A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video)

Gastrointest Endosc. 2010 Dec;72(6):1217-25. doi: 10.1016/j.gie.2010.08.004. Epub 2010 Oct 27.

Abstract

Background: Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, although it is not widely used in the colorectum because of technical difficulty.

Objective: To examine the current status of colorectal ESDs at specialized endoscopic treatment centers.

Design and setting: Multicenter cohort study using a prospectively completed database at 10 specialized institutions.

Patients and interventions: From June 1998 to February 2008, 1111 colorectal tumors in 1090 patients were treated by ESD.

Main outcome measurements: Tumor size, macroscopic type, histology, procedure time, en bloc and curative resection rates and complications.

Results: Included in the 1111 tumors were 356 tubular adenomas, 519 intramucosal cancers, 112 superficial submucosal (SM) cancers, 101 SM deep cancers, 18 carcinoid tumors, 1 mucosa-associated lymphoid tissue lymphoma, and 4 serrated lesions. Macroscopic types included 956 laterally spreading tumors, 30 depressed, 62 protruded, 44 recurrent, and 19 SM tumors. The en bloc and curative resection rates were 88% and 89%, respectively. The mean procedure time ± standard deviation was 116 ± 88 minutes with a mean tumor size of 35 ± 18 mm. Perforations occurred in 54 cases (4.9%) with 4 cases of delayed perforation (0.4%) and 17 cases of postoperative bleeding (1.5%). Two immediate perforations with ineffective endoscopic clipping and 3 delayed perforations required emergency surgery. Tumor size of 50 mm or larger was an independent risk factor for complications, whereas a large number of ESDs performed at an institution decreased the risk of complications.

Limitations: No long-term outcome data.

Conclusions: ESD performed by experienced endoscopists is an effective alternative treatment to surgery, providing high en bloc and curative resection rates for large superficial colorectal tumors.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Video-Audio Media

MeSH terms

  • Adenoma / pathology
  • Adenoma / surgery
  • Aged
  • Carcinoid Tumor / pathology
  • Carcinoid Tumor / surgery
  • Cohort Studies
  • Colonoscopy / methods*
  • Colorectal Neoplasms / pathology*
  • Colorectal Neoplasms / surgery*
  • Dissection / instrumentation
  • Dissection / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Intestinal Mucosa / pathology*
  • Intestinal Mucosa / surgery*
  • Intestinal Perforation / etiology
  • Intestinal Perforation / surgery
  • Lymphoma, B-Cell, Marginal Zone / pathology
  • Lymphoma, B-Cell, Marginal Zone / surgery
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures / instrumentation
  • Minimally Invasive Surgical Procedures / methods*
  • Postoperative Complications / etiology
  • Postoperative Hemorrhage / etiology
  • Postoperative Hemorrhage / surgery
  • Prospective Studies
  • Reoperation
  • Risk Factors