Tu1427 Postoperative Stricture After Endoscopic Submucosal Dissection for Large Colorectal Tumors

Abstract

Tu1426 Endoscopic Submucosal Dissection (ESD) of Large Sessile and Flat Neoplastic Lesions in the Colon: a Single-Center Series With 83 Procedures From Europe Malte Sauer, Ralf Hildenbrand, Reinhard Bollmann, Bernd Sido, Franz Ludwig Dumoulin* Dept. of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany; Department of General and Abdominal Surgery, Gemeinschaftskrankenhaus Bonn, Bonn, Germany; Pathology, Institute for Pathology Bonn Duisdorf, Bonn, Germany Introduction: Endoscopic resection of sessile or flat colorectal neoplasia larger than 20mm is usually performed as piecemeal endoscopic mucosal resection (EMR). The disadvantage is the uncertainty of complete resection with reported recurrence rates between 20-30%. In contrast, endoscopic submucosal dissection (ESD) allows en bloc resection of larger sessile or flat lesions. Colorectal ESD is technically demanding and a higher perforation rate has been reported. Currently, there is little experience with this technique in the US and in Europe with only a few series of ESD in the rectum and sigmoid colon and virtually no data on ESD in the proximal colon. The study aimed at the evaluation of efficacy and safety of this method in a western setting. Patients and Methods: Between October 2012 and November 2013 81 consecutive patients were referred for endoscopic treatment of 83 flat neoplastic lesions O 20mm (rectum / sigmoid colon 23%; localization more proximal: 77%; median size 35mm (10-100mm)). ESDs were carried out by a single endoscopist after prior training (animal model, tutorials) with Japanese ESD experts. Procedures were performed using dual knife (Olympus Medical Company, Japan) and VAIO electrosurgical unit (Erbe Elektromedizin, Germany). Results: Mean procedure time was 103 minutes (20-600). Endoscopic en bloc resection rate was 79,5%, histologically confirmed complete resection was achieved in 49,4% of the procedures with high grade intraepithelial neoplasia or early colorectal cancer in 36% of the cases. We observed complications in 10 patients: microperforations (nZ8; 9.6%) which were clipped without relevant clinical consequences and delayed bleedings requiring transfusion (nZ2; 2,4%). Median length of hospital stay was 3 days (1-6 days), the 30 day mortality rate was 0%. The rate of histologically confirmed complete resection increased from 40% for ESD procedures #1-40 to 58% for ESD procedures #41-83 (pZ 0.09). Conclusions: Colorectal ESD is feasible in the western setting with procedure time and complication rates comparable to published series from Asia. The rate of histologically confirmed complete resection needs further improvement.