title: Endoscopic submucosal dissection of scar-embedded rectal polyps: a prospective study (Esd in scar-embedded rectal polyps).
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) was developed for en bloc resection of superficial neoplasm of the digestive tract. We evaluated feasibility and safety of ESD, as a salvage therapy of large refractory rectal polyps, in a tertiary care setting.
  
  
  METHODS
  We prospectively enrolled in the present study and treated by ESD 11 consecutive patients with rectal polyps (median diameter 3.5 cm; range 2-5 cm), who had previously undergone several attempts of endoscopic resection and not suitable for further standard endoscopic treatment. The ESD was carried out with a standard needle knife. Follow up examinations were scheduled at 3, 6, 12 and 24 months.
  
  
  RESULTS
  We achieved apparently complete resection of polyps in 10/11 patients. In one patient ESD was interrupted and the pathology of the resected fragment showed deep submucosal infiltration; this patient underwent surgery. Deep and lateral margins were shown to be free of neoplasm (radical resection) in six out of 11 patients. However all the 10 patients with apparently complete resection were free of recurrence after a mean follow up of 19.2 months (12-24). A T1 adenocarcinoma was radically resected by ESD, with no recurrence. We recorded 2 cases of subcutaneous emphysema, both treated conservatively.
  
  
  CONCLUSIONS
  Radical resection is difficult to be achieved by ESD in patients with rectal scar-embedded polyps. Nevertheless ESD may be proposed as a definitive treatment of selected patients with refractory polyps, avoiding surgery in the majority of them.
authors.affiliation: Unit of Gastroenterology and Digestive Endoscopy, Arcispedale Santa Maria, Viale Risorgimento 80, 42100 Reggio Emilia, Italy. francesco.azzolini@asmn.re.it
authors.forename: F
authors.initials: F
authors.lastname: Azzolini
authors.forename: L
authors.initials: L
authors.lastname: Camellini
authors.forename: R
authors.initials: R
authors.lastname: Sassatelli
authors.forename: G
authors.initials: G
authors.lastname: Sereni
authors.forename: F
authors.initials: F
authors.lastname: Biolchini
authors.forename: F
authors.initials: F
authors.lastname: Decembrino
authors.forename: L
authors.initials: L
authors.lastname: De Marco
authors.forename: V
authors.initials: V
authors.lastname: Iori
authors.forename: C
authors.initials: C
authors.lastname: Tioli
authors.forename: M
authors.initials: M
authors.lastname: Cavina
authors.forename: G
authors.initials: G
authors.lastname: Bedogni
mesh_terms: D000328:Adult; D000368:Aged; D002921:Cicatrix / Q000150:complications* / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D007417:Intestinal Polyps / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012002:Rectal Diseases / Q000150:complications* / Q000601:surgery*