Endoscopy 2004; 36(4): 306-312
DOI: 10.1055/s-2004-814204
Original Article
© Georg Thieme Verlag Stuttgart · New York

Evaluation of Endoscopic Mucosal Resection for Laterally Spreading Rectal Tumors

S.  Tamura1 , K.  Nakajo2 , Y.  Yokoyama2 , K.  Ohkawauchi1 , T.  Yamada2 , Y.  Higashidani2 , T.  Miyamoto3 , H.  Ueta3 , S.  Onishi1, 2
  • 1Department of Endoscopy, Kochi Medical School, Kochi, Japan
  • 2First Department of Internal Medicine, Kochi Medical School, Kochi, Japan
  • 3Division of Gastroenterology, Kochi Municipal Hata-Kenmin Hospital, Kochi, Japan
Further Information

Publication History

Submitted 18 February 2003

Accepted after revision 5 August 2003

Publication Date:
01 April 2004 (online)

Background and Study Aims: We undertook this retrospective study to evaluate the frequency and prognosis of endoscopic treatment of laterally spreading tumors (LSTs) in the rectum. The recurrence rate for lesions of the lower rectum was compared with that of the upper rectum.
Patients and Methods: During the period from July 1989 to June 2002, a total of 1237 rectal tumors were detected. LSTs accounted for 6.9 % (85/1237) of all rectal tumors. A total of 224 tumors of the lower rectum were detected among the 1237 rectal tumors. LSTs accounted for 16.1 % (36/224) of all the lower rectal tumors. From 85 LST lesions, 67 were evaluated for their prognosis after endoscopic mucosal resection (EMR). Patients whose LSTs had been resected were followed up by endoscopy at the following frequencies: once 15 (22.4 %); twice (more than 1 year), 20 (29.9 %); three times (more than 3 years), 21(31.3 %); and four times or more (more than 5 years), 11 (16.4 %).
Results: A total of 67 patients with endoscopically treated LSTs were followed up by endoscopy. We observed recurrences in two lesions of the upper rectum (2/38, 5.3 %) and five lesions of the lower rectum (5/29, 17.2 %) (P = 0.2364); all seven lesions were resected piecemeal. LSTs whose horizontal margin reached the pectinate line frequently recurred in the lower rectum, at a rate of 80 % (4/5). However, all patients were completely cured by additional endoscopic resections, the greatest number of treatments being four.
Conclusion: For early detection of recurrence and successful endoscopic cure, further colonoscopic examination within a few months after the first treatment is necessary.

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S. Tamura, M. D., Ph. D. 

Department of Endoscopy, Kochi Medical School

Kohasu, Okoh-cho · Nankoku · Kochi, 783-8505 · Japan

Fax: +81-88-8802338

Email: tamuras@hi-ho.ne.jp

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