Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video).
BACKGROUND
Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer; however, it is not widely used in the colorectum because of its technical difficulty.


OBJECTIVE
To determine the feasibility of using ESD for treating large superficial colorectal tumors and to evaluate the clinical outcome.


METHODS
Case series conducted at the National Cancer Center Hospital in Tokyo.


METHODS
A total of 198 consecutive patients were treated for 200 lesions.


METHODS
Procedures were performed, before July 2004, by using a monopolar needle knife or an insulation-tipped knife (IT knife). After July 2004, the procedures were performed by using a bipolar needle knife or an IT knife. After injection of glycerol and sodium hyaluronate acid into the submucosal (sm) layer, a circumferential incision was made and sm dissection was performed endoscopically.


METHODS
The en bloc resection rate was 84% and the curative resection rate was 83%.


RESULTS
Among the 200 ESDs, 51 involved tubular adenomas, 99 intramucosal cancers, 22 minute sm cancers, and 28 sm deep cancers. The median operation time was 90 minutes, and the mean size of resected specimens was 38 mm (range, 20-150 mm). Perforations occurred in 10 cases (5%) and postoperative bleeding in 4 cases (2%), but only 1 perforation case needed emergency surgery, because endoscopic clipping was ineffective.


CONCLUSIONS
No long-term outcome data yet.


CONCLUSIONS
ESD is a feasible technique for treating large superficial colorectal tumors, because it provides a higher en bloc resection rate and is less invasive than surgical resection.
Saito
Yutaka
Y
Division of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Uraoka
Toshio
T
Matsuda
Takahisa
T
Emura
Fabian
F
Ikehara
Hisatomo
H
Mashimo
Yumi
Y
Kikuchi
Tsuyoshi
T
Fu
Kuang-I
KI
Sano
Yasushi
Y
Saito
Daizo
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000145:classification / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology; D008297:Male; D018715:Microscopy, Video; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome