Background
Endoscopic submucosal dissection (ESD) was recently developed to allow en bloc resection
of early neoplasia of the GI tract, including colorectal neoplasia. The endoscopic
technique is technically demanding and not yet standardized, and new devices are needed.
Objective
This study aimed to evaluate the efficacy and safety of a new device that combines
the functions of injection and cutting.
Design
Prospective, pilot, single-arm study.
Methods
Consecutive patients with rectal laterally spreading tumors (LSTs) 3 cm or larger
unsuitable for en bloc resection were enrolled. ESD was performed with a new device
that allows cutting and coagulation as well as a needleless, tissue-selective mucosal
and submucosal elevation through an axial water-jet channel.
Main Outcome Measurement
The primary endpoint of the study was the en bloc resection rate achieved with ESD
in a Western hospital setting.
Results
Overall, ESD was attempted in 40 consecutive patients (27 male, mean age 65.3 years)
with rectal LSTs larger than 3 cm (72.5% LSTs, nongranular type, 5% depressed type,
22.5% protruding type). The mean lesion size was 46.8 ± 10.9 mm (range 33-80 mm).
The mean procedure time was 86.1 ± 35.5 minutes (range 40-190 minutes). The en bloc
resection rate was 90% (36/40). In the remaining patients, resection was completed
with a piecemeal approach. The rate of curative resection (R0) was 32 of 40 LSTs (80%).
Two patients with submucosal invasion were referred for surgery. Perforation occurred
in 1 patient (2.5%), which was managed conservatively. Postoperative bleeding occurred
in 2 patients (5%) and was treated by endoscopic hemostasis.
Limitations
Single-center study with a relatively small number of patients.
Conclusions
ESD is a safe and effective method to provide en bloc and curative resection of large
rectal LSTs. The operating time and adverse event rate were comparable to those of
previously published data from Japanese experts.
Abbreviations:
CRC (colorectal cancer), ESD (endoscopic submucosal dissection), LST (laterally spreading tumor)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The annual report to the nation on the status of cancer, 1973–1997, with a special section on colorectal cancer.Cancer. 2000; 88: 2398-2424
- Estimates of the cancer incidence and mortality in Europe in 2006.Ann Oncol. 2007; 18: 581-592
- Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial.Lancet. 2010; 375: 1624-1633
- Endoscopic mucosal resection for early colorectal neoplasia: pathologic basis, procedures, and outcomes.Dis Colon Rectum. 2009; 52: 1502-1515
- Meta-analysis of endoscopic submucosal dissection versus endoscopic mucosal resection for tumors of the gastrointestinal tract.Endoscopy. 2009; 41: 751-757
- The AFC score: validation of a 4-item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis: results of a prospective multicenter study in 1049 patients.Ann Surg. 2007; 246: 91-96
- Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review.Endoscopy. 2012; 44: 137-150
- The Vienna classification of gastrointestinal epithelial neoplasia.Gut. 2000; 47: 251-255
- Endoscopic submucosal dissection for colorectal epithelial neoplasm.Surg Endosc. 2009; 23: 1546-1551
- Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms.Endoscopy. 2010; 42: 723-729
- Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis.Scand J Gastroenterol. 2010; 45: 1329-1337
- Balloon overtube-guided colorectal endoscopic submucosal dissection.World J Gastroenterol. 2009; 15: 6086-6090
- Efficient hemostatic method for endoscopic submucosal dissection of colorectal tumors.World J Gastroenterol. 2010; 16: 4180-4186
- Endoscopic submucosal dissection for rectal carcinoid tumors.Surg Endosc. 2010; 24: 504-508
- Endoscopic submucosal dissection for colorectal epithelial neoplasms.Dis Colon Rectum. 2010; 53: 161-168
- Advantages of using thin endoscope-assisted endoscopic submucosal dissection technique for large colorectal tumors.Dig Endosc. 2010; 22: 186-191
- Efficacy of an endo-knife with a water-jet function (Flushknife) for endoscopic submucosal dissection of superficial colorectal neoplasms.Am J Gastroenterol. 2010; 105: 314-322
- Advantages of endoscopic submucosal dissection with needle-knife over endoscopic mucosal resection for small rectal carcinoid tumors: a retrospective study.Surg Endosc. 2010; 24: 2607-2612
- Endoscopic submucosal dissection (ESD) for colorectal tumors.Dig Endosc. 2009; 21: S7-S12
- Endoscopic submucosal dissection of early cancers, flat adenomas, and submucosal tumors in the gastrointestinal tract.Clin Gastroenterol Hepatol. 2009; 7: 149-155
- Endoscopic submucosal dissection using sodium hyaluronate, a new technique for en bloc resection of a large superficial tumor in the colon.Inflammopharmacology. 2007; 15: 129-131
- Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum.Endoscopy. 2010; 42: 714-722
- The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: comparison with endoscopic mucosal resection.Endoscopy. 2010; 42: 647-651
- Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum.Endoscopy. 2010; 42: 714-722
- Endoscopic submucosal dissection for colorectal tumors.Gastroenterol Clin Biol. 2009; 33: 1004-1011
- Endoscopic submucosal dissection for residual/locally recurrent lesions after endoscopic therapy for colorectal tumors.J Gastroenterol Hepatol. 2010; 25: 1747-1753
- Endoscopic submucosal dissection and preoperative assessment with endoscopic ultrasonography for the treatment of rectal carcinoid tumors.Surg Endosc. 2010; 24: 1413-1419
- Endoscopic submucosal dissection with a combination of small-caliber-tip transparent hood and flex knife for large superficial colorectal neoplasias including ileocecal lesions.Surg Endosc. 2010; 24: 1941-1947
- Achieving R0 resection in the colorectum using endoscopic submucosal dissection.Br J Surg. 2007; 94: 1536-1542
Article info
Publication history
Accepted:
August 30,
2012
Received:
April 13,
2012
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Repici at [email protected]
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
