A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video)

Abstract

Background: Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, although it is not widely used in the colorectum because of technical difficulty.

Objective: To examine the current status of colorectal ESDs at specialized endoscopic treatment centers.

Design and setting: Multicenter cohort study using a prospectively completed database at 10 specialized institutions.

Patients and interventions: From June 1998 to February 2008, 1111 colorectal tumors in 1090 patients were treated by ESD.

Main outcome measurements: Tumor size, macroscopic type, histology, procedure time, en bloc and curative resection rates and complications.

Results: Included in the 1111 tumors were 356 tubular adenomas, 519 intramucosal cancers, 112 superficial submucosal (SM) cancers, 101 SM deep cancers, 18 carcinoid tumors, 1 mucosa-associated lymphoid tissue lymphoma, and 4 serrated lesions. Macroscopic types included 956 laterally spreading tumors, 30 depressed, 62 protruded, 44 recurrent, and 19 SM tumors. The en bloc and curative resection rates were 88% and 89%, respectively. The mean procedure time ± standard deviation was 116 ± 88 minutes with a mean tumor size of 35 ± 18 mm. Perforations occurred in 54 cases (4.9%) with 4 cases of delayed perforation (0.4%) and 17 cases of postoperative bleeding (1.5%). Two immediate perforations with ineffective endoscopic clipping and 3 delayed perforations required emergency surgery. Tumor size of 50 mm or larger was an independent risk factor for complications, whereas a large number of ESDs performed at an institution decreased the risk of complications.

Limitations: No long-term outcome data.

Conclusions: ESD performed by experienced endoscopists is an effective alternative treatment to surgery, providing high en bloc and curative resection rates for large superficial colorectal tumors.