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This article discusses the risk of lymph node metastasis and recurrence after endoscopic resection of T1 colorectal adenocarcinoma with submucosal invasion greater than 1000µm and no other histological pejorative factors. The study, conducted in 24 European centers, included 219 patients who underwent endoscopic resection between December 2009 and December 2022. The results showed that lesions with submucosal invasion greater than or equal to 2000µm were significantly associated with lymph node metastases and recurrence. The authors suggest that the 1000µm threshold may be too restrictive and that the 2000µm threshold is more relevant for predicting the risk of lymph node metastases. [Extracted from the article]

This article discusses the prevalence, risk factors, and clinical outcomes of perforations following colorectal endoscopic submucosal dissection (ESD). The study analyzed data from 4025 procedures performed in French and Belgian centers between September 2019 and September 2022. The main finding was that conservative treatment was effective in 91.7% of perforations, with surgery required in only 0.8% of cases. Risk factors for perforation included larger lesion size, previous resection, distal colonic location, poor maneuverability, and severe fibrosis. The authors emphasize the importance of informing patients about the benefits and risks of ESD. [Extracted from the article]

This article discusses the impact of annual case volume on the outcomes and safety of colorectal endoscopic submucosal dissection (ESD) procedures. The study included 3770 colorectal ESDs performed in 13 participating centers. The results showed that high-volume centers had higher rates of en bloc resection, R0 resection, and curative resection compared to middle-volume and low-volume centers. The duration of the procedure was also shorter in high-volume centers. However, the study found that the volume of the center was not a significant risk factor for complications such as perforation. Overall, the study suggests that colorectal ESD can be successfully implemented in non-expert settings, but challenging cases should still be referred to experts. [Extracted from the article]

This article discusses the management of submucosal lesions in the colon. The study included 78 patients with 81 colonic submucosal lesions from 11 European centers. The resection techniques used varied, including cold loop resections, conventional mucosectomies, submucosal dissections, and EFTR resections. The study found that R0 en bloc resection was appropriate in 7.4% of cases. The authors propose a new therapeutic approach involving the use of a low-risk, low-cost histological diagnostic technique followed by a more advanced technique if necessary. Further studies are needed to evaluate this strategy and determine the best technique for obtaining histological evidence. [Extracted from the article]

This article discusses the outcomes of colorectal endoscopic submucosal dissection (ESD) procedures in France, specifically comparing the results of colonic and rectal lesions. The study found that ESD is an effective treatment for large superficial colorectal lesions, with high rates of en bloc, R0, and curative resection. After matching patients, there were no significant differences in en bloc and R0 resection rates between colonic and rectal lesions. However, curative resection was more frequent in the colon, while perforation was more frequent in the colon and delayed bleeding was more frequent in the rectum. The study concludes that ESD can be considered a first-line treatment for superficial colorectal lesions larger than 2 cm. [Extracted from the article]

Background and study aims: Distinguishing pancreatic adenocarcinoma from other pancreatic masses remains challenging with current imaging techniques. This prospective study aimed to evaluate the accuracy of a new procedure, imaging the microcirculation pattern of the pancreas by contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) with a new Olympus prototype echo endoscope. Patients and methods: 35 patients presenting with solid pancreatic lesions were prospectively enrolled. All patients had conventional B mode and power Doppler EUS. After an intravenous bolus injection of 2.4 ml of a second-generation ultrasound contrast agent (SonoVue) CEH-EUS was then performed with a new Olympus prototype echo endoscope (xGF-UCT 180). The microvascular pattern was compared with the final diagnosis based on the pathological examination of specimens from surgery or EUS-guided fine-needle aspiration (EUS-FNA) or on follow-up for at least 12 months. Results: The final diagnoses were: 18 adenocarcinomas, 9 neuroendocrine tumors, 7 chronic pancreatitis, and 1 stromal tumor. Power Doppler failed to display microcirculation, whereas harmonic imaging demonstrated it in all cases. Out of 18 lesions with a hypointense signal on CEH-EUS, 16 were adenocarcinomas. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of hypointensity for diagnosing pancreatic adenocarcinoma were 89 %, 88 %, 88 %, 89 %, and 88.5 %, compared with corresponding values of 72 %, 100 %, 77 %, 100 %, and 86 % for EUS-FNA. Of five adenocarcinomas with false-negative results at EUS-FNA, four had a hypointense echo signal at CEH-EUS. Conclusions: CEH-EUS with the new Olympus prototype device successfully visualizes the microvascular pattern in pancreatic solid lesions, and may be useful for distinguishing adenocarcinomas from other pancreatic masses. [ABSTRACT FROM AUTHOR]