Endoscopic submucosal dissection for colorectal laterally spreading tumors

Abstract

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection （ESD） for the treatment of laterally spreading tumors （LST）. Methods ESD was applied to remove 32 colorectal LSTs larger than 2 cm. The characteristics of the tumors and clinical results including en bloc resection rate, procedure time, complication and recurrence rates were retrospectively evaluated. Results The lesions ranged from 2. 5 cm to 8. 0 cm, with a mean diameter of 4. 1 ± 2. 1 cm. En bloc resection was achieved in 29 patients （90.6%） with a mean operation time of 75.7 ± 66. 0 min. Immediate arterial bleed- ing occurred in 5 （15.6%） cases but was stopped successfully by clips or coagulations. Late bleeding occurred in 2 （6. 2% ） and perforations in 3 （9. 4% ）, which were closed successfully by clips without surgery. Pathological diagnosis revealed low-grade intraepithelial dysplasia in 19 （59.4%）, high-grade intraepithelial dysplasia in 6 （ 18.8% ）, and carcinomas in 7 （21.9%）. The lesions were restricted in mucosal layer in 25 （78. 1% ）, infiltrating into sm1 layer in 5 （15.6%） and sm2 layer in 2 （6. 2% ）, and the later 2 were referred to surgery. Twenty patients were followed up for 3-12 months, and no local recurrence was found. Conclusion oESD was an effective and safe therapy for colorectal LST larger than 2 cm. Key words: Colorectal neoplasms; Laterally spreading tumors; Endoscopic submucosal dissection