Mo1378 Endoscopic Submucosal Dissection(ESD)for Residual or Recurrent Colorectal Adenomas: a Single Center Experience

Abstract

Endoscopic Submucosal Dissection(ESD)for Residual or Recurrent Colorectal Adenomas: a Single Center Experience Stefania De Lisi*, Giancarla Fiori, Davide Ravizza, Cristina Trovato, Giuseppe De Roberto, Annalisa De Leone, Darina Tamayo, Cristiano Crosta Division of Endoscopy, European Institute of Oncology, Milan, Italy Background and Aims: Endoscopic submucosal dissection (ESD) of refractory colorectal polyps is a challenging procedure carrying higher risk of complication and lower rate of radical resection than “naive” lesions. To date, few western data is available for ESD in this setting. This study aims to evaluate the feasibility, safety and efficacy of ESD for colorectal polyps refractory to previous endoscopic resection. Material and methods: ESD was performed according to Yamamoto’s technique in patients with residual or recurrent polyps with a diameter 10mm, deemed as unsuitable for further endoscopic treatment. Single channel endoscopes were used for ESD: a gastroscope (Pentax EG2990i, Japan) for rectal polyps, a colonscope (Pentax EC3890Fi, Japan) for colonic ones. A standard needle knife, hook knife and Mucosectom (Pentax, Japan) were used for ESD. Results: Eleven consecutive patients (4/7 M/F mean age 70.6 years) with residual or recurrent colorectal polyps (4 colonic, 7 rectal) were treated. Colonic polyps were located in the sigmoid colon (n 1), in descending colon (n 1), at the splenic flexure (n 1) and in transverse colon (n 1). Median number of previous treatment was 2 (range 1-4), 2 patients also had undergone transanal endoscopic microsurgery. Mean polyps diameter was 24mm (range 10-40mm). Mean procedural time standard deviation was 137 75 minutes (range 45-270 minutes). En bloc resection rate was 6/11(54.5%). Three perforation (27.2%), occurred during ESD, were managed conservatively with clips application; no bleeding was observed. Radical resection rate (R0) was 6/11(54.5%), in 2 patients the margins were not evaluable (Rx) because of coagulation artefacts. Histology revealed low grade dysplasia in 5 patients (45.4%) and high grade dysplasia in 6 patients (54.5%). A mean endoscopic follow-up of 5.6 months (range 3-12 months) was available for 8/11patients, six of them (75%) were free of recurrence. During a short follow-up two diminutive, recurrent adenomas ( 5mm) were found and treated endoscopically in two patients with non-radical (R1) or non evaluable resection (Rx). Conclusions: ESD, although technically difficult, is a relatively safe and effective procedure for treatment of refractory colorectal polyps in patients otherwise candidates for surgery.