Endoscopic submucosal dissection in the treatment of patients with early colorectal carcinoma and precancerous lesions

Abstract

Background: Our study aims to explore the indications and clinical efficacy of endoscopic submucosal dissection (ESD) on the early colorectal carcinoma and precancerous lesions.

Methods: The clinical data of 29 patients with early colorectal carcinoma and precancerous lesions who were treated with ESD at Nantong First People's Hospital between January 2018 and December 2019 were collected. Then the endoscopic morphology, postoperative pathological classification, tumor resection rate, postoperative complications, and follow-up outcomes were analyzed.

Results: Colorectal carcinoma lesions were distributed in the left colon, accounting for 89.6%. There were 14 cases (48.3%) with protuberant endoscopic tumors, accounting for the highest proportion, while 2 cases (6.9%) of the flat tumors, accounting for the lowest proportion. The average operation time for ESD was 123 minutes, and en-bloc resection was 100% while the curative resection rate was 89.6%. There were 3 cases (10.3%) with delayed hemorrhage after ESD, and 1 case with persistent hemorrhage during the operation was transferred to surgical treatment. No cases with infection or perforation after ESD. For postoperative pathological classification, villous-tubular adenoma with low-grade epithelioma accounted for 31%; tubular adenoma with high-grade epithelioma only accounted for 3.4%. There was no recurrence in the follow-up for 1-20 months.

Conclusions: Control of surgical indications strictly, improvement of operation skills, attention to postoperative pathological feedback, and close follow-up are necessary guarantees to improve the clinical effectiveness of ESD.

Keywords: Endoscopic submucosal dissection (ESD); clinical experience; early colorectal carcinoma and precancerous lesions.

Figure 1

Endoscopic submucosal dissection (ESD) treatment and postoperative review of rectal mucosal protuberant lesions. A male patient, 60 years old. (A) 2.0 cm × 1.0 cm mass was observed under the endoscope; (B) 0.5 cm outside the edge of indigo carmine staining was marked; (C) the marked points were first separated outwards with a single-use Dualknife, and then flossing traction stripped the mucosa; (D) the wound surface was treated with the hot biopsy forceps; (E) the specimen was paved and soaked in formaldehyde. Its postoperative pathology shows villous tubular adenoma with low-grade epithelial neoplasia with negative horizontal resection margins. (F,G) After 12 months, no abnormal vessels were observed under linked color imaging (LCI) and blue laser imaging (BLI).