Endoscopic Submucosal Dissection for Large Colorectal Tumor in a Japanese General Hospital

Abstract

Background and Aims. Endoscopic submucosal dissection (ESD) is not widely used in large colorectal lesions because of technical difficulty and possible complications. We aimed to examine the efficacy and safety of ESD for large colorectal neoplasms. Patients and Methods. During the past 5 years, 608 cases of colorectal neoplasm (≧20 mm) were treated by ESD. They were divided into Group A (20–49 mm, 511 cases) and Group B (≧50 mm, 97 cases). Results. The average age, lesion size, and procedure time were 67.4 years, 30.0 mm, and 60.0 min in Group A, and they were 67.1 years, 64.2 mm, and 119.6 min in Group B. En bloc resection rates were 99.2% and 99.0% (P = 0.80), and complication rates were 4.1% and 9.9% (P = 0.03). Complications in Group A consisted of perforation (2.7%), bleeding (1.2%), and ischemic colitis (0.2%). Those in Group B were perforation (8.2%) and bleeding (1.0%). Two cases in Group A and none in Group B required emergency surgery for perforation. Conclusions. There was no difference in efficacy between Groups A and B. Complications were more frequent in Group B, but all perforations in Group B were successfully managed conservatively. ESD can be effective and safe for large colorectal tumors.

Endoscopic Submucosal Dissection for Early Colon Cancer

“…Data on complications after EMR/ESD show similar bleeding rates (EMR 0-11.1%; ESD 0.5-9.5%), but the perforation rate is higher for ESD (1.3-20%) than for EMR (0-5.8%). However, the vast majority of perforations occurring during ESD are small and easily treated during the procedure, and thus the actual need for emergency surgery does not differ for EMR versus ESD [14,18,49,[66][67][68]. ESD is technically demanding and does require long procedure times.…”

“…Thus, a recent study comparing 1,029 cases of conventional EMR with 816 ESD procedures showed a significantly higher procedure time for ESD (96 min) than for EMR (18 min). Procedure times increased with the size of the lesion, although for very large lesions a comparison to laparoscopic surgery would be more appropriate [66,67]. Comparative data are available for ESD versus surgery, but again without a formal head-to-head study.…”

Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

“…Data on complications after EMR/ESD show similar bleeding rates (EMR 0-11.1%; ESD 0.5-9.5%), but the perforation rate is higher for ESD (1.3-20%) than for EMR (0-5.8%). However, the vast majority of perforations occurring during ESD are small and easily treated during the procedure, and thus the actual need for emergency surgery does not differ for EMR versus ESD [ 31 , 47 , 48 , 49 , 50 , 51 ]. ESD is technically demanding and does require long procedure times.…”

“…Thus, a recent study comparing 1,029 cases of conventional EMR with 816 ESD procedures showed a significantly higher procedure time for ESD (96 min) than for EMR (18 min). Procedure times increased with the size of the lesion, although for very large lesions a comparison to laparoscopic surgery would be more appropriate [ 48 , 49 ]. Comparative data are available for ESD versus surgery, but again without a formal head-to-head study.…”

Tissue shielding with polyglycolic acid sheets and fibrin glue on ulcers induced by endoscopic submucosal dissection in a porcine model

“…However, in addition to the stomach, ESD is now applied in the esophagus, large intestine, and duodenum, and as the number of applications in difficult-to-treat cases has grown, so has the number of reports of serious procedural complications. Therefore, the reduction of these complications has become a major issue 2 3 4 5 .…”