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Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan

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Abstract

Background

Conventional endoscopic resection (CER) for early colorectal neoplasia (CRN) is widely accepted as a minimally invasive treatment. Endoscopic submucosal dissection (ESD) was developed in Japan to resect larger lesions, but ESD was not covered by the Japanese national health insurance until April 2012. In addition, treatment strategies vary considerably among medical facilities. To evaluate the current situation in Japan regarding endoscopic treatment of CRNs measuring ≥20 mm, we conducted a prospective multicenter study at 18 medium-volume and high-volume specialized facilities in cooperation with the Japan Society for Cancer of the Colon and Rectum (JSCCR).

Methods

The JSCCR conducted a multicenter, observational study of all patients treated by CER and ESD of CRNs measuring ≥20 mm.

Results

From October 2007 to December 2010, CERs and ESDs were performed on 1,845 CRNs (CERs 1,029; ESDs 816). Lesions diagnosed as protruded, flat, and depressed totaled 541, 1224, and 48, respectively. En bloc resection rates and mean procedure times for CER/ESD were 56.9 %/94.5 % (P < 0.01) and 18 ± 23 min/96 ± 69 min, respectively. The average ESD procedure time was 129 ± 83 min in the ≥40-mm group. As lesion size increased, the CER en bloc resection rate decreased significantly (trend P < 0.01), but the ESD en bloc resection rate remained over 93 %. Perforation and delayed bleeding rates of CER/ESD were 0.8 %/1.6 % (P < 0.05) and 2 %/2.2 % (P = 0.3), respectively.

Conclusions

The en bloc resection rate for ESD was significantly higher than for CER, although complication rates were fairly low. Despite a longer procedure time, safety of colorectal ESD has improved in various facilities in Japan. However, ESD for lesions measuring ≥40 mm must be performed by experienced endoscopists due to the longer procedure time.

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References

  1. Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN, Jemal A, Schymura MJ, Lansdorp-Vogelaar I, Seeff LC, van Ballegooijen M, Goede SL, Ries LA (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116:544–573

    Google Scholar 

  2. Muto T, Bussey HJ, Morson BC (1975) The evolution of cancer of the colon and rectum. Cancer 36:2251–2270

    Article  PubMed  CAS  Google Scholar 

  3. Winawer SJ, Zauber AG, Ho MN, O’Brien MJ, Gottlieb LS, Sternberg SS, Waye JD, Schapiro M, Bond JH, Panish JF et al (1993) Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. N Engl J Med 329:1977–1981

    Article  PubMed  CAS  Google Scholar 

  4. Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, Kumamoto T, Ishiguro S, Kato Y, Shimoda T, Iwashita A, Ajioka Y, Watanabe H, Watanabe T, Muto T, Nagasako K (2004) Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 39:534–543

    Article  PubMed  Google Scholar 

  5. Soetikno RM, Gotoda T, Nakanishi Y, Soehendra N (2003) Endoscopic mucosal resection. Gastrointest Endosc 57:567–579

    Article  PubMed  Google Scholar 

  6. Kudo S (1993) Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 25:455–461

    Article  PubMed  CAS  Google Scholar 

  7. Tanaka S, Haruma K, Oka S, Takahashi R, Kunihiro M, Kitadai Y, Yoshihara M, Shimamoto F, Chayama K (2001) Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 54:62–66

    Article  PubMed  CAS  Google Scholar 

  8. Hotta K, Fujii T, Saito Y, Matsuda T (2009) Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis 24:225–230

    Article  PubMed  Google Scholar 

  9. Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352

    Article  PubMed  Google Scholar 

  10. Ono H, Kondo H, Gotoda T, Shirao K, Yamaguchi H, Saito D, Hosokawa K, Shimoda T, Yoshida S (2001) Endoscopic mucosal resection for treatment of early gastric cancer. Gut 48:225–229

    Article  PubMed  CAS  Google Scholar 

  11. Oka S, Tanaka S, Kaneko I, Mouri R, Hirata M, Kawamura T, Yoshihara M, Chayama K (2006) Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 64:877–883

    Article  PubMed  Google Scholar 

  12. Gotoda T, Kaltenbach T, Soetikno R (2008) Is en bloc resection essential for endoscopic resection of GI neoplasia? Gastrointest Endosc 67:805–807

    Article  PubMed  Google Scholar 

  13. Gotoda T, Kondo H, Ono H, Saito Y, Yamaguchi H, Saito D, Yokota T (1999) A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. Gastrointest Endosc 50:560–563

    Article  PubMed  CAS  Google Scholar 

  14. Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, Sugano K (2002) Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 56:507–512

    Article  PubMed  Google Scholar 

  15. Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66:966–973

    Article  PubMed  Google Scholar 

  16. Antillon MR, Bartalos CR, Miller ML, Diaz-Arias AA, Ibdah JA, Marshall JB (2008) En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 67:332–337

    Article  PubMed  Google Scholar 

  17. Soetikno R, Gotoda T (2009) Con: colonoscopic resection of large neoplastic lesions is appropriate and safe. Am J Gastroenterol 104:272–275

    Article  PubMed  Google Scholar 

  18. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, Yoshida S, Ikehara H, Otake Y, Nakajima T, Matsuda T, Saito D (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225

    Article  PubMed  Google Scholar 

  19. Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651

    Article  PubMed  Google Scholar 

  20. Tanaka S, Terasaki M, Kanao H, Oka S, Chayama K (2012) Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc 24(Suppl 1):73–79

    Article  PubMed  Google Scholar 

  21. Niimi K, Fujishiro M, Kodashima S, Goto O, Ono S, Hirano K, Minatsuki C, Yamamichi N, Koike K (2010) Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 42:723–729

    Article  PubMed  CAS  Google Scholar 

  22. Watanabe T, Itabashi M, Shimada Y, Tanaka S, Ito Y, Ajioka Y, Hamaguchi T, Hyodo I, Igarashi M, Ishida H, Ishiguro M, Kanemitsu Y, Kokudo N, Muro K, Ochiai A, Oguchi M, Ohkura Y, Saito Y, Sakai Y, Ueno H, Yoshino T, Fujimori T, Koinuma N, Morita T, Nishimura G, Sakata Y, Takahashi K, Takiuchi H, Tsuruta O, Yamaguchi T, Yoshida M, Yamaguchi N, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2012) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer. Int J Clin Oncol 17(1):1–29

    Article  PubMed  Google Scholar 

  23. Taku K, Sano Y, Fu KI, Saito Y, Matsuda T, Uraoka T, Yoshino T, Yamaguchi Y, Fujita M, Hattori S, Ishikawa T, Saito D, Fujii T, Kaneko E, Yoshida S (2007) Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol 22:1409–1414

    Article  PubMed  Google Scholar 

  24. Uraoka T, Kawahara Y, Kato J, Saito Y, Yamamoto K (2009) Endoscopic submucosal dissection in the colorectum: present status and future prospects. Dig Endosc 21(Suppl 1):S13–S16

    Article  PubMed  Google Scholar 

  25. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, Matsukuma S, Kanai T, Kurihara H, Ozawa K, Yoshimura K, Bekku S (2004) Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 127:385–394

    Article  PubMed  Google Scholar 

  26. Kudo S, Kashida H, Tamura T, Kogure E, Imai Y, Yamano H, Hart AR (2000) Colonoscopic diagnosis and management of nonpolypoid early colorectal cancer. World J Surg 24:1081–1090

    Article  PubMed  CAS  Google Scholar 

  27. Fujii T, Hasegawa RT, Saitoh Y, Fleischer D, Saito Y, Sano Y, Kato S (2001) Chromoscopy during colonoscopy. Endoscopy 33:1036–1041

    PubMed  CAS  Google Scholar 

  28. Matsuda T, Saito Y, Fujii T, Uraoka T, Nakajima T, Kobayashi N, Emura F, Ono A, Shimoda T, Ikematsu H, Fu KI, Sano Y, Fujimori T (2009) Size does not determine the grade of malignancy of early invasive colorectal cancer. World J Gastroenterol 15:2708–2713

    Article  PubMed  Google Scholar 

  29. Matsuda T, Fujii T, Saito Y, Nakajima T, Uraoka T, Kobayashi N, Ikehara H, Ikematsu H, Fu KI, Emura F, Ono A, Sano Y, Shimoda T, Fujimori T (2008) Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms. Am J Gastroenterol 103:2700–2706

    Article  PubMed  Google Scholar 

  30. Sano Y, Ikematsu H, Fu KI, Emura F, Katagiri A, Horimatsu T, Kaneko K, Soetikno R, Yoshida S (2009) Meshed capillary vessels by use of narrow-band imaging for differential diagnosis of small colorectal polyps. Gastrointest Endosc 69:278–283

    Article  PubMed  Google Scholar 

  31. Ikematsu H, Matsuda T, Emura F, Saito Y, Uraoka T, Fu KI, Kaneko K, Ochiai A, Fujimori T, Sano Y (2010) Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterol 10:33

    Google Scholar 

  32. Wada Y, Kudo SE, Kashida H, Ikehara N, Inoue H, Yamamura F, Ohtsuka K, Hamatani S (2009) Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc 70:522–531

    Article  PubMed  Google Scholar 

  33. Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597

    Article  PubMed  CAS  Google Scholar 

  34. Tanaka S, Oka S, Chayama K (2008) Strategy of endoscopic treatment for colorectal tumor; recent progress and perspective. Springer, Tokyo

    Google Scholar 

  35. Saito Y, Fujii T, Kondo H, Mukai H, Yokota T, Kozu T, Saito D (2001) Endoscopic treatment for laterally spreading tumors in the colon. Endoscopy 33:682–686

    Article  PubMed  CAS  Google Scholar 

  36. Matsuda T, Parra-Blanco A, Saito Y, Sakamoto T, Nakajima T (2010) Assessment of likelihood of submucosal invasion in non-polypoid colorectal neoplasms. Gastrointest Endosc Clin N Am 20:487–496

    Article  PubMed  Google Scholar 

  37. (1983) General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Japanese Research Society for Cancer of the Colon and Rectum. Jpn J Surg 13:557–573

  38. Uraoka T, Fujii T, Saito Y, Sumiyoshi T, Emura F, Bhandari P, Matsuda T, Fu KI, Saito D (2005) Effectiveness of glycerol as a submucosal injection for EMR. Gastrointest Endosc 61:736–740

    Article  PubMed  Google Scholar 

  39. Sano Y, Fu KI, Saito Y, Doi T, Hanafusa M, Fujii S, Fujimori T, Ohtsu A (2006) A newly developed bipolar-current needle-knife for endoscopic submucosal dissection of large colorectal tumors. Endoscopy 38(Suppl 2):E95

    Article  PubMed  Google Scholar 

  40. Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683 quiz 645

    Article  PubMed  Google Scholar 

  41. Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39:418–422

    Article  PubMed  CAS  Google Scholar 

  42. Toyonaga T, Man IM, Morita Y, Sanuki T, Yoshida M, Kutsumi H, Inokuchi H, Azuma T (2009) The new resources of treatment for early stage colorectal tumors: EMR with small incision and simplified endoscopic submucosal dissection. Dig Endosc 21(Suppl 1):S31–S37

    Article  PubMed  Google Scholar 

  43. Sakamoto T, Matsuda T, Nakajima T, Saito Y (2012) Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors. Clin Gastroenterol Hepatol 10:22–26

    Article  PubMed  Google Scholar 

  44. Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, Dixon MF, Fenoglio-Preiser CM, Flejou JF, Geboes K, Hattori T, Hirota T, Itabashi M, Iwafuchi M, Iwashita A, Kim YI, Kirchner T, Klimpfinger M, Koike M, Lauwers GY, Lewin KJ, Oberhuber G, Offner F, Price AB, Rubio CA, Shimizu M, Shimoda T, Sipponen P, Solcia E, Stolte M, Watanabe H, Yamabe H (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47:251–255

    Article  PubMed  CAS  Google Scholar 

  45. Sakamoto T, Saito Y, Fukunaga S, Nakajima T, Matsuda T (2011) Learning curve associated with colorectal endoscopic submucosal dissection for endoscopists experienced in gastric endoscopic submucosal dissection. Dis Colon Rectum 54:1307–1312

    Article  PubMed  Google Scholar 

  46. Moss A, Bourke MJ, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, Zanati S, Chen RY, Byth K (2011) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 140:1909–1918

    Article  PubMed  Google Scholar 

  47. Kobayashi N, Saito Y, Sano Y, Uragami N, Michita T, Nasu J, Matsuda T, Fu KI, Fujii T, Fujimori T, Ishikawa T, Saito D (2007) Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth? Endoscopy 39:701–705

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This study was performed within the framework of a project undertaken by the Colorectal Endoscopic Resection Standardization Implementation Working Group in Japanese Society for Cancer of the Colon and Rectum Grants.

Disclosures

Takeshi Nakajima, Yutaka Saito, Shinji Tanaka, Hiroyasu Iishi, Shin-ei Kudo, Hiroaki Ikematsu, Masahiro Igarashi, Yuusuke Saitoh, Yuji Inoue, Kiyonori Kobayashi, Takashi Hisasbe, Takahisa Matsuda, Hideki Ishikawa, and Ken-ichi Sugihara have no conflict of interests or financial ties to disclose.

Author information

Authors and Affiliations

  1. Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takeshi Nakajima, Yutaka Saito & Takahisa Matsuda

  2. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan

    Shinji Tanaka

  3. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Hiroyasu Iishi

  4. Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan

    Shin-ei Kudo

  5. Department of Gastroenterology & Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Hiroaki Ikematsu

  6. Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan

    Masahiro Igarashi

  7. Digestive Disease Center, Asahikawa City Hospital, Hokkaido, Japan

    Yuusuke Saitoh

  8. Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan

    Yuji Inoue

  9. Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan

    Kiyonori Kobayashi

  10. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan

    Takashi Hisasbe

  11. Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Osaka, Japan

    Hideki Ishikawa

  12. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

    Ken-ichi Sugihara

Authors
  1. Takeshi Nakajima
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  2. Yutaka Saito
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  3. Shinji Tanaka
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  4. Hiroyasu Iishi
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  5. Shin-ei Kudo
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  6. Hiroaki Ikematsu
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  7. Masahiro Igarashi
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  8. Yuusuke Saitoh
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  9. Yuji Inoue
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  10. Kiyonori Kobayashi
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  11. Takashi Hisasbe
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  12. Takahisa Matsuda
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  13. Hideki Ishikawa
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  14. Ken-ichi Sugihara
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Corresponding author

Correspondence to Takeshi Nakajima.

Additional information

This study was conducted on behalf of the Colorectal Endoscopic Resection Standardization Implementation Working Group, Japanese Society for Cancer of the Colon and Rectum, Tokyo, Japan. The working group that participated in this study are listed in “Appendix”.

Appendix

Appendix

Facilities that participated the study

The patients were enrolled at the 18 institutions affiliated with the Colorectal Endoscopic Resection Standardization Implementation Working Group of JSCCR as follows: (1) Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Takeshi Nakajima, Yutaka Saito, Takahisa Matsuda); (2) Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan (Shinji Tanaka); (3) Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (Hiroyasu Iishi); (4) Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan (Shin-ei Kudo); (5) Department of Gastroenterology & Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan (Hiroaki Ikematsu); (6) Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan (Masahiro Igarashi); (7) Digestive Disease Center, Asahikawa City Hospital, Hokkaido, Japan (Yuusuke Saitoh); (8) Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan (Yuji Inoue); (9) Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan (Kiyonori Kobayashi); (10) Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan (Takashi Hisasbe); (11) Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan (Osamu Tsuruta); (12) Gastrointestinal Center, Sano Hospital, Hyogo, Japan (Yasushi Sano); (13) Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan (Hiro-o Yamano); (14) Department of Gastroenterology, JR West Osaka Railway Hospital, Osaka, Japan (Seiji Shimizu); (15) Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan (Naohisa Yahagi); (16) Department of Surgery, Teikyo University Hospital, Tokyo, Japan (Toshiaki Watanabe); (17) Department of Gastroenterology, Chofu Surgical Clinic, Tokyo, Japan (Hisashi Nakamura); (18) Gastroenterology, Takahiro Fujii Clinic, Tokyo, Japan (Takahiro Fujii).

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Nakajima, T., Saito, Y., Tanaka, S. et al. Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 27, 3262–3270 (2013). https://doi.org/10.1007/s00464-013-2903-x

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