Endoscopy 2009; 41(9): 758-761
DOI: 10.1055/s-0029-1215028
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation

N.  Yoshida1 , 2 , N.  Wakabayashi1 , K.  Kanemasa2 , Y.  Sumida2 , D.  Hasegawa3 , K.  Inoue1 , Y.  Morimoto1 , A.  Kashiwa1 , H.  Konishi1 , N.  Yagi1 , Y.  Naito1 , A.  Yanagisawa4 , T.  Yoshikawa1
  • 1Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
  • 2Center for Digestive and Liver disease, Nara City Hospital, Nara, Japan
  • 3Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
  • 4Department of Surgical Pathology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
Further Information

Publication History

submitted 3 November 2008

accepted after revision 8 July 2009

Publication Date:
10 September 2009 (online)

Background and study aim: Endoscopic submucosal dissection (ESD) for colorectal tumors is not generally recommended because of the technical difficulties and complications, including perforation. These aspects of ESD are thoroughly analyzed in our retrospective study.

Patients and methods: We studied 105 colorectal tumors, from 100 patients, that were treated by ESD at the Kyoto Prefectural University of Medicine or Nara City Hospital between 2005 and 2008. We analyzed tumor size, operation time, rate of en bloc resection, and complications. In addition, we thoroughly investigated the cases of perforation.

Results: The average tumor size was 30.4 mm; average operation time, 102 min; and rate of en bloc resection, 88.5 %. Perforation occurred in 10.4 % of the ESD procedures. Of the 11 perforations, 8 were detected during ESD and treated by clip closure during endoscopy, while 3 were evident only on subsequent routine computed tomography (CT); these were also managed conservatively. A case of postoperative hemorrhage was also observed.

Conclusions: ESD effectively achieved a high rate of en bloc resection. However, the perforation rate was substantial; hence, improvement in the ESD method is required. The outcomes of ESD, especially for early colorectal malignancies, need to be assessed further.

References

  • 1 Walsh R M, Ackroyd F W, Shellito P C. Endoscopic resection of large sessile colorectal polyps.  Gastrointest Endosc. 1992;  38 303-309
  • 2 Tanaka S, Haruma K, Oka S. et al . Clinicopathological features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm.  Gastrointest Endosc. 2001;  54 62-66
  • 3 Iishi H, Tatsuta M, Iseki K. et al . Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps.  Gastrointest Endosc. 2000;  51 697-700
  • 4 Patankar S K, Larach S W, Ferrara A. et al . Prospective comparison of laparoscopic vs. open resections for colorectal adenocarcinoma over a ten-year period.  Dis Colon Rectum. 2003;  46 601-611
  • 5 Yamamoto H, Kawata H, Sunada K. et al . Successful en bloc resection of large superficial tumors in the stomach and colon using sodium hyaluronate and small-caliber-tip transparent hood.  Endoscopy. 2003;  35 690-694
  • 6 Tanaka S, Oka S, Kaneko I. et al . Endoscopic submucosal dissection for colorectal neoplasia: Possibility of standardization.  J Gastroenterol. 2007;  66 100-107
  • 7 Saito Y, Uraoka T, Matsuda T. et al . Endoscopic treatment of large superficial colorectal tumors: A case series of 200 endoscopic submucosal dissections [with video].  Gastrointest Endosc. 2007;  66 966-973
  • 8 Fujishiro M, Yahagi N, Kakushima N. et al . Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases.  Clin Gastroenterol Hepatol. 2007;  5 678-683
  • 9 Tamegai Y, Saito Y, Masaki N. et al . Endoscopic submucosal dissection: a safe technique for colorectal tumors.  Endoscopy. 2007;  39 418-422
  • 10 Toyonaga T, Nishino E, Dozaiku T. et al . Management to prevent bleeding during endoscopic submucosal dissection using the Flush knife for gastric tumors.  Dig Endosc. 2007;  19 14-18

N. YoshidaMD, PhD 

Department of Molecular Gastroenterology and Hepatology
Kyoto Prefectural University of Medicine, Graduate School of Medical Science

465 Kajii-cho, Kawaramachi-Hirokoji
Kamigyo-ku, Kyoto 602-8566
Japan

Fax: +81-75-2510710

Email: naohisa@koto.kpu-m.ac.jp