Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Feb 7;16(5):588-95.
doi: 10.3748/wjg.v16.i5.588.

Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

Philippe Ah Soune  1 , Charles Ménard, Ezzedine Salah, Ariadne Desjeux, Jean-Charles Grimaud, Marc Barthet
Affiliations

Large endoscopic mucosal resection for colorectal tumors exceeding 4 cm

Philippe Ah Soune et al. World J Gastroenterol. .

Abstract

Aim: To evaluate the feasibility and the outcome of endoscopic mucosal resection (EMR) for large colorectal tumors exceeding 4 cm (LCRT) undergoing piecemeal resection.

Methods: From January 2005 to April 2008, 146 digestive tumors larger than 2 cm were removed with the EMR technique in our department. Of these, 34 tumors were larger than 4 cm and piecemeal resection was carried out on 26 colorectal tumors. The mean age of the patients was 71 years. The mean follow-up duration was 12 mo.

Results: LCRTs were located in the rectum, left colon, transverse colon and right colon in 58%, 15%, 4% and 23% of cases, respectively. All were sessile tumors larger than 4 cm with a mean size of 4.9 cm (4-10 cm). According to the Paris classification, 34% of the tumors were type Is, 58% type IIa, 4% type IIb and 4% type IIc. Pathological examination showed tubulous adenoma in 31%, tubulo-villous adenoma in 27%, villous adenoma in 42%, high-grade dysplasia in 38%, in situ carcinoma in 19% of the cases and mucosal carcinoma (m2) in 8% of the cases. The two cases (7.7%) of procedural bleeding that occurred were managed endoscopically and one small perforation was treated with clips. During follow-up, recurrence of the tumor occurred in three patients (12%), three of whom received endoscopic treatment.

Conclusion: EMR for tumors larger than 4 cm is a safe and effective procedure that could compete with endoscopic submucosal dissection, despite providing incomplete histological assessment.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Endoscopic piecemeal mucosal resection image. A: Large lateral spreading rectal tumor (adenoma with high grade dysplasia); B: Submucosal lifting of the tumor using saline with adrenaline 1/10 000; C: Capture of the lifted part of the tumor with a needle snare; D: Piecemeal resection of the rectal tumor; E: Final aspect at the end of the resection (procedure duration 70 min).
Figure 2
Figure 2
One year follow-up: a scar is visible without any sign of recurrence.
See this image and copyright information in PMC

References

    1. Iishi H, Tatsuta M, Kitamura S, Narahara H, Iseki K, Ishiguro S. Endoscopic resection of large sessile colorectal polyps using a submucosal saline injection technique. Hepatogastroenterology. 1997;44:698–702. - PubMed
    1. Tada M, Murakami A, Karita M, Yanai H, Okita K. Endoscopic resection of early gastric cancer. Endoscopy. 1993;25:445–450. - PubMed
    1. Karita M, Tada M, Okita K, Kodama T. Endoscopic therapy for early colon cancer: the strip biopsy resection technique. Gastrointest Endosc. 1991;37:128–132. - PubMed
    1. Kanamori T, Itoh M, Yokoyama Y, Tsuchida K. Injection-incision--assisted snare resection of large sessile colorectal polyps. Gastrointest Endosc. 1996;43:189–195. - PubMed
    1. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–2059. - PubMed