title: Endoscopic submucosal dissection for superficial rectal tumors: prospective evaluation in France.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) provides a high en bloc resection rate for superficial colorectal tumors. The aims of this study were to assess the feasibility of ESD in France and to evaluate the complete resection rate at 1 year.
  
  
  METHODS
  Patients with superficial rectal tumors ≥ 10 mm in size were prospectively included in the study at nine French expert centers between February 2010 and June 2012. The study was stopped temporarily because of a high complication rate. Study recruitment resumed following remedial action.
  
  
  RESULTS
  A total of 45 patients were included (mean age 67 years; 24 males). The immediate perforation rate was 18 % (n = 8), and salvage surgery was not required. Six patients (13 %) had late bleeding, which was treated endoscopically in five patients and surgically in one patient who had required blood transfusion. The mortality rate was zero. The en bloc resection rate was 64 % (29/45), and the curative R0 resection rate was 53 % (24/45). Three patients (7 %) had an invasive tumor (two sm1, one T2). At 1-year follow-up, endoscopic examinations showed complete resection in 38 /43 patients (88 %). At the end of the study, after the remedial action, the en bloc resection rate had increased from 52 % to 82 %, and the perforation rate had decreased significantly from 34 % to 0 %.
  
  
  CONCLUSIONS
  The study reflects the initial prospective experience of ESD in France, and suggests that curative R0 resection rates should increase and complication rates should decrease with experience and corrective actions.
authors: Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors: Gabriel
authors: G
authors: Rahmi
authors: Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors: Bilal
authors: B
authors: Hotayt
authors: Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.
authors: Stanislas
authors: S
authors: Chaussade
authors: Department of Gastroenterology and Digestive Endoscopy, Edouard Herriot Hospital, Lyon, France.
authors: Vincent
authors: V
authors: Lepilliez
authors: Department of Digestive Endoscopy, Institut Paoli-Calmettes, Marseille, France.
authors: Marc
authors: M
authors: Giovannini
authors: Department of Gastroenterology and Digestive Endoscopy, Nouvel Hôpital Civil, Strasbourg, France.
authors: Dimitri
authors: D
authors: Coumaros
authors: Department of Gastroenterology and Digestive Endoscopy, Henry Mondor Hospital, Paris, France.
authors: Antoine
authors: A
authors: Charachon
authors: Department of Gastroenterology and Digestive Endoscopy, Centre Hospitalier Régional de Brest, Brest, France.
authors: Franck
authors: F
authors: Cholet
authors: Department of Gastroenterology and Digestive Endoscopy, Saint Joseph Hospital, Marseille, France.
authors: Arthur
authors: A
authors: Laquière
authors: Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors: Elia
authors: E
authors: Samaha
authors: Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.
authors: Frédéric
authors: F
authors: Prat
authors: Department of Gastroenterology and Digestive Endoscopy, Edouard Herriot Hospital, Lyon, France.
authors: Thierry
authors: T
authors: Ponchon
authors: Department of Digestive Endoscopy, Institut Paoli-Calmettes, Marseille, France.
authors: Erwan
authors: E
authors: Bories
authors: Department of Gastroenterology and Digestive Endoscopy, Centre Hospitalier Régional de Brest, Brest, France.
authors: Michel
authors: M
authors: Robaszkiewicz
authors: Department of Gastroenterology and Digestive Endoscopy, Saint Joseph Hospital, Marseille, France.
authors: Christian
authors: C
authors: Boustière
authors: Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
authors: Christophe
authors: C
authors: Cellier
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects / Q000193:education; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005602:France; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology*; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D019106:Postoperative Hemorrhage / Q000209:etiology*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome