title: Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers.
abstract: OBJECTIVE
  To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies.
  
  
  METHODS
  The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESD had premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography.
  
  
  RESULTS
  Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence.
  
  
  CONCLUSIONS
  ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.
authors.affiliation: Division of Gastroenterology, Kocaeli University Medical School, Kocaeli 41000, Turkey. shulagu@hotmail.com
authors.forename: Sadettin
authors.initials: S
authors.lastname: Hulagu
authors.forename: Omer
authors.initials: O
authors.lastname: Senturk
authors.forename: Cem
authors.initials: C
authors.lastname: Aygun
authors.forename: Orhan
authors.initials: O
authors.lastname: Kocaman
authors.forename: Altay
authors.initials: A
authors.lastname: Celebi
authors.forename: Tolga
authors.initials: T
authors.lastname: Konduk
authors.forename: Deniz
authors.initials: D
authors.lastname: Koc
authors.forename: Goktug
authors.initials: G
authors.lastname: Sirin
authors.forename: Ugur
authors.initials: U
authors.lastname: Korkmaz
authors.forename: Ali Erkan
authors.initials: AE
authors.lastname: Duman
authors.forename: Neslihan
authors.initials: N
authors.lastname: Bozkurt
authors.forename: Gokhan
authors.initials: G
authors.lastname: Dindar
authors.forename: Tan
authors.initials: T
authors.lastname: Attila
authors.forename: Yesim
authors.initials: Y
authors.lastname: Gurbuz
authors.forename: Orhan
authors.initials: O
authors.lastname: Tarcin
authors.forename: Cem
authors.initials: C
authors.lastname: Kalayci
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome