Abstract
Background and Aims. Endoscopic submucosal dissection (ESD) is not widely used in large colorectal lesions because of technical difficulty and possible complications. We aimed to examine the efficacy and safety of ESD for large colorectal neoplasms. Patients and Methods. During the past 5 years, 608 cases of colorectal neoplasm (≧20 mm) were treated by ESD. They were divided into Group A (20–49 mm, 511 cases) and Group B (≧50 mm, 97 cases). Results. The average age, lesion size, and procedure time were 67.4 years, 30.0 mm, and 60.0 min in Group A, and they were 67.1 years, 64.2 mm, and 119.6 min in Group B. En bloc resection rates were 99.2% and 99.0% (P = 0.80), and complication rates were 4.1% and 9.9% (P = 0.03). Complications in Group A consisted of perforation (2.7%), bleeding (1.2%), and ischemic colitis (0.2%). Those in Group B were perforation (8.2%) and bleeding (1.0%). Two cases in Group A and none in Group B required emergency surgery for perforation. Conclusions. There was no difference in efficacy between Groups A and B. Complications were more frequent in Group B, but all perforations in Group B were successfully managed conservatively. ESD can be effective and safe for large colorectal tumors.
Highlights
More than 20 years have passed since the introduction of endoscopic mucosal resection (EMR) to the treatment of digestive tract tumors, and the endoscopic treatment is widely performed for early digestive tract cancers including stomach esophageal, and colon cancers [1,2,3,4]
Based on the established preoperative diagnostic techniques, large lesions have been shown to be completely curable by divided endoscopic mucosal resection (EMR), which is currently performed worldwide
There are many lesions for which en bloc resection by endoscopic submucosal dissection (ESD) is desirable, such as large, depressed lesions untreatable by snare EMR, lesions strongly suspected of slight SM invasion before surgery, and lesions with fibrosis
Summary
More than 20 years have passed since the introduction of endoscopic mucosal resection (EMR) to the treatment of digestive tract tumors, and the endoscopic treatment is widely performed for early digestive tract cancers including stomach esophageal, and colon cancers [1,2,3,4]. ESD is a minimally invasive treatment and enables the en bloc resection for early colorectal neoplasm. It is not widely used in the large neoplastic lesions because of technical difficulty and complications. We aimed to examine the safety, efficacy and complications of ESD for large colorectal neoplasms (larger than 20 mm) in a nonacademic hospital in Japan, retrospectively. Endoscopic submucosal dissection (ESD) is not widely used in large colorectal lesions because of technical difficulty and possible complications. During the past 5 years, 608 cases of colorectal neoplasm (≧20 mm) were treated by ESD They were divided into Group A (20–49 mm, 511 cases) and Group B (≧50 mm, 97 cases). ESD can be effective and safe for large colorectal tumors
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