title: Safe and efficient colorectal endoscopic submucosal dissection in European settings: is successful implementation of the procedure possible?
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) is gaining worldwide recognition as valuable alternative to treat early colorectal neoplasia. Although the method is perceived as technically difficult and carries a higher risk of complications than conventional endoscopy, the oncological results are very promising. Herein we aim to present the treatment outcomes of ESD for lesions in the colon and rectum at the beginning of our learning curve.
  
  
  METHODS
  Seventy consecutive cases of colorectal ESD carried out in our center between June 2013 and May 2014 were analyzed. Effectiveness of dissection, complications and tumor recurrence after 3 months of treatment were investigated.
  
  
  RESULTS
  Of the 70 ESD procedures, 39 were in the rectum, 10 in the sigmoid, eight in the descending colon, six in the ascending colon and seven in the cecum. Average size of removed tumors was 38.1 mm. In 50 cases, en-block resection was achieved. In this group, 97% cases were R0 resection. Perforation occurred in four cases (5.7%) of which three were managed with endoclips. In four cases, significant bleeding occurred. In a follow-up examination, two of 41 patients (4.9%) had recurrent adenoma that was successfully endoscopically removed.
  
  
  CONCLUSIONS
  The results confirm that ESD is an effective and safe modality for treatment of colorectal epithelial neoplasia in the colon and rectum even at the beginning of the learning curve. After proper training, results in Europe and Japan may be comparable.
authors.affiliation: General and Colorectal Surgery Department, Medical University, Lodz, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Spychalski
authors.forename: Adam
authors.initials: A
authors.lastname: Dziki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D015331:Cohort Studies; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000379:methods; D005060:Europe; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D061214:Patient Safety; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: colonoscopy; colorectal cancer; endoscopy; intestinal polyp; learning curve