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Clinical Application of Endoscopic Submucosal Dissection in Malignant Gastrointestinal Tumors...
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Clinical Application of Endoscopic Submucosal Dissection in Malignant Gastrointestinal Tumors and Precursors

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 31 March 2025 | Viewed by 3024

Special Issue Editors

Prof. Dr. Rainer Schöfl

E-Mail Website
Guest Editor
Department of Gastroenterology, Ordensklinikum Linz Barmherzige Schwestern, 4010 Linz, Austria
Interests: endoscopy; hepatology; gastroenterology; inflammatory bowel disease; biliary tract diseases; liver diseases
Prof. Dr. Reinhold Függer

E-Mail Website
Guest Editor
Department of General, Visceral, Thoracic and Transplant Surgery, Ordensklinikum Linz, 4010 Linz, Austria
Interests: surgical oncology; pancreas, liver; bile; upper GI; surgical infection
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Advanced healthcare systems support systematic screening programs for the diagnosis of premalignant and early malignant lesions. To ensure maximum benefit for patients, these findings should be treated using minimally invasive techniques. This not only improves prognosis but also contributes to anatomical and functional organ preservation.

Within the gastrointestinal tract, the most advanced endoscopic technique for achieving these goals is endoscopic submucosal dissection (ESD). It competes with endoscopic mucosal resection and snare polypectomy, as well as hybrids with other endoscopic interventions and laparoscopic surgical access. Depending on the results of pretherapeutic staging, more invasive options, such as surgical resection, radiation, or systemic medical therapies, might represent the preferred choice. This underscores the critical importance of the staging process.

In this Special Issue, we are gathering original data on advanced endoscopic imaging and staging, along with the application of ESD in the esophagus, stomach, duodenum, and colorectum. Reviews on ESD, highlighting its advantages and drawbacks within the therapeutic network, will complement this virtual collection of articles.

We warmly invite researchers to contribute to our project, and we encourage readers to benefit from the insights shared in this collection.

Prof. Dr. Rainer Schöfl
Prof. Dr. Reinhold Függer
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • endoscopy
  • endoscopic submucosal dissection
  • endoscopic surgery
  • laparoscopic surgery
  • minimally invasive surgery

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Published Papers (4 papers)

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Research

16 pages, 1246 KiB  
Article
Resection of Early Colorectal Neoplasms Using Endoscopic Submucosal Dissection: A Retrospective Multicenter Cohort Study
by Katarzyna Winter, Przemysław Kasprzyk, Zuzanna Nowicka, Suzuki Noriko, Alberto Herreros-de-Tejada and Michał Spychalski
J. Clin. Med. 2024, 13(22), 6989; https://doi.org/10.3390/jcm13226989 - 20 Nov 2024
Viewed by 514
Abstract
Background: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery in the treatment of early colorectal cancer under certain conditions. Aim: The aim of the study was to analyze factors influencing the ESD procedure in early colorectal cancer, with the [...] Read more.
Background: Endoscopic submucosal dissection (ESD) is a reliable method that can replace surgery in the treatment of early colorectal cancer under certain conditions. Aim: The aim of the study was to analyze factors influencing the ESD procedure in early colorectal cancer, with the intention of improving its effectiveness. Patients and Methods: We conducted a multicenter, retrospective cohort study on 214 patients who underwent ESD procedures for early colorectal cancer from January 2016 to October 2023. Results:En bloc resection was achieved in 197 (92.1%) of ESD procedures, R0 resection in 149 (69.6%), and curative resection in 54 (40.9%). The submucosal invasion was classified as level 1 (SM1) in 96 cases (45.3%), level 2 (SM2) in 61 cases (28.8%), and level 3 (SM3) in 36 cases (17%). R0 resection was achieved more often in the rectum—92 (81.4%), compared to the right—24 (64.9%) and left colon—33 (61.1%), p = 0.009. In rectal tumors, R0 resection was achieved in 51 (98.1%) SM1 invasion, 27 (73%) SM2 invasion, and 13 (65%) SM3 invasion (p < 0.001). Lateral and vertical resection margins were positive in 12 (7.7%) and 52 (25.2%) cases, respectively. Vertical resection margins were statistically more often positive in lesions located in the right colon—11 cases (28.9%) and left colon—21 cases (38.9%), than in rectum—20 cases (17.5%); p = 0.010. Complications were found in 32 (15%) cases of ESD procedure—perforation in 12 cases (5.6%) and delayed bleeding in four cases (1.9%). Procedures performed in the right colon were associated with a significantly higher risk of any complications (30%) and perforations (15%) than those performed in the rectum (10.3% and 2.6%) or the left colon (13.8% and 5.2%; p = 0.016; p = 0.015), respectively. Conclusions: ESD for early colon cancer is a viable strategy due to its effectiveness and low complication rate. The ESD technique performed in the rectum yields the best results; however, in the right colon, it still requires careful attention. Full article
(This article belongs to the Special Issue Clinical Application of Endoscopic Submucosal Dissection in Malignant Gastrointestinal Tumors and Precursors)
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19 pages, 1111 KiB  
Article
Endoscopic Local Excision (ELE) with Knife-Assisted Resection (KAR) Techniques Followed by Adjuvant Radiotherapy and/or Chemotherapy for Invasive (T1bsm2,3/T2) Early Rectal Cancer: A Multicenter Retrospective Cohort
by George Tribonias, Apostolis Papaefthymiou, Petros Zormpas, Stefan Seewald, Maria Zachou, Federico Barbaro, Michel Kahaleh, Gianluca Andrisani, Shaimaa Elkholy, Mohamed El-Sherbiny, Yoriaki Komeda, Raghavendra Yarlagadda, Georgios Tziatzios, Kareem Essam, Hany Haggag, Gregorios Paspatis and Georgios Mavrogenis
J. Clin. Med. 2024, 13(22), 6951; https://doi.org/10.3390/jcm13226951 - 18 Nov 2024
Viewed by 495
Abstract
Background: Resected rectal polyps with deep invasion into the submucosa (pT1b-sm2,3) or the muscle layer (pT2) are currently confronted with surgery due to non-curative resection. Aims: We evaluated the efficacy, safety, and locoregional control of adjuvant radiotherapy (RT) and/or chemotherapy (CT) following endoscopic [...] Read more.
Background: Resected rectal polyps with deep invasion into the submucosa (pT1b-sm2,3) or the muscle layer (pT2) are currently confronted with surgery due to non-curative resection. Aims: We evaluated the efficacy, safety, and locoregional control of adjuvant radiotherapy (RT) and/or chemotherapy (CT) following endoscopic KAR (knife-assisted resection) in patients with invasive early rectal cancers who are unwilling or unsuitable for additional surgical resection. Methods: Fifty-one patients with early rectal cancers, pT1b or pT2, underwent post-resection adjuvant RT and/or CT in 15 centers worldwide. “En bloc” macroscopic resection, R0 resection, recurrence rate, and adverse events following resection and adjuvant therapy were recorded in a multicenter retrospective cohort study. Results: Diagnostic staging (38/51, 75%) was the main reason for ELE. Macroscopic “en bloc” resection was demonstrated in 50/51 (98%), with an average follow-up of 20.6 months. Endoscopic recurrence occurred in 7/51 (13.7%) of patients, with mean time for diagnosis of recurrence at 8.9 months. Adjuvant therapy consisted of RT in 49.0% (25/51), CT in 11.8% (6/51), and combined CRT in 39.2% (20/51) of the cases. Perforation, severe post-procedural bleeding, and incontinence were the most frequent complications. The absence of superficial ulceration was associated with macroscopic complete resection, while the lesions with lower budding stage, clear lateral margins, lesion size < 40 mm, and needle-type knife used were associated with less endoscopic recurrencies. Conclusions: Our data investigated adjuvant RT and/or CT after endoscopic KAR of infiltrative rectal cancers (pT1bsm2,3-pT2) as being safe and effective for locoregional control and providing a non-surgical treatment option for patients with a non-curative resection. Full article
(This article belongs to the Special Issue Clinical Application of Endoscopic Submucosal Dissection in Malignant Gastrointestinal Tumors and Precursors)
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12 pages, 1877 KiB  
Article
Endoscopic Submucosal Dissection for Early Gastric Cancer Exceeding Expanded Criteria—Long-Term Outcomes from the German ESD Registry
by Kathrin Riedl, Andreas Probst, Alanna Ebigbo, Ingo Steinbrück, Hans-Peter Allgaier, David Albers, Matthias Mende, Michael Anzinger, Joerg Schirra, Viktor Rempel, Albrecht Lorenz, Siegbert Faiss, Ingo Wallstabe, Ulrike Denzer, Andreas Wannhoff, Franz Ludwig Dumoulin, Anna Muzalyova and Helmut Messmann
J. Clin. Med. 2024, 13(18), 5538; https://doi.org/10.3390/jcm13185538 - 19 Sep 2024
Viewed by 995
Abstract
Background and aims: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric cancer (EGC), often fulfilling guideline criteria (GC) or expanded criteria (EC). When lesions exceed the EC, surgical resection is recommended. However, a subgroup of these patients are not [...] Read more.
Background and aims: Endoscopic submucosal dissection (ESD) has become a standard treatment for early gastric cancer (EGC), often fulfilling guideline criteria (GC) or expanded criteria (EC). When lesions exceed the EC, surgical resection is recommended. However, a subgroup of these patients are not treated surgically. The aim of this study was to investigate the long-term follow-up of patients after ESD for EGC outside the EC (out of indication; OI). Methods: Patients who were included in the prospective German ESD registry were analyzed when ESD was performed for EGC. Patients were stratified in three groups according to histopathological features (GC, EC and OI). The results were evaluated in terms of patient characteristics, procedure characteristics and follow-up data. Results: Over a 48-month period, 195 patients from 14 German centers were included. In total, 71 lesions (36.4%) met the guideline criteria, 70 lesions (35.9%) corresponded to the expanded criteria and 54 lesions (27.7%) turned out to be OI. The R0 resection rate was significantly higher for the GC and EC groups than for the OI group (94.4% vs. 84.3% vs. 55.6%, p < 0.001). Additional surgery was not performed in 72% (39/54) of patients in the OI group. During a mean follow-up of 37 months, overall survival showed no significant difference between the EC and OI groups when endoscopic follow-up was performed without additional surgery (p = 0.064). Conclusions: The results show that a good long-term survival can be achieved after ESD for patients with OI lesions without additional surgery. The treatment decision has to be made on an individual basis, taking the patient’s comorbidities and the risk of surgical resection into account. Full article
(This article belongs to the Special Issue Clinical Application of Endoscopic Submucosal Dissection in Malignant Gastrointestinal Tumors and Precursors)
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10 pages, 1839 KiB  
Article
Retrospective Analysis of Rectal Endoscopic Submucosal Dissection at Ordensklinikum Linz and Kepler Universitätsklinikum Linz
by Nikolaj Swiridoff, Alexander Ziachehabi, Friedrich Wewalka, Georg Spaun, Vedat Alibegovic and Rainer Schöfl
J. Clin. Med. 2024, 13(12), 3530; https://doi.org/10.3390/jcm13123530 - 17 Jun 2024
Viewed by 620
Abstract
Background and study aim: Endoscopic submucosal dissection is a minimally invasive endoscopic procedure for the removal of neoplastic benign and early malignant lesions in the gastrointestinal tract. In this study, we analyse the success and safety of rectal ESD at Linz hospitals, [...] Read more.
Background and study aim: Endoscopic submucosal dissection is a minimally invasive endoscopic procedure for the removal of neoplastic benign and early malignant lesions in the gastrointestinal tract. In this study, we analyse the success and safety of rectal ESD at Linz hospitals, focusing on a specific endoscopist. Additionally, we examine whether there is a learning curve regarding success parameters. Methods: This retrospective study included all 102 patients who underwent endoscopic submucosal dissection of the rectum by a defined endoscopist at Ordensklinikum Hospital and Kepler University Hospital between December 2010 and May 2021. With the collected data, a descriptive statistic was carried out and regression analyses were performed. Results: The en bloc resection rate was 78.4% and the rate of lesions removed in healthy tissue was 55.6%. The average procedure time was 179 min and the complication rate was 7.8%. In total, 26.4% of cases showed carcinoma; in 25.9% of these cases, an oncologically curative resection was achieved with ESD. Follow-up data were available for 61.1% of cases, with recurrence being diagnosed in 3.6% of cases. A learning curve was observed regarding the rate of lesions removed in healthy tissue and the procedure time, but not regarding the en bloc resection rate. Conclusions: Endoscopic submucosal dissection is a safe method for the removal of large rectal adenomas and early carcinomas. The en bloc resection rate of the analysed procedures is within the range of comparable European studies. The rate of lesions removed in healthy tissue is below the R0 resection rate of the comparative literature; however, a learning curve could be observed in this parameter. Full article
(This article belongs to the Special Issue Clinical Application of Endoscopic Submucosal Dissection in Malignant Gastrointestinal Tumors and Precursors)
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