Efficacy and safety of endoscopic submucosal dissection for submucosal tumors of the colon and rectum

Published:October 05, 2017DOI:

      Background and Aims

      Endoscopic submucosal dissection (ESD) of colorectal submucosal tumors (SMTs) is becoming increasingly common; however, there have been few large consecutive studies analyzing its therapeutic efficacy and safety. The aim of this study was to evaluate the efficacy, safety, and long-term outcomes of ESD for colorectal SMTs.


      This retrospective study included 412 consecutive patients with colorectal SMTs who underwent ESD at the Zhongshan Hospital of Fudan University from January 2008 to July 2014. Tumor histopathology, completeness of resection, adverse events, tumor recurrence, and distant metastasis were analyzed.


      Complete resection was achieved for 358 lesions (86.9%). Thirteen patients had serious adverse events (3.2%) including bleeding and perforation, and 28 patients (6.8%) had post-ESD electrocoagulation syndrome (PEECS). Because more ESDs for colorectal SMTs were performed by endoscopists, the rate of complete resection increased (78.5% vs 88.5%), and the rate of serious adverse events decreased (9.2% vs 2.0%). SMTs in the colon increased the risk of incomplete resection (19.6% vs 11.3%), serious adverse events (8.7% vs 1.6%), and PEECS (16.3% vs 4.1%). SMTs originating from the muscularis propria and sized ≥20 mm increased the rate of PEECS (22.7% vs 5.9% and 31.3% vs 5.8%, respectively).


      ESD is effective for resection of colorectal SMTs and rarely causes serious adverse events. Tumor location and the experience of endoscopists influence the complete resection rate and the development of serious adverse events. ESD is feasible for large tumors and tumors in the muscularis propria, but this is associated with relatively high risks of adverse events.


      ESD (endoscopic submucosal dissection), NET (neuroendocrine tumor), PEECS (post-ESD electrocoagulation syndrome), SMT (submucosal tumor)
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      Linked Article

      • Endoscopic submucosal dissection for resection of submucosal tumors of the colon and rectum: Within reach, or the edge of tomorrow?
        Gastrointestinal EndoscopyVol. 87Issue 2
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          The terms submucosal tumor (SMT) and subepithelial tumor (SET) are often used synonymously. SET has been suggested to more distinctly describe tumors of the muscularis mucosa, submucosal layer, and muscularis propria, whereas SMT more specifically describes tumors arising from the submucosal layer. Although SETs are usually benign, a subset including gastrointestinal stromal tumors (GIST), neuroendocrine tumors (NET), and granular cell tumors (GCT) have malignant potential. Management options for smaller SETs with suspected malignant potential have typically included serial endoscopic and endosonographic surveillance or resection with EMR, whereas larger lesions are generally referred for surgical resection.
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