| Endoscopic Submucosal Dissection for Colorectal Neoplasia: Early Outcomes After 260 Cases. |
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Lee, Eun Jung , Lee, Jae Bum , Lee, Suk Hee , Kim, Do Sun , Lee, Doo Han , Youk, Eui Gon |
1Department of Surgery, Daehang Hospital, Seoul, Korea. youkgon@hanmail.net
2Department of Pathology, Daehang Hospital, Seoul, Korea. |
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| Abstract |
PURPOSE
Endoscopic submucosal dissection (ESD), a recently introduced endoscopic technique, makes it possible to perform an en-bloc resection of a lesion regardless of its size. The aim of this study was to report early experiences with colorectal ESD performed in our hospital.
METHODS
Between October 2006 and December 2008, we performed an ESD for 260 consecutive cases of colorectal neoplasia in 255 patients. We evaluated the clinical outcomes, except for two failure cases of bowel perforation.
RESULTS
The mean resected tumor size was 24.2+/-9.8 (5-60) mm. Our overall endoscopic en-bloc resection rate was 93.0% (240/258). and the pathologically margin free rate was 91.5% (236/258). Perforation occurred in 7.7% (20/260) of the cases. In 17 patients, perforation was managed by endoscopic clipping without salvage surgery; the other three patients underwent a laparoscopic operation. Pathological examination showed an adenocarcinoma in 35.4% of the cases (92/260). We recommended additional radical surgery in 13 cases (submucosal invasion less than 1 mm with unfavorable pathology: 1 case; unknown depth of submucosal invasion: 1 case; submucosal invasion > or =1 mm: 9 cases; invasion to proper muscle: 2 cases). We were able to check the recurrence rate through colonoscopy for 125 patients. During the mean follow-up period of 8.0+/-4.3 (3-21) mo, there were no recurrences.
CONCLUSION
ESD was technically difficult, had a substantial risk of perforation, and needed a long procedure time.
However, ESD enabled en-bloc resection of large colorectal tumors. As experience with the technique increases, ESD might gradually replace piecemeal endoscopic mucosal resection (EMR) and radical colon resection in the treatment of colorectal tumors. |
| Key Words:
Endoscopic submucosal dissection; Endoscopic mucosal resection; Colorectal tumor; Endoscopic treatment |
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