Endoscopic Submucosal Dissection for Colorectal Epithelial Neoplasms with Submucosal Fibrosis

Abstract

Background and Aims: Endoscopic mucosal resection (EMR) is a widely accepted treatment for colorectal epithelial neoplasms; however, this technique is not suitable for non-lifting intraepithelial neoplasms with submucosal fibrosis caused by previous endoscopic treatment or biopsy. The aim of this study was to evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for non-lifting epithelial neoplasms. Patients and methods: Between April 2003 and September 2007, ESD was performed on 22 consecutive patients with 22 colorectal epithelial neoplasms with submucosal fibrosis who had preoperative diagnoses of mucosal or slight submucosally invasive neoplasms. The en bloc resection rate, complication, and local recurrence were assessed in these lesions. Results: The mean size of tumors was 23 ± 3 mm in diameter. The submucosal fibrosis was caused by previous endoscopic treatment in 13 lesions, and caused by previous biopsy in 9 lesions. Among 22 lesions, 14 involved tubular adenomas, 7 non invasive carcinomas, and one invasive carcinoma. The rate of en bloc resection was 77.2% (17/22), and en bloc resection with tumor-free lateral/ basal margins (R0 resection) was 63.6% (14/22). Three (13.6%) immediate perforations that occurred during ESD were successfully managed conservatively, and there was no case of postoperative bleeding. Two multiple-piece resections of 17 lesions (11.8%), which were successfully followed by colonoscopy more than 2 months after ESD (mean follow-up period: 15.0 ± 4.2 months), were found as locally recurrent tumor 2 and 21 months after ESD. Conclusion: ESD appears to be effective treatment for non-lifting epithelial neoplasms with submucosal fibrosis; however, we should consider whether lesions would be appropriate to ESD due to the high risk of perforation.