PMID- 36118634
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220920
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 10
IP  - 9
DP  - 2022 Sep
TI  - Underwater endoscopic submucosal dissection and hybrid endoscopic submucosal 
      dissection as rescue therapy in difficult colorectal cases.
PG  - E1225-E1232
LID - 10.1055/a-1882-4306 [doi]
AB  - Background and study aims  Colorectal endoscopic submucosal dissection (ESD) is 
      still not widely used due to its technical difficulty and the risk of 
      complications. Rescue therapies such as hybrid ESD (H-ESD) have been proposed for 
      very difficult cases, as has underwater ESD (U-ESD). This study evaluated the 
      safety and efficacy of H-ESD and U-ESD in difficult cases. Patients and methods  
      The hospital charts of consecutive patients referred for colorectal ESD between 
      January 2014 and February 2021 because they were considered difficult cases were 
      retrospectively analyzed. The primary outcome of the study was en bloc resection 
      rate; secondary outcomes were the rate of complete resection, procedure speed, 
      and incidence of adverse events (AEs). Results  Fifty-nine colorectal neoplasms 
      were considered, 22 of which were removed by U-ESD and 37 by H-ESD. The en bloc 
      resection rate in the U-ESD group was 100 %, while it was 59.5 % in the H-ESD 
      group. Dissection speed was 17.7mm (2) /min in the U-ESD group and 8.3 mm (2) 
      /min in the H-ESD group. The AE rate was low in the U-ESD group and moderately 
      high during H-ESD (5 % and 21.6 %, respectively; and perforation rate 0 % and 
      10.8 %, respectively). Larger lesions were treated with U-ESD, while more 
      fibrotic ones were treated with H-ESD. Conclusions  U-ESD and H-ESD are both 
      effective and safe techniques in difficult colorectal situations. U-ESD is 
      particularly effective and fast for large lesions when it is not possible to 
      obtain comfortable knife position, while H-ESD is more suitable for very fibrotic 
      lesions.
CI  - The Author(s). This is an open access article published by Thieme under the terms 
      of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
      permitting copying and reproduction so long as the original work is given 
      appropriate credit. Contents may not be used for commercial purposes, or adapted, 
      remixed, transformed or built upon. 
      (https://creativecommons.org/licenses/by-nc-nd/4.0/).
FAU - Cecinato, Paolo
AU  - Cecinato P
AD  - Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio 
      Emilia, Italy.
FAU - Lucarini, Matteo
AU  - Lucarini M
AD  - Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio 
      Emilia, Italy.
FAU - Campanale, Chiara
AU  - Campanale C
AD  - Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio 
      Emilia, Italy.
FAU - Azzolini, Francesco
AU  - Azzolini F
AD  - Unit of Digestive Endoscopy, Vita-Salute San Raffaele University, Milan, Italy.
FAU - Bassi, Fabio
AU  - Bassi F
AD  - Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio 
      Emilia, Italy.
FAU - Sassatelli, Romano
AU  - Sassatelli R
AD  - Unit of Gastroenterology and Digestive Endoscopy, Azienda USL-IRCCS di Reggio 
      Emilia, Italy.
LA  - eng
PT  - Journal Article
DEP - 20220914
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC9473857
COIS- Competing interests The authors declare that they have no conflict of interest.
EDAT- 2022/09/20 06:00
MHDA- 2022/09/20 06:01
PMCR- 2022/09/01
CRDT- 2022/09/19 04:14
PHST- 2021/11/27 00:00 [received]
PHST- 2022/04/20 00:00 [accepted]
PHST- 2022/09/19 04:14 [entrez]
PHST- 2022/09/20 06:00 [pubmed]
PHST- 2022/09/20 06:01 [medline]
PHST- 2022/09/01 00:00 [pmc-release]
AID - 10.1055/a-1882-4306 [doi]
PST - epublish
SO  - Endosc Int Open. 2022 Sep 14;10(9):E1225-E1232. doi: 10.1055/a-1882-4306. 
      eCollection 2022 Sep.