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

 Da Hyun Jung  ;  Young Hoon Youn  ;  Jie-Hyun Kim  ;  Hyojin Park 
 GASTROINTESTINAL ENDOSCOPY, Vol.81(3) : 614-620, 2015 
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Issue Date
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 ; Humans ; Intestinal Mucosa/pathology ; Intestinal Mucosa/surgery* ; Male ; Middle Aged ; Retrospective Studies
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jie-Hyun(김지현) ORCID logo https://orcid.org/0000-0002-9198-3326
Park, Hyo Jin(박효진) ORCID logo https://orcid.org/0000-0003-4814-8330
Youn, Young Hoon(윤영훈) ORCID logo https://orcid.org/0000-0002-0071-229X
Jung, Da Hyun(정다현)
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