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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(06): E757-E763
DOI: 10.1055/a-2316-7755
Original article

Outcomes in colorectal endoscopic submucosal dissection for large protruded lesions: A retrospective multicenter study

Hideyuki Chiba 
1   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan
,
Ken Ohata
2   Gastroenterology, NTT Medical Center Tokyo, Shinagawa-ku, Japan
,
Akimichi Hayashi
1   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan
,
Yu Ebisawa
1   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan
,
Mikio Kobayashi
1   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan
,
Jun Arimoto 
1   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan
,
Hiroki Kuwabara 
1   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan
,
Yohei Minato
2   Gastroenterology, NTT Medical Center Tokyo, Shinagawa-ku, Japan
,
Michiko Nakaoka 
1   Gastroenterology, Omori Red Cross Hospital, Ota-Ku, Japan
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Abstract

Background and study aims Colorectal endoscopic submucosal dissection (ESD) is increasingly used for treating early-stage colorectal cancer, including large, protruded lesions (LPL). However, the challenges posed by LPLs, especially those accompanied by severe fibrosis or muscle-retracting sign (MRS), remain unclear. This study aims to investigate ESD outcomes for LPL, focusing on factors such as tumor size and, submucosal fibrosis.

Patients and methods In a multicenter retrospective study (June 2012 to May 2023), data from 526 patients with 542 LPL lesions (≥ 2 cm) were analyzed. Parameters included lesion size, procedure time, dissection speed, physician experience, submucosal fibrosis, and adverse events. The tunnel method, including the double tunnel method, was used for cases with severe fibrosis or MRS. Multivariate analysis assessed factors affecting procedure difficulty, particularly LPLs ≥ 4 cm.

Results The study revealed an impressive en bloc resection rate of 97.8% and a curative resection rate of 78.6% for LPLs. Notably, fibrosis and MRS were present in 25% and 18% of 4-cm LPLs, respectively, and their frequency tended to increase as the tumor diameter increased. One treatment strategy for LPLs was the tunneling method, which was used most frequently (41 cases, 7.6%). Factors affecting dissection speed included larger tumor size, submucosal fibrosis, MRS, and physician experience.

Conclusions Treating LPLs through colorectal ESD presents significant challenges, especially in patients with fibrosis and MRS. This study highlights the importance of recognizing these complexities, and that more reliable resection strategy must be established for accurate pathological evaluation

Keywords

Endoscopy Lower GI Tract - Colorectal cancer - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE...) - Polyps / adenomas / ...


Publication History

Received: 08 January 2024

Accepted after revision: 19 April 2024

Accepted Manuscript online:
29 April 2024

Article published online:
06 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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