Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: Is it feasible?

Background Colorectal endoscopic submucosal dissection (ESD) was applied to lesions, such as giant colorectal lateral spreading tumors (LSTs) > 10 cm, by an expert ESD endoscopist despite several limitations, such as a relatively high perforation rate and high technical difficulty. Objective To i...

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Bibliographic Details
Published in:Gastrointestinal endoscopy 2015-03, Vol.81 (3), p.614-620
Main Authors: Jung, Da Hyun, MD, Youn, Young Hoon, MD, PhD, Kim, Jie-Hyun, MD, PhD, Park, Hyojin, MD, PhD
Format: Article
Language:English
Subjects:
Adenocarcinoma - pathology
Adenocarcinoma - surgery
Adenoma - pathology
Adenoma - surgery
Adult
Aged
Aged, 80 and over
Colonoscopy - methods
Colorectal Neoplasms - pathology
Colorectal Neoplasms - surgery
Dissection - methods
Feasibility Studies
Female
Gastroenterology and Hepatology
Humans
Intestinal Mucosa - pathology
Intestinal Mucosa - surgery
Male
Middle Aged
Retrospective Studies
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Summary:Background Colorectal endoscopic submucosal dissection (ESD) was applied to lesions, such as giant colorectal lateral spreading tumors (LSTs) > 10 cm, by an expert ESD endoscopist despite several limitations, such as a relatively high perforation rate and high technical difficulty. Objective To investigate the feasibility and safety of ESD for giant colorectal LSTs ≥ 10 cm. Design Retrospective study. Setting Tertiary-care center. Patients A total of 163 patients underwent colorectal ESD between 2009 and 2014 by a single expert ESD endoscopist at Gangnam Severance Hospital, Seoul, Korea. Among them, 9 patients had giant colorectal LSTs ≥ 10 cm. Interventions Review of records. Main Outcome Measurements Clinicopathologic factors and oncologic outcome associated with ESD between giant colorectal LSTs and others. Results Colorectal LSTs ≥ 10 cm were classified as giant colorectal LSTs. Nine giant colorectal LST lesions were localized to the following regions: descending colon (n = 1), sigmoid colon (n = 1), and rectum (n = 7). The average maximal diameter of giant colorectal LSTs was 120.8 mm, and the procedure time was 270.0 minutes. Two lesions were of the whole nodular type, and 7 were focal nodular lesions. The en bloc and curative resection rates for ESD for giant colorectal LSTs were 88.9% and 100%, respectively. The adverse event rate was 44.4%. No strictures, local recurrences, or distant metastases occurred over a mean follow-up period of 27.1 months. Limitations Retrospective, single-center study. Conclusions ESD of giant colorectal LSTs appears to be a feasible and curative treatment, even though it is associated with a higher adverse event rate, higher degree of technical difficulty, and longer procedure time.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2014.09.001