Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis

Roel M. M. Bogie; Manon H. J. Veldman; Luc A. R. S. Snijders; Bjorn Winkens; Tonya Kaltenbach; Ad A. M. Masclee; Takahisa Matsuda; Eveline J. A. Rondagh; Roy Soetikno; Shinji Tanaka; Han-Mo Chiu; Silvia Sanduleanu-Dascalescu

doi:10.1055/s-0043-121144

Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis

Roel M. M. Bogie, Manon H. J. Veldman, Luc A. R. S. Snijders, Bjorn Winkens, Tonya Kaltenbach, Ad A. M. Masclee, Takahisa Matsuda, Eveline J. A. Rondagh, Roy Soetikno, Shinji Tanaka, Han-Mo Chiu, Silvia Sanduleanu-Dascalescu^*

^*Corresponding author for this work

Research output: Contribution to journal › (Systematic) Review article › peer-review

Abstract

Background and study aims Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment.

Methods We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95% confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes.

Results We identified 2949 studies, of which 48 were included. Overall, 8.5% (95 % CI 6.5%-10.5%) of LSTs contained SMI. The risk of SMI differed among the LST sub-types: 31.6% in non-granular pseudodepressed LSTs (95 % CI 19.8%-43.4%), 10.5% in granular nodular mixed LSTs (95% CI 5.9%-15.1 %), 4.9% in non-granular flat elevated LSTs (95% CI 2.1%-7.8%), and 0.5% in granular homogenous LSTs (95% CI 0.1%-1.0%). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95% CI 1.24 -5.02). The proportion of SMI increased with lesion size (10-19mm, 4.6 %; 20-29mm, 9.2 %; >= 30mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8% (95% CI 0.6%-1.1%).

Conclusion The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the

Original language	English
Pages (from-to)	263-282
Number of pages	20
Journal	Endoscopy
Volume	50
Issue number	3
DOIs	https://doi.org/10.1055/s-0043-121144
Publication status	Published - Mar 2018

Keywords

MUCOSAL RESECTION
CLINICOPATHOLOGICAL FEATURES
NEOPLASTIC LESIONS
CLINICAL-OUTCOMES
NONPOLYPOID FLAT
FOLLOW-UP
K-RAS
20 MM
PREVALENCE
DISSECTION

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10.1055/s-0043-121144

1 Erratum / corrigendum / retractions

Correction: Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis
Bogie, R. M. M., Veldman, M. H. J., Snijders, L. A. R. S., Winkens, B., Kaltenbach, T., Masclee, A. A. M., Matsuda, T., Rondagh, E. J. A., Soetikno, R., Tanaka, S., Chiu, H-M. & Sanduleanu-Dascalescu, S., 2018, In: Endoscopy. 50, 3, p. 4
Research output: Contribution to journal › Erratum / corrigendum / retractions › Academic

Cite this

Bogie, R. M. M., Veldman, M. H. J., Snijders, L. A. R. S., Winkens, B., Kaltenbach, T., Masclee, A. A. M., Matsuda, T., Rondagh, E. J. A., Soetikno, R., Tanaka, S., Chiu, H.-M., & Sanduleanu-Dascalescu, S. (2018). Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis. Endoscopy, 50(3), 263-282. https://doi.org/10.1055/s-0043-121144

@article{9424de9d402e42b895a800c0c490474e,

title = "Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis",

abstract = "Background and study aims Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment.Methods We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95% confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes.Results We identified 2949 studies, of which 48 were included. Overall, 8.5% (95 % CI 6.5%-10.5%) of LSTs contained SMI. The risk of SMI differed among the LST sub-types: 31.6% in non-granular pseudodepressed LSTs (95 % CI 19.8%-43.4%), 10.5% in granular nodular mixed LSTs (95% CI 5.9%-15.1 %), 4.9% in non-granular flat elevated LSTs (95% CI 2.1%-7.8%), and 0.5% in granular homogenous LSTs (95% CI 0.1%-1.0%). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95% CI 1.24 -5.02). The proportion of SMI increased with lesion size (10-19mm, 4.6 %; 20-29mm, 9.2 %; >= 30mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8% (95% CI 0.6%-1.1%).Conclusion The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the",

keywords = "MUCOSAL RESECTION, CLINICOPATHOLOGICAL FEATURES, NEOPLASTIC LESIONS, CLINICAL-OUTCOMES, NONPOLYPOID FLAT, FOLLOW-UP, K-RAS, 20 MM, PREVALENCE, DISSECTION",

author = "Bogie, {Roel M. M.} and Veldman, {Manon H. J.} and Snijders, {Luc A. R. S.} and Bjorn Winkens and Tonya Kaltenbach and Masclee, {Ad A. M.} and Takahisa Matsuda and Rondagh, {Eveline J. A.} and Roy Soetikno and Shinji Tanaka and Han-Mo Chiu and Silvia Sanduleanu-Dascalescu",

year = "2018",

month = mar,

doi = "10.1055/s-0043-121144",

language = "English",

volume = "50",

pages = "263--282",

journal = "Endoscopy",

issn = "0013-726X",

publisher = "Georg Thieme Verlag",

number = "3",

}

Bogie, RMM, Veldman, MHJ, Snijders, LARS, Winkens, B, Kaltenbach, T, Masclee, AAM, Matsuda, T, Rondagh, EJA, Soetikno, R, Tanaka, S, Chiu, H-M & Sanduleanu-Dascalescu, S 2018, 'Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis', Endoscopy, vol. 50, no. 3, pp. 263-282. https://doi.org/10.1055/s-0043-121144

TY - JOUR

T1 - Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion

T2 - a meta-analysis

AU - Bogie, Roel M. M.

AU - Veldman, Manon H. J.

AU - Snijders, Luc A. R. S.

AU - Winkens, Bjorn

AU - Kaltenbach, Tonya

AU - Masclee, Ad A. M.

AU - Matsuda, Takahisa

AU - Rondagh, Eveline J. A.

AU - Soetikno, Roy

AU - Tanaka, Shinji

AU - Chiu, Han-Mo

AU - Sanduleanu-Dascalescu, Silvia

PY - 2018/3

Y1 - 2018/3

N2 - Background and study aims Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment.Methods We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95% confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes.Results We identified 2949 studies, of which 48 were included. Overall, 8.5% (95 % CI 6.5%-10.5%) of LSTs contained SMI. The risk of SMI differed among the LST sub-types: 31.6% in non-granular pseudodepressed LSTs (95 % CI 19.8%-43.4%), 10.5% in granular nodular mixed LSTs (95% CI 5.9%-15.1 %), 4.9% in non-granular flat elevated LSTs (95% CI 2.1%-7.8%), and 0.5% in granular homogenous LSTs (95% CI 0.1%-1.0%). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95% CI 1.24 -5.02). The proportion of SMI increased with lesion size (10-19mm, 4.6 %; 20-29mm, 9.2 %; >= 30mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8% (95% CI 0.6%-1.1%).Conclusion The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the

AB - Background and study aims Many studies have reported on laterally spreading tumors (LSTs), but systematic reviews of the data to determine their risk of containing submucosal invasion (SMI) are lacking. We systematically screened and analyzed the available literature to provide a more solid basis for evidence-based treatment.Methods We conducted a systematic search in PubMed, Embase, the Cochrane Library, and Scopus for published articles until July 2017. We estimated pooled prevalence or odds ratios (ORs) with 95% confidence intervals (CIs), using random-effects models. We classified endoscopic subtypes into granular LST, which comprises the homogeneous and nodular mixed subtypes, and non-granular LST, which comprises the flat elevated and pseudodepressed subtypes.Results We identified 2949 studies, of which 48 were included. Overall, 8.5% (95 % CI 6.5%-10.5%) of LSTs contained SMI. The risk of SMI differed among the LST sub-types: 31.6% in non-granular pseudodepressed LSTs (95 % CI 19.8%-43.4%), 10.5% in granular nodular mixed LSTs (95% CI 5.9%-15.1 %), 4.9% in non-granular flat elevated LSTs (95% CI 2.1%-7.8%), and 0.5% in granular homogenous LSTs (95% CI 0.1%-1.0%). SMI was more common in distally rather than in proximally located LSTs (OR 2.50, 95% CI 1.24 -5.02). The proportion of SMI increased with lesion size (10-19mm, 4.6 %; 20-29mm, 9.2 %; >= 30mm, 16.5 %). The pooled prevalence of patients with one or more LSTs in the general colonoscopy population was 0.8% (95% CI 0.6%-1.1%).Conclusion The majority of LSTs are non-invasive at the time of colonoscopic detection and can be treated with (piecemeal) endoscopic mucosal resection. Pretreatment diagnosis of endoscopic subtype, specifying areas of concern (nodule or depression), determines those LSTs at highest risk of containing SMI, where en bloc resection is the

KW - MUCOSAL RESECTION

KW - CLINICOPATHOLOGICAL FEATURES

KW - NEOPLASTIC LESIONS

KW - CLINICAL-OUTCOMES

KW - NONPOLYPOID FLAT

KW - FOLLOW-UP

KW - K-RAS

KW - 20 MM

KW - PREVALENCE

KW - DISSECTION

U2 - 10.1055/s-0043-121144

DO - 10.1055/s-0043-121144

M3 - (Systematic) Review article

C2 - 29179230

SN - 0013-726X

VL - 50

SP - 263

EP - 282

JO - Endoscopy

JF - Endoscopy

IS - 3

ER -

Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis

Abstract

Keywords

Access to Document

Research output

Correction: Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: a meta-analysis

Cite this