title: The new resources of treatment for early stage colorectal tumors: EMR with small incision and simplified endoscopic submucosal dissection.
abstract: BACKGROUND
  Early stage colorectal tumors can be removed by endoscopic mucosal resection (EMR) but larger tumors (> or =20 mm) may require piecemeal resection. The development of endoscopic submucosal dissection (ESD) has enabled en-bloc resection of lesions regardless of size and shape. However ESD of colorectal tumor is technically difficult. As the resources, we perform EMR with small incision (EMR with SI) for more reliable EMR, and also ESD with snaring (simplified ESD) for easier and safer ESD. AIM & METHODS: The aim of the study was to retrospectively compare the treatment results of the following 3 methods (EMR with SI/ simplified ESD/ ESD). We treated 24/44/468 colorectal tumors, and examined the tumor size, resected specimen size, procedure time, en-bloc resection rate, complication rate.
  
  
  RESULTS
  The median tumor size (mm) (EMR with SI/simplified EMR/ESD) was 20/17/30 (EMR with SI vs simplified ESD: P = n.s, simplified ESD vs ESD: P < 0.0001). The median resected specimen size (mm) was 22.5/26/41 (EMR with SI vs simplified ESD: P = 0.0018, simplified ESD vs ESD: P < 0.0001). The procedure time (min.) was 19/27/60 (EMR with SI vs simplified ESD: P = n.s, simplified ESD vs ESD: P < 0.0001) The en-bloc resection rate (%) was 83.3/90.9/98.9. The complication rate (post-operative bleeding rate/perforation rate) was 0/0, 2.3/4.5, 1.5/1.5 (simplified ESD vs ESD: P = n.s).
  
  
  CONCLUSIONS
  Endoscopic mucosal resection with small incision (EMR with SI) and ESD with snaring (simplified ESD) are a good option to fill the differences between conventional EMR and ESD, and also considered to become nice steps to the introduction of ESD.
authors.affiliation: Department of Endoscopy, Kobe University Hospital, Japan. toyonaga@med.kobe-u.ac.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Toyonaga
authors.forename: Mariko
authors.initials: M
authors.lastname: Man-I
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Morita
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Sanuki
authors.forename: Masaru
authors.initials: M
authors.lastname: Yoshida
authors.forename: Hiromu
authors.initials: H
authors.lastname: Kutsumi
authors.forename: Hideto
authors.initials: H
authors.lastname: Inokuchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Azuma
mesh_terms: D003113:Colonoscopy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric