title: Endoscopic submucosal dissection for flat or sessile colorectal neoplasia > 20 mm: A European single-center series of 182 cases.
abstract: OBJECTIVE
  Colorectal endoscopic submucosal dissection (ESD) is an attractive method for en bloc resection of larger flat neoplastic lesions. Experience with this method is limited in the Western World.
  
  
  METHODS
  A total of 182 consecutive flat or sessile colorectal lesions (cecum n = 43; right-sided colon n = 65; left-sided colon n = 11, rectum: n = 63) with a size > 20 mm (mean 41.0 ± 17.4 mm) were resected in 178 patients. The data were recorded prospectively.
  
  
  RESULTS
  ESD was technically feasible in 85.2 % of patients with a mean procedure time of 127.5 min (± 99.8) min and a complication rate of 11.5 % (microperforation 9.3 %, delayed bleeding 2.7 %, no case of emergency surgery, 30-day mortality rate 0 %). For 155 successfully completed procedures the en bloc and R0 resection rates were 88.4 and 62.6 %. Efficacy was better for smaller lesions (20 mm to 49 mm; n = 131) than for larger lesions (50 mm to 140 mm; n = 51) with R0 rates of 70.8 vs. 40.5 % (P < 0.001) and procedure times of 92.7 ± 62.4 minutes vs. 217.0 ± 120.9 minutes (P < 0,001).
  
  
  CONCLUSIONS
  This series confirms the efficacy of ESD for en bloc resection of colorectal lesions > 20 mm. RESULTS are satisfactory for lesions up to 50 mm. ESD for larger lesions was associated with low R0 resection rates and very long procedure times. The clinical consequences of microperforations were minor and do not argue against the spread of ESD in the West. Meeting presentations: The data were presented in part at DDW 2014, Chicago IL, USA (Gastrointest Endosc 2014; 79: AB536).
authors.affiliation: Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Sauer
authors.affiliation: Institute für Pathology Bonn-Duisdorf, Bonn, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Hildenbrand
authors.affiliation: Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan.
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Oyama
authors.affiliation: Department of General and Abdominal Surgery, Gemeinschaftskrankenhaus Bonn, Bonn, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Sido
authors.affiliation: Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Yahagi
authors.affiliation: Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany.
authors.forename: Franz Ludwig
authors.initials: FL
authors.lastname: Dumoulin