Clinical Endoscopy

Transforming outcomes: the pivotal role of self-expanding metal stents in right- and left-sided malignant colorectal obstructions-bridge to surgery: a comprehensive review and meta-analysis: Sheza Malik, Priyadarshini Loganathan, Hajra Khan, Abul Hasan Shadali, Pradeep Yarra, Saurabh Chandan, Babu P. Mohan, Douglas G. Adler, Shivangi Kothari; Received May 10, 2024 Accepted July 10, 2024 Published online February 3, 2025; DOI: https://doi.org/10.5946/ce.2024.120 [Epub ahead of print]

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Self-expanding metallic stents (SEMS) are an alternative to emergency surgery (ES) for malignant colorectal obstruction. This study aimed to compare surgical outcomes between SEMS as a bridge to surgery (BTS) and ES in patients with malignant colorectal obstruction.
Methods
A comprehensive database search was conducted until October 2023 to compare outcomes between SEMS as a BTS and ES. A subgroup analysis of results by malignancy site was performed.
Results
We analyzed 57 studies, including 7,223 patients over a mean duration of 35.4 months. SEMS as a BTS showed clinical and technical success rates of 88.0% (95% confidence interval [CI], 86.1%–90.1%; I2=68%) and 91.6% (95% CI, 89.7%–93.7%; I2=66%), respectively. SEMS as a BTS revealed reduced postoperative adverse events (odds ratio [OR], 0.51; 95% CI, 0.41–0.63; I2=70%; p<0.001) and 30-day mortality (OR, 0.52; 95% CI, 0.37–0.72; I2=10%; p<0.001) compared to ES. Subgroup analysis showed postoperative mortality of 5% and 1.5% for left- and right-sided malignancies, respectively. Adverse events were 15% and 33% for the right and left colon, respectively.
Conclusions
SEMS as a BTS demonstrated a higher success rate, fewer postoperative adverse events, and a reduced 30-day mortality rate than ES, supporting its use as the preferred initial intervention for right- and left-sided obstructions and indicating broader clinical adoption.

443 View
69 Download

Cold snare polypectomy versus cold endoscopic mucosal resection for small colorectal polyps: a meta-analysis of randomized controlled trials: Vishali Moond, Priyadarshini Loganathan, Sheza Malik, Dushyant Singh Dahiya, Babu P. Mohan, Daryl Ramai, Michele McGinnis, Deepak Madhu, Mohammad Bilal, Aasma Shaukat, Saurabh Chandan; Clin Endosc 2024;57(6):747-758. Published online August 23, 2024; DOI: https://doi.org/10.5946/ce.2024.081

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: Cold snare polypectomy (CSP) is routinely performed for small colorectal polyps (≤10 mm). However, challenges include insufficient resection depth and immediate bleeding, hindering precise pathological evaluation. We aimed to compare the outcomes of cold endoscopic mucosal resection (CEMR) with that of CSP for colorectal polyps ≤10 mm, using data from randomized controlled trials (RCTs).
Methods
Multiple databases were searched in December 2023 for RCTs reporting outcomes of CSP versus CEMR for colorectal polyps ≤10 mm in size. Our primary outcomes were rates of complete and en-bloc resections, while our secondary outcomes were total resection time (seconds) and adverse events, including immediate bleeding, delayed bleeding, and perforation.
Results
The complete resection rates did not significantly differ (CSP, 91.8% vs. CEMR 94.6%), nor did the rates of en-bloc resection (CSP, 98.9% vs. CEMR, 98.3%) or incomplete resection (CSP, 6.7% vs. CEMR, 4.8%). Adverse event rates were similarly insignificant in variance. However, CEMR had a notably longer mean resection time (133.51 vs. 91.30 seconds).
Conclusions
Our meta-analysis of seven RCTs showed that while both CSP and CEMR are equally safe and effective for resecting small (≤10 mm) colorectal polyps, the latter is associated with a longer resection time.

3,468 View
304 Download

Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis: Talia F. Malik, Vaishnavi Sabesan, Babu P. Mohan, Asad Ur Rahman, Mohamed O. Othman, Peter V. Draganov, Gursimran S. Kochhar; Clin Endosc 2024;57(3):317-328. Published online February 29, 2024; DOI: https://doi.org/10.5946/ce.2023.205

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD).
Methods
Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity.
Results
Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%–95.4%; I2=0%), 81.5% (95% CI, 72.5%–88%; I2=43%), and 48.9% (95% CI, 32.1%–65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%–7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%–13%; I2=10%) and 5.3% (95% CI, 3.1%–8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%–18.2%; I2=55%) and 13% (95% CI, 8.5%–19.3%; I2=54%), respectively.
Conclusions
ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection.

Citations

Citations to this article as recorded by

Molecular Mechanisms and Clinical Aspects of Colitis-Associated Cancer in Ulcerative Colitis
Jesus K. Yamamoto-Furusho, Fausto D. Gutierrez-Herrera
Cells.2025; 14(3): 162. CrossRef
Colitis-Associated Dysplasia in Inflammatory Bowel Disease: Features and Endoscopic Management
Sara C. Schiavone, Livia Biancone, Mariasofia Fiorillo, Andrea Divizia, Roberto Mancone, Benedetto Neri
Cancers.2025; 17(5): 784. CrossRef

4,472 View
121 Download
2 Web of Science
2 Crossref

Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis: Rajat Garg, Amandeep Singh, Manik Aggarwal, Jaideep Bhalla, Babu P. Mohan, Carol Burke, Tarun Rustagi, Prabhleen Chahal; Clin Endosc 2021;54(3):379-389. Published online April 29, 2021; DOI: https://doi.org/10.5946/ce.2020.276

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm.
Methods
We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR.
Results
A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%.
Conclusions
Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

Citations

Citations to this article as recorded by

Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Hye Kyung Jeon, Gwang Ha Kim
Gut and Liver.2025; 19(1): 19. CrossRef
Water-assisted colonoscopy in inflammatory bowel diseases: From technical implications to diagnostic and therapeutic potentials
Raffaele Pellegrino, Giovanna Palladino, Michele Izzo, Ilaria De Costanzo, Fabio Landa, Alessandro Federico, Antonietta Gerarda Gravina
World Journal of Gastrointestinal Endoscopy.2024; 16(12): 647. CrossRef
Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy
Quang Dinh Le, Nhan Quang Le, Duc Trong Quach
JGH Open.2024;[Epub] CrossRef
Polypectomy Techniques for Pedunculated and Nonpedunculated Polyps
Karl Kwok, Sasan Mosadeghi, Daniel Lew
Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(4): 361. CrossRef
Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials
Matheus Henrique Gonçalves de Souza, Paula Arruda do Espirito Santo, Fauze Maluf-Filho, Luciano Lenz
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef
EMR and ESD: Indications, techniques and results
Mamoon Ur Rashid, Mohammad Alomari, Sadaf Afraz, Tolga Erim
Surgical Oncology.2022; 43: 101742. CrossRef
Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions
Andrew W. Yen, Joseph W. Leung, Malcom Koo, Felix W. Leung
Endoscopy International Open.2022; 10(06): E791. CrossRef
Underwater or conventional endoscopic mucosal resection for intermediate‐sized colorectal neoplasm?
Li‐Chun Chang
Advances in Digestive Medicine.2021; 8(3): 133. CrossRef

6,300 View
157 Download
9 Web of Science
9 Crossref

Efficacy and Safety of Lumen-Apposing Stents for Management of Pancreatic Fluid Collections in a Community Hospital Setting: Rajat Garg, Abdelkader Chaar, Susan Szpunar, Babu P. Mohan, Mohammed Barawi; Clin Endosc 2020;53(4):480-486. Published online October 16, 2019; DOI: https://doi.org/10.5946/ce.2019.116

Abstract PDF PubReader ePub

Background
/Aims: Endoscopic ultrasound-guided transmural drainage and necrosectomy employing lumen-apposing metal stent (LAMS) are used for treating pancreatic fluid collections (PFCs) with excellent results from academic centers. Herein, we report the efficacy and safety of LAMS in the treatment of PFCs at a community hospital.
Methods
We retrospectively reviewed the etiology of pancreatitis, type and size of PFCs, length of procedure, technical success, clinical success, adverse events, and stent removal. The primary outcome was the rate of clinical success, and secondary outcomes were technical success and adverse events.
Results
Twenty-seven patients with a mean age of 54.1±6.5 years were included, 44% of which were men. The mean size of the PFCs was 9.7±5.0 cm (range, 3–21). The most common etiology of pancreatitis was alcohol (44%) followed by idiopathic causes (30%) and presence of gallstones (22%). The diagnosis was pseudocyst in 44.4% (12/27) and walled off necrosis in 55.6% (15/27) of patients. There was 100% technical success without any complications. Clinical success was achieved in 22 of 27 patients (81.5%) who underwent stent removal.
Conclusions
Our study is the first to report that endoscopic therapy of PFCs using LAMS is safe and effective even in a community hospital setting with limited resources and support compared to large academic centers.

Citations

Citations to this article as recorded by

EUS-guided interventional therapies for pancreatic diseases
Rongmin Xu, Kai Zhang, Nan Ge, Siyu Sun
Frontiers in Medicine.2024;[Epub] CrossRef
Trans-cavity lumen-apposing metal stent removal: an alternative safe modality
Giacomo Emanuele Maria Rizzo, Ilaria Tarantino
Clinical Endoscopy.2023; 56(1): 129. CrossRef
Lumen-apposing-metal stent misdeployment in endoscopic ultrasound-guided drainages: A systematic review focusing on issues and rescue management
Elia Armellini, Flavio Metelli, Andrea Anderloni, Anna Cominardi, Giovanni Aragona, Michele Marini, Fabio Pace
World Journal of Gastroenterology.2023; 29(21): 3341. CrossRef
Lumen-apposing metal stents
Carlo Fabbri, Chiara Coluccio, Cecilia Binda, Alessandro Fugazza, Andrea Anderloni, Ilaria Tarantino
Endoscopic Ultrasound.2022; 11(1): 59. CrossRef
Endoscopic Drainage of Giant Pancreatic Pseudocysts Using Both Lumen-Apposing Metal Stent and Plastic Stent: A Report of Two Cases and Review of the Current Literature
Hussam I. A. Alzeerelhouseini, Muawiyah Elqadi, Mohammad N. Elqadi, Sadi A. Abukhalaf, Hazem A. Ashhab, Yoshifumi Nakayama
Case Reports in Gastrointestinal Medicine.2021; 2021: 1. CrossRef
Editors' Choice of Noteworthy Clinical Endoscopy Publications in the First Decade
Gwang Ha Kim, Kwang An Kwon, Do Hyun Park, Jimin Han
Clinical Endoscopy.2021; 54(5): 633. CrossRef
Comparative outcomes of endoscopic ultrasound‐guided lumen‐apposing mental stents drainage for pancreatic pseudocysts and walled‐off necrosis: Case series and meta‐analysis
Jing Li, Qian Zhang, Anni Zhou, Guiping Zhao, Peng Li
Chronic Diseases and Translational Medicine.2021; 7(3): 157. CrossRef
Reply
Kazuki Takeishi, Toru Ikegami, Tomoharu Yoshizumi, Nao Fujimori, Masaki Mori
Liver Transplantation.2020; 26(5): 727. CrossRef
Safety and efficacy of lumen-apposing metal stents versus plastic stents to treat walled-off pancreatic necrosis: systematic review and meta-analysis
Vinay Chandrasekhara, Marc Barthet, Jacques Devière, Fateh Bazerbachi, Sundeep Lakhtakia, Jeffrey J. Easler, Joyce A. Peetermans, Edmund McMullen, Ornela Gjata, Margaret L. Gourlay, Barham K. Abu Dayyeh
Endoscopy International Open.2020; 08(11): E1639. CrossRef

10,935 View
220 Download
8 Web of Science
9 Crossref

Search