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

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.

[1]  K. Hotta,et al.  Local recurrence after endoscopic resection of colorectal tumors , 2009, International Journal of Colorectal Disease.

[2]  Shin-ei Kudo,et al.  Colonoscopic Diagnosis and Management of Nonpolypoid Early Colorectal Cancer , 2000, World Journal of Surgery.

[3]  E. Kogure,et al.  Endoscopic submucosal dissection: a safe technique for colorectal tumors , 2007, Endoscopy.

[4]  T. Matsuda,et al.  A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. , 2007, Gastrointestinal endoscopy.

[5]  K. Hosokawa,et al.  [Recent advances in endoscopic mucosal resection for early gastric cancer]. , 1998, Gan to kagaku ryoho. Cancer & chemotherapy.

[6]  Yasushi Sano,et al.  Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). , 2007, Gastrointestinal endoscopy.

[7]  K. Sugano,et al.  Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. , 2002, Gastrointestinal endoscopy.

[8]  D. Rex.  Have we defined best colonoscopic polypectomy practice in the United States? , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[9]  Toshihide Kumamoto,et al.  Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study , 2004, Journal of Gastroenterology.

[10]  Y. Sano,et al.  Determining the treatment strategy for colorectal neoplastic lesions: endoscopic assessment or the non-lifting sign for diagnosing invasion depth? , 2007, Endoscopy.

[11]  S. Yoshida,et al.  Endoscopic mucosal resection for treatment of early gastric cancer , 2001, Gut.

[12]  Y. Sano,et al.  A newly developed bipolar-current needle-knife for endoscopic submucosal dissection of large colorectal tumors. , 2006, Endoscopy.

[13]  Y. Sano,et al.  Iatrogenic perforation associated with therapeutic colonoscopy: A multicenter study in Japan , 2007, Journal of gastroenterology and hepatology.

[14]  E. Furth,et al.  Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of 101 cases. , 2002, Gastrointestinal endoscopy.

[15]  K. Chayama,et al.  Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. , 2001, Gastrointestinal endoscopy.

[16]  T. Azuma,et al.  THE NEW RESOURCES OF TREATMENT FOR EARLY STAGE COLORECTAL TUMORS: EMR WITH SMALL INCISION AND SIMPLIFIED ENDOSCOPIC SUBMUCOSAL DISSECTION , 2009, Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society.

[17]  T. Fujii,et al.  Chromoscopy During Colonoscopy , 2001, Endoscopy.

[18]  Jun Kato,et al.  ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE COLORECTUM: PRESENT STATUS AND FUTURE PROSPECTS , 2009, Digestive Endoscopy.

[19]  Y. Sano,et al.  Efficacy of the Invasive/Non-invasive Pattern by Magnifying Chromoendoscopy to Estimate the Depth of Invasion of Early Colorectal Neoplasms , 2008, The American Journal of Gastroenterology.

[20]  S. Yoshida,et al.  Endoscopic mucosal resection for colorectal neoplastic lesions , 1994, Diseases of the colon and rectum.

[21]  T. Matsuda,et al.  Effectiveness of glycerol as a submucosal injection for EMR. , 2005, Gastrointestinal endoscopy.

[22]  N. Yamamichi,et al.  Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. , 2007, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[23]  T. Itoi,et al.  Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection , 2010, Surgical Endoscopy.

[24]  T. Gotoda,et al.  Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum , 2006, Gut.

[25]  T. Fujii,et al.  Endoscopic treatment for laterally spreading tumors in the colon. , 2001, Endoscopy.

[26]  Nib Soehendra,et al.  Endoscopic mucosal resection. , 2001, Gastrointestinal endoscopy.

[27]  A. Munakata,et al.  Correlation of lifting versus non-lifting and microscopic depth of invasion in early colorectal cancer. , 1999, Gastrointestinal endoscopy.

[28]  P. Deyhle,et al.  A Method for Endoscopic Electroresection of Sessile Colonic Polyps , 1973 .

[29]  H. Ono,et al.  A new endoscopic mucosal resection procedure using an insulation-tipped electrosurgical knife for rectal flat lesions: report of two cases. , 1999, Gastrointestinal endoscopy.

[30]  J. Ibdah,et al.  En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). , 2008, Gastrointestinal endoscopy.

[31]  S. Cross,et al.  Achieving R0 resection in the colorectum using endoscopic submucosal dissection , 2007, The British journal of surgery.

[32]  S. Kudo,et al.  Endoscopic Mucosal Resection of Flat and Depressed Types of Early Colorectal Cancer , 1993, Endoscopy.

[33]  T. Matsuda,et al.  Treatment strategy for laterally spreading tumors in Japan: Before and after the introduction of endoscopic submucosal dissection , 2009, Journal of gastroenterology and hepatology.

[34]  H. Tajiri,et al.  New Endoscopic Treatment for Intramucosal Gastric Tumors Using an Insulated-Tip Diathermic Knife , 2001, Endoscopy.

[35]  M F Dixon,et al.  The Vienna classification of gastrointestinal epithelial neoplasia , 2000, Gut.