[Endoscopic therapy of adenomatous polyps and early-stage carcinomas of the colon and rectum].
OBJECTIVE
To assess the clinical efficacy of endoscopic treatment for colorectal adenomatous polyps and early-stage carcinomas.


METHODS
Between January 2006 and October 2007, 245 patients with colorectal adenomatous polyps and early-stage carcinomas with lifting sign(+) were treated by such endoscopic techniques as polypectomy, endoscopic mucosal resection (EMR), endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD).


RESULTS
Two hundred and fifty-three lesions ranged from 0.5 to 8.5 cm and the mean resected size was 2.3 cm, of which 157 were smaller than 2 cm and 96 larger than 2 cm. Confirmed pathologically, 249 lesions were successfully resected and the resection rate was 98.4% (249/253). None of patients had massive hemorrhage during the procedure and 2 had delayed bleeding. 1 had a little free air in abdominal cavity, 2 patients had subcutaneous emphysema due to deep tearing of the muscle layer, all 3 recovered after several days' conservative treatment. Visible perforation occurred in 4 cases during the dissection, of which 3 were typically closed with metallic endo-clip without surgical treatment, and 1 was managed surgically with obvious distention and much abdominal free air. The rate of resectional complication was judged to be 3.6% (9/253). Eight cases were transferred to surgery altogether after endoscopic procedure. Two hundred and thirty-one cases were followed up with confirmed healing of the large artificial ulcer after ESD except for local recurrence in 3 cases after EPMR.


CONCLUSIONS
Endoscopic resection appears to be an efficacious procedure to treat adenomatous polyp and early-stage carcinoma and provide pathological information about the whole lesion. Measures should be taken to reduce the complication rate of endoscopic resection in the future.
Zhou
Ping-Hong
PH
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China. zhou1968@yahoo.cn
Yao
Li-Qing
LQ
Chen
Wei-Feng
WF
D018256:Adenomatous Polyps / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D020776:Endoscopes, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome