Intraluminal lavage to remove exfoliated tumor cells after colorectal endoscopic submucosal dissection.
Endoscopic submucosal dissection (ESD) involves dissection of tumors and manipulation of them in an exposed condition for prolonged periods. A large number of tumor cells are exfoliated into the intestinal lumen after colorectal ESD. The aim of this study was to determine whether lavage volume has an influence on tumor cell clearance after colorectal ESD.



Twenty patients who underwent colorectal ESD at our hospital between July 2013 and December 2014 were studied. Cytological examination of intraluminal lavage samples associated incremental increases in lavage volume was collected. This prospective study was approved by the ethics committee of our hospital.



No patients had exfoliated tumor cells in their samples before ESD. Four patients (20 %) had exfoliated tumor cells in their samples after lavage with 500 ml, while one patient (5 %) had exfoliated tumor cells after lavage with 1000 or 1500 ml.



Tumor cells are exfoliated into the intestinal lumen by tumor manipulation during colorectal ESD. There seems to be a risk for implantation after ESD, as well as rectal surgery. Sufficient intraluminal lavage of more than 1000 ml may be desirable to remove exfoliated tumor cells after colorectal ESD.
Departments of Surgery, Nara Medical University, Kashihara, Japan. inotaka@naramed-u.ac.jp.
Takashi
T
Inoue
Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan.
Hisao
H
Fujii
Departments of Surgery, Nara Medical University, Kashihara, Japan.|Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan.
Fumikazu
F
Koyama
Departments of Surgery, Nara Medical University, Kashihara, Japan.
Shinji
S
Nakamura
Departments of Surgery, Nara Medical University, Kashihara, Japan.
Takeshi
T
Ueda
Departments of Surgery, Nara Medical University, Kashihara, Japan.
Naoto
N
Nishigori
Departments of Surgery, Nara Medical University, Kashihara, Japan.
Keijiro
K
Kawasaki
Departments of Surgery, Nara Medical University, Kashihara, Japan.
Shinsaku
S
Obara
Departments of Surgery, Nara Medical University, Kashihara, Japan.
Takayuki
T
Nakamoto
Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan.
Kazuaki
K
Uchimoto
Department of Pathology, Nara Medical University, Kashihara, Japan.
Kohei
K
Morita
Department of Pathology, Nara Medical University, Kashihara, Japan.
Takeshi
T
Nishikawa
Department of Pathology, Nara Medical University, Kashihara, Japan.
Chiho
C
Ohbayashi
Departments of Surgery, Nara Medical University, Kashihara, Japan.
Yoshiyuki
Y
Nakajima
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery*; D003584:Cytological Techniques; D000069916:Endoscopic Mucosal Resection / Q000379:methods*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D011446:Prospective Studies; D007507:Therapeutic Irrigation / Q000379:methods*
Colorectal endoscopic submucosal dissection; Exfoliated tumor cells; Implantation; Intraluminal lavage; Local recurrence