Original article
Outcomes of Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms in 200 Consecutive Cases

https://doi.org/10.1016/j.cgh.2007.01.006Get rights and content

Background & Aims: The clinical outcomes for endoscopic submucosal dissection (ESD), a novel endoluminal surgery for gastrointestinal neoplasm in the colorectum, are reported. Methods: ESD was performed on 186 consecutive patients with 200 colorectal epithelial neoplasms who had preoperative diagnoses of mucosal or slight submucosally invasive neoplasms. In addition, these could be of large size, with submucosal fibrosis, or located on an intestinal fold. The therapeutic efficacy and safety were assessed. Results: The targeted lesions consisted of 102 adenomas, 72 noninvasive carcinomas, and 26 invasive carcinomas. Seven lesions (3.5%) were histologically considered to be at substantial risk for nodal metastasis after ESD. The rate of en bloc resection was 91.5% (183/200), and en bloc resection with tumor-free lateral/basal margins (R0 resection) was 70.5% (141/200). Two lesions (1%) required emergency colonoscopies as a result of hematochezia after ESD. Eleven (5.5%) immediate perforations that occurred during ESD were successfully managed conservatively, but 1 (0.5%) delayed perforation required laparotomy. Two multiple-piece resections of 111 tumors (1.8%), which were successfully followed by colonoscopy (median follow-up, 18 months; range, 12–60 months), were found as locally recurrent tumors 2 and 21 months after ESD. No lymph node or distant metastasis was detected in 77 patients with noninvasive or invasive carcinoma (median follow-up, 24 months; range, 6–74 months). Conclusions: ESD is applicable in the colorectum with promising results. However, when considering the risks and benefits, piecemeal endoscopic resection or colorectal resection might be more appropriate for some subgroups of large flat neoplasms or those with submucosal fibrosis.

Section snippets

Patients and Methods

Between July 2000–March 2006, 186 consecutive patients, who had a total of 200 colorectal epithelial neoplasms, gave written informed consent to be treated with ESD at our hospital. Surgery was performed by 2 ESD specialists who were highly experienced in performing ESD in the stomach. Lesions with an indication for ESD were determined by endoscopic features by using chromoendoscopy with or without magnifying endoscopy. In addition, endoscopic ultrasonography was performed for lesions with a

Results

Table 1 summarizes the clinicopathologic features of colorectal epithelial neoplasms treated by ESD. Even small tumors 6 mm in size were resected by ESD because of the existence of scarring that rendered them non-lifting and difficult to resect with conventional EMR. Twenty-six tumors (13%) were histologically revealed to be invasive carcinoma. Seven tumors (3.5%), 6 with SM2 or deeper invasion including 2 tumors with vessel infiltration and 1 tumor with SM1 invasion plus vessel infiltration,

Discussion

Several clinical studies regarding the efficacy and safety of ESD in the stomach have been reported. The technique shows high tumor eradication rates but substantial risks during the procedure.6 We previously reported the possibility of using ESD in the esophagus21 and the rectum,7 which showed results similar to those of the stomach case series.6 These findings suggest a high likelihood of successful application in the whole colorectum, but the key issue might be how to innovate in the

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