title: Efficacy and Safety of Endoscopic Submucosal Dissection for Colorectal Carcinoids.
abstract: OBJECTIVE
  Although endoscopic submucosal dissection (ESD) of colorectal carcinoids is increasing, little is known about long-term outcomes of patients. We investigated the efficacy and safety of ESD of colorectal carcinoids and evaluated long-term outcomes, including local recurrence and metastasis.
  
  
  METHODS
  We performed a retrospective analysis of data collected from 239 consecutive patients with colorectal carcinoids <20 mm who underwent endoscopic ultrasonography (to evaluate the size of tumor and the depth of invasion), followed by ESD from January 2007 through October 2012 at the Zhongshan Hospital of Fudan University. Histology and patient data were collected during a median follow-up period of 52 months (range, 25-94 months) to determine tumor stage and type, completeness of resection, complications, tumor recurrence, and distant metastasis.
  
  
  RESULTS
  En bloc resection was achieved for all of the 239 treated lesions; tumor tissues were completely resected for 216 of the lesions (90.38%). Eight patients had ESD-related complications (3.35%). As more ESDs were performed by endoscopists, the rate of complete tumor resection increased, and the rate of complications decreased. ESD of carcinoids in colon increased the risk of non-R0 resection and the rate of complications. During the follow-up period, all patients remained free from local recurrence. However, distant metastases were detected in 6 patients (2.51%); lymphovascular invasion was a risk factor for metastasis.
  
  
  CONCLUSIONS
  ESD is effective for the resection of rectal carcinoids <20 mm and causes complications in less than 4% of patients. ESD for colonic carcinoids is feasible but associated with a higher non-R0 resection rate and a trend toward higher complications risk. Tumor features and stage determine risk for distant metastasis, so long-term follow-up is essential.
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China.
authors.forename: Li-Qing
authors.initials: LQ
authors.lastname: Yao
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China.
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China.
authors.forename: Yi-Qun
authors.initials: YQ
authors.lastname: Zhang
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China.
authors.forename: Wei-Feng
authors.initials: WF
authors.lastname: Chen
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Shi
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China.
authors.forename: Shi-Lun
authors.initials: SL
authors.lastname: Cai
authors.affiliation: Department of Diagnostic Radiology, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Yin-Yin
authors.initials: YY
authors.lastname: Chen
authors.affiliation: Department of Pathology, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Yan-Hong
authors.initials: YH
authors.lastname: Xie
authors.affiliation: Department of Pathology, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Department of Gastroenterology, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Shi-Yao
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China. Electronic address: pinghongzhou@yahoo.com.
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Zhou
authors.affiliation: Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai, China; Endoscopy Research Institute of Fudan University, Shanghai, China. Electronic address: zhongamy2002@yahoo.com.
authors.forename: Yun-Shi
authors.initials: YS
authors.lastname: Zhong
mesh_terms: D000328:Adult; D000368:Aged; D002276:Carcinoid Tumor / Q000473:pathology / Q000601:surgery*; D002681:China; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006651:Histocytochemistry; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Colorectal Carcinoid; Endoscopic Submucosal Dissection; Therapy