complete resection rate was significantly higher (83.9% vs. 32.2%, p < 0.001), recurrence rate was lower (0.5% vs. 7.1%, p < 0.001), procedure time was longer (55.4 ± 47.0 vs. 25.6 ± 32.7 min, p < 0.001), and total direct procedural costs at the initial resection were higher (1480.0 ± 728.0 vs. 729.8 ± 299.7 USD, p < 0.001) in the ESD group than in the EPMR group. The total number of surveillance endoscopies was higher in the EPMR group (1.7 ± 1.5 vs. 1.3 ± 1.1, p = 0.003). The cumulative total costs of ESD and EPMR were comparable at 3 and 2 years' follow-up in the adenoma and mucosal/superficial submucosal cancer subgroups, respectively.Conclusions: Colorectal ESD was associated with higher complete resection and lower recurrence rates. EPMR showed shorter procedure times and similar cumulative total direct costs. ESD or EPMR should be chosen based on both clinical outcomes and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background: Little is known about the natural history of perianal fistulas in Asian populations with Crohn's disease (CD).Aims: We investigated the incidence and outcomes of perianal CD (pCD) in Korean CD patients.Methods: A nationwide population-based cohort of 6265 CD patients diagnosed in 2010-2014 was analyzed to investigate the incidence and outcomes of pCD. The results were validated in a hospital-based cohort of 2923 CD patients diagnosed in 1981-2015. Factors associated with pCD development were analyzed. The incidence and outcomes of pCD were compared between the prebiologic and biologic eras.Results: pCD occurred in 39.2% of the population-based cohort and 56.1% of the hospital-based cohort during the median follow-up of 4.2 and 8.5 years, respectively. The cumulative incidence of pCD was 40.0% at 5 years after CD diagnosis in the population-based cohort and 62.5% at 20 years in the hospital-based cohort. In multivariate analysis, pCD development was positively associated with male sex, younger age and colonic involvement at diagnosis, early diagnosis, and CD diagnosis in the prebiologic era. The cumulative probability of proctectomy at 10, 20, and 30 years after pCD diagnosis was 2.9%, 12.2%, and 16.2%, respectively. The cumulative incidence of pCD occurring after CD diagnosis and the cumulative probability of proctectomy were significantly lower in the biologic era than in the prebiologic era (p < 0.001 and p = 0.03, respectively).Conclusions: Compared with Western patients with CD, Korean patients show a high incidence of pCD but have a low probability of proctectomy, suggesting the favorable course of pCD. [ABSTRACT FROM AUTHOR]

Background: The fatty acid profile of the fecal metabolome and its association with colorectal cancer (CRC) has not been fully evaluated.Aims: We aimed to compare the fecal fatty acid profiles of CRC patients and healthy controls.Methods: We enrolled 26 newly diagnosed CRC patients and 28 healthy individuals between July 2014 and August 2014 from our institute. Long- and short-chain fatty acids were extracted from fecal samples and analyzed using gas chromatography-mass spectrometry.Results: Regarding fecal long-chain fatty acids, the levels of total ω-6 polyunsaturated fatty acids and, particularly, of linoleic acid (C18:2ω-6) were significantly higher in male CRC patients than in healthy men (2.750 ± 2.583 vs. 1.254 ± 0.966 µg/mg feces, P = 0.040; 2.670 ± 2.507 vs. 1.226 ± 0.940 µg/mg feces, P = 0.034, respectively). In addition, the levels of total monounsaturated fatty acid and, particularly, of oleic acid (C18:1ω-9) were significantly higher in male CRC patients than in healthy men (1.802 ± 1.331 vs. 0.977 ± 0.625 µg/mg feces, P = 0.027; 1.749 ± 1.320 vs. 0.932 ± 0.626 µg/mg feces, P = 0.011, respectively). However, those differences were not shown in female gender. The level of fecal short-chain fatty acids was not different between CRC patients and healthy controls.Conclusions: There were changes in the profiles of fecal fatty acid metabolomes in CRC patients compared to healthy controls, implying that fecal fatty acids could be used as a novel screening tool for CRC. [ABSTRACT FROM AUTHOR]

Background: The optimal colon-cleansing method after failure of bowel preparation (BP) for colonoscopy has not been established. Aims: We aimed to compare BP rescue methods after failed initial BP and to identify risk factors for rescue BP failure. Methods: Eighty-five patients with BP failure after 4 L polyethylene glycol (PEG) ingestion were prospectively enrolled from March 2008 to March 2012. A second colonoscopy was performed either on the same day after ingestion of another 2 L PEG (group A) or 1 week later after ingestion of 4 L PEG plus 20 mg oral bisacodyl (group B). Differences between groups in terms of BP quality and risk factors for a poor BP on the second colonoscopy were investigated. Results: Median patient age was 59 years, 45 were male (52.9 %), and 17 (20 %) had poor BP on the second colonoscopy. For group B, the multivariable-adjusted odds ratio (OR) for poor BP on the second colonoscopy relative to group A was 0.68 (95 % confidence interval [CI], 0.16-2.95). Adequately ingested PEG during the initial colonoscopy was associated with poor BP on the second colonoscopy (OR 4.05; 95 % CI 1.04-15.75). The two groups had similar patient discomfort rates during the second BP. Conclusions: The two groups did not differ in rescue BP failure rate. Initial BP failure after adequate consumption of 4 L PEG may be a risk factor for rescue BP failure. A stricter BP regimen should be considered for these patients. [ABSTRACT FROM AUTHOR]

Objective: A retrospective study was performed to compare the clinical and radiological results between local bone graft with a cage and without using a cage in patients treated with posterior lumbar interbody fusion surgery. Methods: A total of 115 consecutive patients who underwent PLIF in three institutions were evaluated from December 2005 to December 2010. 53 patients received PLIF with local bone graft combined with using one PEEK cage, and 62 patients received the PLIF with local bone graft without using a cage. The clinical data and perioperative complications of the patients in the two groups were recorded. Preoperative and postoperative radiographs were taken to calculate the disc height and the interbody bony fusion rate. Functional outcome was assessed using the Kirkaldy-Willis criteria at the follow-up time. The results between the cage group and no cage group were compared. Results: The mean follow-up time was 19 months in no cage group and 18.5 months in cage group ( P = 0.716). 20.9 % of patients (13 cases) in no cage group and 20.7 % of patients (11 cases) in cage group developed surgical complications perioperatively ( P = 0.978). 51.6 % patients in no cage group got excellent functional outcome at the final follow-up while 54.7 % patients in cage group ( P = 0.944). The mean interbody bony fusion time was 7.5 ± 4.5 months in no cage group and 8 ± 3.5 months in cage group ( P = 0.841). According to the radiographs measurement, no significant difference was found for the disc height at each level between the two groups at the final follow-up. Conclusion: Local bone graft without a cage is as beneficial as that with a cage for PLIF. Comparing with local bone graft using a single cage, we believe that the purely local bone graft is a more ideal way in single PLIF. [ABSTRACT FROM AUTHOR]