Feasibility and safety of endoscopic submucosal dissection for large colorectal tumors.
OBJECTIVE
Recently, endoscopic submucosal dissection (ESD) has been applied for superficial colorectal neoplasms and the number of publications about it has been increasing, but little is known about the outcomes of colorectal ESD for the lesions > 50 mm. In this study, we evaluated the feasibility and safety of colorectal ESD for the lesions > 50 mm compared with the lesions < 50 mm.


METHODS
A total of 674 superficial colorectal neoplasms in 629 patients treated by ESD at Kobe University Hospital from July 2008 to July 2013 were included in the analysis.


RESULTS
The median operation time (range) in the large lesion group (≥ 5 cm) was 109 (37 to 596) minutes, and it was 55 (6 to 248) minutes in the small lesion group (< 5 cm). Median procedure speed (range) in the large lesion group was 0.28 (0.06 to 0.83) cm2/min, and it was 0.19 (0.04 to 0.83) cm2/min in the small lesion group. The en bloc resection rate and the curative resection rate in the small lesion group was 98.7% and 96.0%, and those were 95.7% and 91.4% in the large lesion group, respectively. In terms of adverse events, perforation, muscle damage, and postoperative bleeding occurred at similar frequency in both groups.


CONCLUSIONS
ESD on colorectal lesions > 50 mm takes longer operation time; however, it is resected time effectively without increasing the risk of adverse events compared with smaller lesions by ESD.
*Department of Endoscopy, Kobe University Hospital †Department of Internal Medicine, Division of Gastroenterology, Graduate School of Medicine, Kobe University, Kobe, Japan.
Shinwa
S
Tanaka
Takashi
T
Toyonaga
Yoshinori
Y
Morita
Namiko
N
Hoshi
Tsukasa
T
Ishida
Yoshiko
Y
Ohara
Tetsuya
T
Yoshizaki
Fumiaki
F
Kawara
Takeshi
T
Azuma
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D016896:Treatment Outcome