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, 50 (4), 379-387

Endoscopic Mucosal Resection With Circumferential Mucosal Incision for Colorectal Neoplasms: Comparison With Endoscopic Submucosal Dissection and Between Two Endoscopists With Different Experiences

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Endoscopic Mucosal Resection With Circumferential Mucosal Incision for Colorectal Neoplasms: Comparison With Endoscopic Submucosal Dissection and Between Two Endoscopists With Different Experiences

Dong-Hoon Yang et al. Clin Endosc.

Abstract

Background/aims: Endoscopic mucosal resection with circumferential mucosal incision (CMI-EMR) may offer benefits comparable to those of endoscopic submucosal dissection (ESD), while requiring less technical proficiency than ESD.

Methods: We retrospectively compared the outcomes of CMI-EMR (n=34) and size-matched ESD (n=102), which were performed by a Korean endoscopist for colorectal epithelial lesions of 20-35 mm. Procedural parameters of CMI-EMRs performed by an American ESD novice (n=30) were compared with those performed by the Korean endoscopist.

Results: The lesion size was 22.3±3.9 mm and 22.9±2.4 mm in the CMI-EMR and size-matched ESD groups, respectively (p=0.730). The resection time was 12.7±7.0 minutes in the CMI-EMR group and 45.6±30.1 minutes in the ESD group (p<0.001). The en bloc resection rate was 94.1% in the CMI-EMR group and 100% in the ESD group (p=0.061). There were no differences in the en bloc resection and complication rates of CMI-EMRs between a Korean and an American endoscopist.

Conclusions: For the treatment of moderate-size colorectal lesions, CMI-EMR showed a trend toward lower en bloc resection rate, but required shorter procedure time than ESD. CMI-EMR outcomes were similar when performed by a Korean ESD expert and an American ESD novice.

Keywords: Colon; Endoscopic mucosal resection; Endoscopic submucosal dissection; Neoplasms; Rectum.

Conflict of interest statement

Conflicts of Interest: The authors have no financial conflicts of interest.

Figures

Fig. 1.
Fig. 1.
Representative example of an endoscopic submucosal dissection. (A) A laterally spreading tumor on the rectum. (B) The submucosal layer was exposed after precutting and trimming. (C) An additional submucosal dissection was performed. (D) After dissecting more than 75% of the lesion, a mucosal incision was made on the oral side. The scope was retroflexed in this image. (E) A clean-based artificial ulcer remained after complete excision of the lesion. (F) The lesion was removed en bloc.
Fig. 2.
Fig. 2.
Representative example of an endoscopic mucosal resection with circumferential mucosal incision. (A) A 20-mm-sized laterally spreading tumor was noted on the rectum. (B, C) After submucosal injection using sodium hyaluronate solution, a circumferential mucosal incision was performed using the tip of the snare. (D, E) The lesion was snared along with the circumferential groove and resected en bloc. (F) The lesion was identified as a villotubular adenoma with a high-grade dysplasia of 22×18 mm in size.
Fig. 3.
Fig. 3.
Selection of cases. (A) Case selection from among the ≥20-mm colorectal lesions that were removed using endoscopic mucosal resection with circumferential mucosal incision (CMI-EMR) or endoscopic submucosal dissection (ESD) at a Korean center. The size of the lesions removed using CMI-EMR ranged between 20 and 35 mm. After excluding lesions larger than 35 mm, size-matched ESD cases were randomly selected and matched with the CMI-EMR cases at a 1:3 ratio. (B) CMI-EMR cases performed by an experienced Korean endoscopist and an inexperienced American endoscopist were categorized as the Korean CMI-EMR group and the US CMI-EMR group, respectively.

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