Endoscopic Mucosal Resection for Advanced Non-Polypoid Colorectal Adenoma and Early Stage Carcinoma

Abstract

Endoscopic mucosal resection (EMR) techniques were evaluated in the treatment of non-polypoid colorectal lesions. Methods: 154 patients with non-polypoid colorectal lesions (n = 170) were included in the study. Tumor location, shape, size, and depth (in malignant lesions) were determined by endoscopy and endoscopic ultrasound (in left-sided lesions with a non-lifting sign). EMR was performed using either the lift and cut or the suck and cut technique with a cap-fitted endoscope for type IIc (depressed) lesions. Results: lesion size ranged from 0.8 to 30 mm. Complete resection was achieved in all 162 adenomas and 6 of 8 carcinomas. En-bloc resection was accomplished in 124 lesions, whereas 46 lesions were removed with piecemeal technique. Histopathological examination of neoplasm treated by EMR showed adenoma in 162 and early-stage carcinoma (pT1) in 8 cases. Because of the non-lifting sign, 2 of 170 tumors were not treated endoscopically and referred to surgical resection revealing a pT2 adenocarcinoma in both cases. Only two patients experienced a procedure-related bleeding, successfully treated by hemoclip application in both cases. No local recurrence was observed for both and early-stage carcinomas during a mean follow-up of 21 months (range 6 to 36 months). Conclusions: advanced non-polypoid colorectal adenomas and early-stage carcinomas can be safely and effectively resected by endoscopic mucosal resection.