Feasibility and Safety of Endoscopic Submucosal Dissection (ESD) for Treatment of Colorectal Tumors and Effectiveness of Measures to Prevent Complications. -Compared to Therapeutic Results from Gastric ESD-

Abstract

Background: Endoscopic submucosal dissection (ESD) is now widely accepted for treatment of early gastric cancer and ESD is currently being applied to treat colorectal cancer . There are concerns, however, about the possible high risk of peritonitis caused by perforations during ESD in the colon due to its thin wall and the presence of stool. Objective: Evaluate feasability and safety of colonic ESD and effectiveness of preventive measures against complications in comparison with therapeutic results from gastric ESD. Patients: In the gastric group (male/female: 67/9; mean age: 68.7 ± 8.6 years), 76 patients with 81 lesions were treated at Tokyo Medical University Hospital from April 2005 to November 2007. In the colonic group (male/female: 6/5; mean age: 64.0 ± 7.8 years), 11 patients with 11 lesions were treated at the same facility from June 2006 to November 2007. Methods: We compared lesion sizes, en-bloc resection rates, procedure times, length of hospital stays following ESD procedures and incidence of complications between the two groups. As for preventive measures taken to prevent complications during colonic ESDs, carbon dioxide insufflation was utilized to reduce patient discomfort and a bipolar needle-knife (B-knife) and an insulation-tip knife (IT knife) were initially used to reduce the risk of perforation. More recently, we have been using a newly designed ball-tip B-knife to further enhance operational safety. In order to prevent peritonitis, patients were given 2000-3000ml of polyethylene glycol (PEG) together with antibiotics the mornings of their procedures. Results: Mean lesion size was 20.7 ± 11.8 mm (range, 5-60 mm) in the gastric group and 50 ± 33mm (range, 20-110 mm) in the colonic group. The en-bloc resection rate was 90.6% compared to 72.2% and mean procedure time was 104.0 ± 70.5 minutes compared to 200.2 ± 188.3 minutes in the gastric and colonic groups, respectively. Mean length of hospital stay following ESD was shorter in the colonic group; 7.3 ± 3.9 days (range, 3-10 days) compared to in the gastric group; 10.2 ± 8.3 days (range, 5-31 days). The incidence of complications was 6 cases (7.4%) of delayed bleeding and 2 cases (2.5%) of perforation in the gastric group while there were no complications whatsoever in the colonic group. Conclusions: It is possible that colonic ESD is as safe as gastric ESD provided instruments developed specifically for use in the colon are used and adequate measures are taken to prevent complications. Under such circumstances, we consider ESD to be a feasible therapy for colorectal tumors.