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Su1718 Metachronous Neoplasia and Local Recurrence After Colorectal ESD
Abstracts
Su1717 Clinicopathological Features and Endoscopic Characteristics of Inverted SSA/P Kenji Takashima*1, Yasuhiro Oono1, Motohiro Kojima2, Maomi Imajoh1, Tomohiro Kadota1, Shozo Osera1, Hiroyuki Morimoto1, Hiroaki Ikematsu1, Tomonori Yano1, Kazuhiro Kaneko1 1 Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan; 2Pathology Division, National Cancer Center Hospital East, Chiba, Japan Background and Aim: Most colorectal carcinomas (CRCs) originate from adenomas. In contrast a serrated neoplastic pathway has been recently accepted, which CRCs develop from serrated lesions. Serrated lesions are classified into three groups: hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA). SSA/Ps have been reported as precursors of sporadic CRCs with microsatellite instability (MSI), BRAF mutation and CpG island methylator phenotype (CIMP). Therefore, clarification of SSA/Ps is very important to prevent CRCs. We detected differential SSA/P and this case named as an inverted SSA/P (InSSA/P) was the first report in the world. The aim of this retrospective study is to clarify the clinicopathological characteristics and endoscopic features of InSSA/P. Methods: A total of 441 colorectal serrated lesions treated with endoscopic resection from January 2010 to June 2015 at our hospital were histologically reviewed, and 104 SSA/Ps from 80 patients were selected. Histopathological diagnosis of SSA/P was confirmed according to the Japanese Society for Cancer of the Colon and Rectum. Of these, InSSA/P was defined and classified into; expansive growth type and infiltrating growth type, as follows. Expansive growth type was defined as endophytic growth of hyperplastic gland with clear delimited border. Infiltrating growth type was defined as endophytic growth of scattered hyperplastic gland with the invagination into submucosal layer or submucasal lymphoid tissue and invagination into submucosa is always found. The clinicopathological characteristics and endoscopic features were investigated between InSSA/P and SSA/P. Results: Of the 104 lesion, 37 were InSSA/P (35.6%). Expansive growth type was 15cases (40.5%) and Infiltrating growth type were 22 cases (59.5%). The median age of InSSAP and SSA/Ps were 70 and 67 years, respectively. Tumor size of InSSAP and SSA/Ps were relatively small with a median size of 9 and 10 mm in diameter. In the clinocopathological findings of the InSSA/P, the presence of adherent mucous, the frequency of the right-side colon, dilated type-II pit pattern, irregularly dilated vessel and presence of depression were demonstrated in 89%(33/37), 73%(27/33), 54%(20/37), 75%(28/37) and 46%(17/37), respectively. In contrast, those of the SSA/Ps were demonstrated in 86%(58/67), 84%(56/67), 55%(37/67), 58%(39/67), 12%(8/67), respectively. By univariate analysis, the presence of depression was significant variable (p<0.001). In expansive growth type, the presence of depression was 87% (13/15), whereas in infiltrating growth type was 27% (5/22). Conclusions: InSSA/P was detected in 35.6% (37/104) of all lesions. Depressed surfaces were more frequent in InSSA/P than SSA/ P. However, InSSA/P with Infiltrating growth type can be difficult to identify endoscopically by the presence of depression.
Su1718 Metachronous Neoplasia and Local Recurrence After Colorectal ESD Daisuke Takei*1, Keita Harada1, Shiho Takashima2, Toshihiro Inokuchi2, Yuusaku Sugihara2, Asuka Nakarai2, Masahiro Takahara2, Sakiko Hiraoka2, Hiroyuki Okada2 1 Division of Endoscopy, Okayama University Hospital, Okayama, Japan; 2Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Background and Aims: Most of the surveillance policies were established based on the risk of metachronous occurrence of colorectal cancer or advanced neoplasia. There are several reports about colonoscopic surveillance after polypectomy or endoscopic mucosal resection (EMR) for colorectal polyps. Recently, a few reports about treatment results of colorectal endoscopic submucosal dissection (ESD) came out. Nevertheless, there were scarce reports about prognostic analysis, especially no report focused on the metachronous neoplasia, after colorectal ESD. The aim of this study is to assess the risk of metachronous adenomas which needed resection after colorectal ESD and to establish appropriate post-ESD colonoscopic surveillance. Methods: A total of 225 patients who underwent colorectal ESD in Okayama University Hospital between February 2008 and July 2014 were enrolled. We excluded 124 patents for the following reasons; (i) follow-up period < 12 months, (ii) residual or local recurrent lesions after the endoscopic treatment, (iii) presence of familial adenomatous polyposis: FAP, hereditary non-polyposis colorectal cancer: HNPCC or hyperplastic polyposis, (iv) underwent additional surgery after ESD, (v) having previous history of surgery for advanced colorectal cancers. Consequently, we retrospectively analyzed clinicopathological features on 101 lesions of 101 patients that underwent ESD. Results: Metachronous occurrence of adenomas after ESD was detected in 21 cases (20.8%), whereas local recurrence was detected in only three cases (2.9%). Comparison of clinicopathological characteristics between the groups which divided according to metachronous occurrence of adenomas showed that the
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number of synchronous adenomas at index colonoscopy was more (p Z 0.02), and the rate of LST-NG was higher (p < 0.01) in metachronous adenoma group. Univariate analysis indicated that tumor size (< 35mm), macroscopic type (LST-NG), and number of synchronous adenomas ( 3) were associated with metachronous occurrence of adenomas (HR: 2.49, 95% CI: 1.03-6.57, p Z 0.042 ; HR: 2.49, 95% CI: 1.04-6.32, p Z 0.039 ; HR: 3.08, 95% CI: 1.29-7.83, p Z 0.0108, respectively). Multivariate analysis indicated that the number of synchronous adenomas analyzed at index colonoscopy were significantly associated with metachronous adenomas (HR: 2.54, 95% CI: 1.04-6.52, p < 0.05). All of the recurrence tumors including local recurrence were treated with endoscopic resection, and curative resections were achieved in all cases. Conclusions: Concerning the tumor recurrent risk after colorectal ESD, we should give more attention to metachronous adenomas that occur at other sites rather than the local recurrence. And when we make a plan of colonoscopic surveillance after colorectal ESD, we should be more careful about the case in which the number of synchronous adenomas was 3 or more.
Su1719 Clinicopathological and Molecular Characteristics of SSA/Ps and TSAs According to Their Location Yoshihito Tanaka*1, Hiro-o Yamano1, Hiro-o Matsushita1, Kenjiro Yoshikawa1, Eiji Harada1, MIchiko Nakaoka1, Yuko Yoshida1, Tamotsu Sugai2, Eiichiro Yamamoto3, Hiromu Suzuki3 1 Digestive Disease Center, Akita Red Cross Hospital, Akita, Akita, Japan; 2 Pathology, Iwate Medical University, Morioka, Japan; 3Molecular Biology, Sapporo Medical University, Sapporo, Japan Background: Generally, SSA/Ps tend to be located in the proximal colon, and TSAs tend to be located in the distal colon and rectum. The respective clinicopathological and molecular characteristics of SSA/Ps and TSAs according to their locations is unclear. Aim: The aim of this study was to clarify clinicopathological and molecular characteristics of SSA/Ps and TSAs according to their location. Subjects: SSA/P subjects (90 lesions) and TSA subjects (44 lesions) were endoscopically resected at our center between February 2009 and September 2014. It was possible to compare magnifying endoscopy findings, histological findings and genetic analysis results. Methods: Subjects were endoscopically resected at our center. Each lesion was observed by magnifying endoscopy before endoscopic resection. Genetic mutation (BRAF, KRAS) and DNA methylation of each lesion was investigated by pyrosequencing analysis. We examined the differences between proximal colon lesions and distal colon lesions for SSA/Ps and TSAs. Results: With respect to the gross morphology, regardless of the location, flat lesions were often found in SSA/Ps, and protruded lesions were often found in TSAs. Observing pit patterns of lesions with magnifying endoscopy, pit patterns were type II – open in 93.6% of proximal colonic SSA/Ps. However, pit patterns were varied in distal colonic SSA/Ps, with type II – open being present in only 33.2% of cases.Multiple pit patterns were often observed in TSAs regardless of location.Pit patterns were type IV – serration in 80.0% of proximal colonic TSAs and 91.2% of distal colonic TSAs.85.9% of proximal colonic SSA/Ps exhibited BRAF mutation and 66.7% of proximal colonic SSA/Ps were CIMP positive. In contrast, 50.0% of distal colonic SSA/Ps exhibited BRAF mutation, 33.3% exhibited KRAS mutation, while 16.7% were wild type. CIMP positive distal colonic SSA/Ps were low at 16.7%.In terms of proximal colonic TSAs, genetic mutations were varied. 30.0% exhibited BRAF mutation, 40.0% exhibited KRAS mutation and 30.0% were wild type. There was a high proportion of CIMP positive lesions (60.0%) in proximal colonic TSAs. In contrast, 61.8% of distal colonic TSAs exhibited BRAF mutation and 20.6% of distal colonic TSAs were CIMP positive. Conclusion: Gene background differed depending on the location of both SSA/Ps and TSAs alike.This study indicated the possibility of reflecting the differences in gene background in magnifying endoscopy findings, particularly in the case of SSA/Ps.
Su1720 Risk Factors for Recurrence After Polypectomy of Large Colonic Polyps - A Prospective Single Centre Study Marcel Tantau*2,1, Irina I. Visovan1, Lidia Ciobanu2, Alina Tantau2 1 Gastroenterology, S.C. TVM Med SERV S.R.L., Cluj Napoca, Romania; 2 Gastroenterology, University of Medicine and Pharmacy, Cluj Napoca, Romania Background: The endoscopic removal of large colonic polyps is a difficult technique, associated with risk of complications and recurrence. Aim: The main purpose of this study was to assess the rate and risk factors of recurrence of large colorectal polyps from a cohort of Romanian patients. Methods: Between February 2011 and August 2014 a total number of 288 consecutive patients with large polyps were treated in our center. In this 288 patients, 316 large polyps were found, 46 of them beeing right-sided and 270 left-sided. The number of polpys detected per patient was 1.09. The mean size of polyps was 29.099.61 mm (minimum 20 mm, maximum 60 mm). All of pediculated polyps and some of the semipediculated ones, were resected with snare catheter without submucosal injection solutions. Detachable endo-loop was placed in 37 (34.9%) of this pediculated polyps. All the mucosectomys were
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB409
Su1717 Clinicopathological Features and Endoscopic Characteristics of Inverted SSA/P Kenji Takashima*1, Yasuhiro Oono1, Motohiro Kojima2, Maomi Imajoh1, Tomohiro Kadota1, Shozo Osera1, Hiroyuki Morimoto1, Hiroaki Ikematsu1, Tomonori Yano1, Kazuhiro Kaneko1 1 Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Chiba, Japan; 2Pathology Division, National Cancer Center Hospital East, Chiba, Japan Background and Aim: Most colorectal carcinomas (CRCs) originate from adenomas. In contrast a serrated neoplastic pathway has been recently accepted, which CRCs develop from serrated lesions. Serrated lesions are classified into three groups: hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P) and traditional serrated adenoma (TSA). SSA/Ps have been reported as precursors of sporadic CRCs with microsatellite instability (MSI), BRAF mutation and CpG island methylator phenotype (CIMP). Therefore, clarification of SSA/Ps is very important to prevent CRCs. We detected differential SSA/P and this case named as an inverted SSA/P (InSSA/P) was the first report in the world. The aim of this retrospective study is to clarify the clinicopathological characteristics and endoscopic features of InSSA/P. Methods: A total of 441 colorectal serrated lesions treated with endoscopic resection from January 2010 to June 2015 at our hospital were histologically reviewed, and 104 SSA/Ps from 80 patients were selected. Histopathological diagnosis of SSA/P was confirmed according to the Japanese Society for Cancer of the Colon and Rectum. Of these, InSSA/P was defined and classified into; expansive growth type and infiltrating growth type, as follows. Expansive growth type was defined as endophytic growth of hyperplastic gland with clear delimited border. Infiltrating growth type was defined as endophytic growth of scattered hyperplastic gland with the invagination into submucosal layer or submucasal lymphoid tissue and invagination into submucosa is always found. The clinicopathological characteristics and endoscopic features were investigated between InSSA/P and SSA/P. Results: Of the 104 lesion, 37 were InSSA/P (35.6%). Expansive growth type was 15cases (40.5%) and Infiltrating growth type were 22 cases (59.5%). The median age of InSSAP and SSA/Ps were 70 and 67 years, respectively. Tumor size of InSSAP and SSA/Ps were relatively small with a median size of 9 and 10 mm in diameter. In the clinocopathological findings of the InSSA/P, the presence of adherent mucous, the frequency of the right-side colon, dilated type-II pit pattern, irregularly dilated vessel and presence of depression were demonstrated in 89%(33/37), 73%(27/33), 54%(20/37), 75%(28/37) and 46%(17/37), respectively. In contrast, those of the SSA/Ps were demonstrated in 86%(58/67), 84%(56/67), 55%(37/67), 58%(39/67), 12%(8/67), respectively. By univariate analysis, the presence of depression was significant variable (p<0.001). In expansive growth type, the presence of depression was 87% (13/15), whereas in infiltrating growth type was 27% (5/22). Conclusions: InSSA/P was detected in 35.6% (37/104) of all lesions. Depressed surfaces were more frequent in InSSA/P than SSA/ P. However, InSSA/P with Infiltrating growth type can be difficult to identify endoscopically by the presence of depression.
Su1718 Metachronous Neoplasia and Local Recurrence After Colorectal ESD Daisuke Takei*1, Keita Harada1, Shiho Takashima2, Toshihiro Inokuchi2, Yuusaku Sugihara2, Asuka Nakarai2, Masahiro Takahara2, Sakiko Hiraoka2, Hiroyuki Okada2 1 Division of Endoscopy, Okayama University Hospital, Okayama, Japan; 2Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Background and Aims: Most of the surveillance policies were established based on the risk of metachronous occurrence of colorectal cancer or advanced neoplasia. There are several reports about colonoscopic surveillance after polypectomy or endoscopic mucosal resection (EMR) for colorectal polyps. Recently, a few reports about treatment results of colorectal endoscopic submucosal dissection (ESD) came out. Nevertheless, there were scarce reports about prognostic analysis, especially no report focused on the metachronous neoplasia, after colorectal ESD. The aim of this study is to assess the risk of metachronous adenomas which needed resection after colorectal ESD and to establish appropriate post-ESD colonoscopic surveillance. Methods: A total of 225 patients who underwent colorectal ESD in Okayama University Hospital between February 2008 and July 2014 were enrolled. We excluded 124 patents for the following reasons; (i) follow-up period < 12 months, (ii) residual or local recurrent lesions after the endoscopic treatment, (iii) presence of familial adenomatous polyposis: FAP, hereditary non-polyposis colorectal cancer: HNPCC or hyperplastic polyposis, (iv) underwent additional surgery after ESD, (v) having previous history of surgery for advanced colorectal cancers. Consequently, we retrospectively analyzed clinicopathological features on 101 lesions of 101 patients that underwent ESD. Results: Metachronous occurrence of adenomas after ESD was detected in 21 cases (20.8%), whereas local recurrence was detected in only three cases (2.9%). Comparison of clinicopathological characteristics between the groups which divided according to metachronous occurrence of adenomas showed that the
www.giejournal.org
number of synchronous adenomas at index colonoscopy was more (p Z 0.02), and the rate of LST-NG was higher (p < 0.01) in metachronous adenoma group. Univariate analysis indicated that tumor size (< 35mm), macroscopic type (LST-NG), and number of synchronous adenomas ( 3) were associated with metachronous occurrence of adenomas (HR: 2.49, 95% CI: 1.03-6.57, p Z 0.042 ; HR: 2.49, 95% CI: 1.04-6.32, p Z 0.039 ; HR: 3.08, 95% CI: 1.29-7.83, p Z 0.0108, respectively). Multivariate analysis indicated that the number of synchronous adenomas analyzed at index colonoscopy were significantly associated with metachronous adenomas (HR: 2.54, 95% CI: 1.04-6.52, p < 0.05). All of the recurrence tumors including local recurrence were treated with endoscopic resection, and curative resections were achieved in all cases. Conclusions: Concerning the tumor recurrent risk after colorectal ESD, we should give more attention to metachronous adenomas that occur at other sites rather than the local recurrence. And when we make a plan of colonoscopic surveillance after colorectal ESD, we should be more careful about the case in which the number of synchronous adenomas was 3 or more.
Su1719 Clinicopathological and Molecular Characteristics of SSA/Ps and TSAs According to Their Location Yoshihito Tanaka*1, Hiro-o Yamano1, Hiro-o Matsushita1, Kenjiro Yoshikawa1, Eiji Harada1, MIchiko Nakaoka1, Yuko Yoshida1, Tamotsu Sugai2, Eiichiro Yamamoto3, Hiromu Suzuki3 1 Digestive Disease Center, Akita Red Cross Hospital, Akita, Akita, Japan; 2 Pathology, Iwate Medical University, Morioka, Japan; 3Molecular Biology, Sapporo Medical University, Sapporo, Japan Background: Generally, SSA/Ps tend to be located in the proximal colon, and TSAs tend to be located in the distal colon and rectum. The respective clinicopathological and molecular characteristics of SSA/Ps and TSAs according to their locations is unclear. Aim: The aim of this study was to clarify clinicopathological and molecular characteristics of SSA/Ps and TSAs according to their location. Subjects: SSA/P subjects (90 lesions) and TSA subjects (44 lesions) were endoscopically resected at our center between February 2009 and September 2014. It was possible to compare magnifying endoscopy findings, histological findings and genetic analysis results. Methods: Subjects were endoscopically resected at our center. Each lesion was observed by magnifying endoscopy before endoscopic resection. Genetic mutation (BRAF, KRAS) and DNA methylation of each lesion was investigated by pyrosequencing analysis. We examined the differences between proximal colon lesions and distal colon lesions for SSA/Ps and TSAs. Results: With respect to the gross morphology, regardless of the location, flat lesions were often found in SSA/Ps, and protruded lesions were often found in TSAs. Observing pit patterns of lesions with magnifying endoscopy, pit patterns were type II – open in 93.6% of proximal colonic SSA/Ps. However, pit patterns were varied in distal colonic SSA/Ps, with type II – open being present in only 33.2% of cases.Multiple pit patterns were often observed in TSAs regardless of location.Pit patterns were type IV – serration in 80.0% of proximal colonic TSAs and 91.2% of distal colonic TSAs.85.9% of proximal colonic SSA/Ps exhibited BRAF mutation and 66.7% of proximal colonic SSA/Ps were CIMP positive. In contrast, 50.0% of distal colonic SSA/Ps exhibited BRAF mutation, 33.3% exhibited KRAS mutation, while 16.7% were wild type. CIMP positive distal colonic SSA/Ps were low at 16.7%.In terms of proximal colonic TSAs, genetic mutations were varied. 30.0% exhibited BRAF mutation, 40.0% exhibited KRAS mutation and 30.0% were wild type. There was a high proportion of CIMP positive lesions (60.0%) in proximal colonic TSAs. In contrast, 61.8% of distal colonic TSAs exhibited BRAF mutation and 20.6% of distal colonic TSAs were CIMP positive. Conclusion: Gene background differed depending on the location of both SSA/Ps and TSAs alike.This study indicated the possibility of reflecting the differences in gene background in magnifying endoscopy findings, particularly in the case of SSA/Ps.
Su1720 Risk Factors for Recurrence After Polypectomy of Large Colonic Polyps - A Prospective Single Centre Study Marcel Tantau*2,1, Irina I. Visovan1, Lidia Ciobanu2, Alina Tantau2 1 Gastroenterology, S.C. TVM Med SERV S.R.L., Cluj Napoca, Romania; 2 Gastroenterology, University of Medicine and Pharmacy, Cluj Napoca, Romania Background: The endoscopic removal of large colonic polyps is a difficult technique, associated with risk of complications and recurrence. Aim: The main purpose of this study was to assess the rate and risk factors of recurrence of large colorectal polyps from a cohort of Romanian patients. Methods: Between February 2011 and August 2014 a total number of 288 consecutive patients with large polyps were treated in our center. In this 288 patients, 316 large polyps were found, 46 of them beeing right-sided and 270 left-sided. The number of polpys detected per patient was 1.09. The mean size of polyps was 29.099.61 mm (minimum 20 mm, maximum 60 mm). All of pediculated polyps and some of the semipediculated ones, were resected with snare catheter without submucosal injection solutions. Detachable endo-loop was placed in 37 (34.9%) of this pediculated polyps. All the mucosectomys were
Volume 83, No. 5S : 2016 GASTROINTESTINAL ENDOSCOPY AB409