Endoscopic Submucosal Dissection for Colorectal Tumors

Eun-jung Lee, MD, Jae Bum Lee, MD, Suk Hee Lee, MD PhD, Do Sun Kim, MD PhD, Doo Han Lee, MD PhD, Du Seok Lee, MD PhD, Eui Gon Youk, MD PhD. Daehang Hospital

Purpose: Endoscopic Submucosal Dissection (ESD) is a very useful endoscopic technique, making it possible to perform an en bloc resection of a lesion regardless of the size. Since the introduction of ESD to our hospital, we have performed 1000 colorectal ESD over 4 years and 8 months. The aim of this study is to report our colorectal ESD experience. Methods: Between October 2006 and August 2011, we performed ESD on 1000 consecutive colorectal tumors in 966 patients. We evaluated the clinical outcomes of these cases. Results: The mean resected tumor size was 24.1±13.3(3-145) mm. Our overall endoscopic en bloc resection rate was 97.5% (975/1000) and pathologically margin free rate was 91.2% (912/1000), respectively. Our perforation rate was 5.3% (53/1000). For 50 patients, perforation was managed by conservative management with/without endoscopic clipping while the other three patients received emergency laparoscopic operation. Pathological examination showed adenocarcinoma in 37.2% of cases (372/1000). We recommended additional radical surgery to 74 cases (submucosal invasion less than 1 mm with unfavorable pathology: 17 cases, unknown depth of submucosal invasion: 1 case, submucosal invasion ≥ 1mm: 54 cases, invasion to proper muscle: 2 cases). Follow-up colonoscopies were performed on 610 patients. During the median follow-up period of 12(3-58) months, there were three recurrences (0.5%). Conclusions: ESD is technically difficult, with a substantial risk of perforation. Yet, ESD enabled en bloc resection of large colorectal tumors. As experience with the technique increases, ESD may gradually replace piecemeal EMR and radical colon resection in the treatment of colorectal tumors.

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