Endoscopic submucosal dissection for early colorectal neoplasms: Clinical experience in a tertiary medical center in Taiwan

Mei-Yu Tseng, Jung-Chun Lin, Tien-Yu Huang, Yu-Lueng Shih, Heng-Cheng Chu, Wei-Kuo Chang, Tsai-Yuan Hsieh, Peng-Jen Chen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objectives. Endoscopic submucosal dissection (ESD) is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1) lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG) ≧20 mm and laterally spreading tumors-granular type (LST-G) ≧30 mm; (2) lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3 ± 12.9 years, and the male-female ratio was 1.8: 1. The mean tumor size was 37.2 ± 17.9 mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0%) and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD. © 2013 Mei-Yu Tseng et al.
Original languageEnglish
JournalGastroenterology Research and Practice
Volume2013
DOIs
Publication statusPublished - 2013
Externally publishedYes

Fingerprint

Taiwan
Colorectal Neoplasms
Glandular and Epithelial Neoplasms
Endoscopic Mucosal Resection
Neoplasms
Gastrointestinal Neoplasms
General Hospitals
Japan
Fibrosis
Hemorrhage
Morbidity
Mortality

Keywords

  • adult
  • aged
  • article
  • blood vessel clip
  • cancer recurrence
  • cancer surgery
  • colonoscopy
  • colorectal tumor
  • distant metastasis
  • endoscopic submucosal dissection
  • female
  • follow up
  • histopathology
  • human
  • major clinical study
  • male
  • postoperative hemorrhage
  • surgical technique
  • Taiwan
  • tumor localization
  • tumor volume

Cite this

Endoscopic submucosal dissection for early colorectal neoplasms: Clinical experience in a tertiary medical center in Taiwan. / Tseng, Mei-Yu; Lin, Jung-Chun; Huang, Tien-Yu; Shih, Yu-Lueng; Chu, Heng-Cheng; Chang, Wei-Kuo; Hsieh, Tsai-Yuan; Chen, Peng-Jen.

In: Gastroenterology Research and Practice, Vol. 2013, 2013.

Research output: Contribution to journalArticle

Tseng, Mei-Yu ; Lin, Jung-Chun ; Huang, Tien-Yu ; Shih, Yu-Lueng ; Chu, Heng-Cheng ; Chang, Wei-Kuo ; Hsieh, Tsai-Yuan ; Chen, Peng-Jen. / Endoscopic submucosal dissection for early colorectal neoplasms: Clinical experience in a tertiary medical center in Taiwan. In: Gastroenterology Research and Practice. 2013 ; Vol. 2013.
@article{58f0047782fe41bbae55f94091aa3bed,
title = "Endoscopic submucosal dissection for early colorectal neoplasms: Clinical experience in a tertiary medical center in Taiwan",
abstract = "Objectives. Endoscopic submucosal dissection (ESD) is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1) lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG) ≧20 mm and laterally spreading tumors-granular type (LST-G) ≧30 mm; (2) lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3 ± 12.9 years, and the male-female ratio was 1.8: 1. The mean tumor size was 37.2 ± 17.9 mm. The en bloc resection rate was 90.2{\%} and the R0 resection rate was 89.1{\%}. Perforations during ESD occurred in 11 patients (12.0{\%}) and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD. {\circledC} 2013 Mei-Yu Tseng et al.",
keywords = "adult, aged, article, blood vessel clip, cancer recurrence, cancer surgery, colonoscopy, colorectal tumor, distant metastasis, endoscopic submucosal dissection, female, follow up, histopathology, human, major clinical study, male, postoperative hemorrhage, surgical technique, Taiwan, tumor localization, tumor volume",
author = "Mei-Yu Tseng and Jung-Chun Lin and Tien-Yu Huang and Yu-Lueng Shih and Heng-Cheng Chu and Wei-Kuo Chang and Tsai-Yuan Hsieh and Peng-Jen Chen",
note = "被引用次數:8 Export Date: 22 March 2016 通訊地址: Chen, P.-J.; Division of Gastroenterology, Tri-Service General Hospital, National Defence Medical Center, Neihu, Taipei 114, Taiwan; 電子郵件: endoscopy@ndmctsgh.edu.tw 參考文獻: Liou, J.-M., Lin, J.-T., Huang, S.-P., Chiu, H.-M., Wang, H.-P., Lee, Y.-C., Lin, J.-W., Wu, M.-S., Screening for colorectal cancer in average-risk Chinese population using a mixed strategy with sigmoidoscopy and colonoscopy (2007) Diseases of the Colon and Rectum, 50 (5), pp. 630-640. , DOI 10.1007/s10350-006-0857-y; Cunningham, D., Atkin, W., Lenz, H.J., Lynch, H.T., Minsky, B., Nordlinger, B., Starling, N., Colorectal cancer (2010) The Lancet, 375 (9719), pp. 1030-1047. , 2-s2.0-77949437015 10.1016/S0140-6736(10)60353-4; Saito, Y., Uraoka, T., Yamaguchi, Y., Hotta, K., Sakamoto, N., Ikematsu, H., Fukuzawa, M., Saito, D., A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video) (2010) Gastrointestinal Endoscopy, 72 (6), pp. 1217-1225. , 2-s2.0-78649496657 10.1016/j.gie.2010.08.004; Tanaka, S., Oka, S., Kaneko, I., Hirata, M., Mouri, R., Kanao, H., Yoshida, S., Chayama, K., Endoscopic submucosal dissection for colorectal neoplasia: Possibility of standardization (2007) Gastrointestinal Endoscopy, 66 (1), pp. 100-107. , DOI 10.1016/j.gie.2007.02.032, PII S0016510707003355; Taku, K., Sano, Y., Fu, K.-I., Saito, Y., Matsuda, T., Uraoka, T., Yoshino, T., Yoshida, S., Iatrogenic perforation associated with therapeutic colonoscopy: A multicenter study in Japan (2007) Journal of Gastroenterology and Hepatology, 22 (9), pp. 1409-1414. , DOI 10.1111/j.1440-1746.2007.05022.x; Yoshida, N., Yagi, N., Naito, Y., Yoshikawa, T., Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications (2010) World Journal of Gastroenterology, 16 (14), pp. 1688-1695. , 2-s2.0-77950992651 10.3748/wjg.v16.i14.1688; Lee, D.S., Jeon, S.W., Park, S.Y., Jung, M.K., Cho, C.M., Tak, W.Y., Kweon, Y.O., Kim, S.K., The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: Comparison with endoscopic mucosal resection (2010) Endoscopy, 42 (8), pp. 647-651. , 2-s2.0-77955127879 10.1055/s-0030-1255591; The Paris endoscopic classification of superficial neoplastic lesions: Esophagus, stomach, and colon (2002) Gastrointestinal Endoscopy, 58 (6 SUPPLEMENT), pp. S3-S4; Kudo, S.-E., Tamura, S., Nakajima, T., Yamano, H.-O., Kusaka, H., Watanabe, H., Diagnosis of colorectal tumorous lesions by magnifying endoscopy (1996) Gastrointestinal Endoscopy, 44 (1), pp. 8-14; Uraoka, T., Saito, Y., Matsuda, T., Ikehara, H., Gotoda, T., Saito, D., Fujii, T., Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum (2006) Gut, 55 (11), pp. 1592-1597. , DOI 10.1136/gut.2005.087452; Kitajima, K., Fujimori, T., Fuji, S., Takeda, J., Ohkura, Y., Kawamata, H., Kumamoto, T., Nagasako, K., Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: A Japanese collaborative study (2004) Journal of Gastroenterology, 39 (6), pp. 534-543; Ueno, H., Mochizuki, H., Hashiguchi, Y., Shimazaki, H., Aida, S., Hase, K., Matsukuma, S., Bekku, S., Risk factors for an adverse outcome in early invasive colorectal carcinoma (2004) Gastroenterology, 127 (2), pp. 385-394. , DOI 10.1053/j.gastro.2004.04.022, PII S0016508504007176; Saito, Y., Uraoka, T., Matsuda, T., Emura, F., Ikehara, H., Mashimo, Y., Kikuchi, T., Saito, D., Endoscopic treatment of large superficial colorectal tumors: A case series of 200 endoscopic submucosal dissections (with video) (2007) Gastrointestinal Endoscopy, 66 (5), pp. 966-973. , DOI 10.1016/j.gie.2007.02.053, PII S0016510707004166; Fujishiro, M., Yahagi, N., Kakushima, N., Kodashima, S., Muraki, Y., Ono, S., Yamamichi, N., Omata, M., Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases (2007) Clinical Gastroenterology and Hepatology, 5 (6), pp. 678-683. , DOI 10.1016/j.cgh.2007.01.006, PII S154235650700064X; Nishiyama, H., Isomoto, H., Yamaguchi, N., Fukuda, E., Ikeda, K., Ohnita, K., Mizuta, Y., Shikuwa, S., Endoscopic submucosal dissection for colorectal epithelial neoplasms (2010) Diseases of the Colon and Rectum, 53 (2), pp. 161-168. , 2-s2.0-77449128259 10.1007/DCR.0b013e3181b78cb6; Tanaka, S., Tamegai, Y., Tsuda, S., Saito, Y., Yahagi, N., Yamano, H.O., Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan (2010) Digestive Endoscopy, 22 (1), pp. S2-S8. , 2-s2.0-77952233238 10.1111/j.1443-1661.2010.00952.x; Hotta, K., Saito, Y., Matsuda, T., Shinohara, T., Oyama, T., Local recurrence and surveillance after endoscopic resection of large colorectal tumors (2010) Digestive Endoscopy, 22, pp. S63-S68. , supplement 1 2-s2.0-77952210189 10.1111/j.1443-1661.2010.00965.x; Saito, Y., Fukuzawa, M., Matsuda, T., Fukunaga, S., Sakamoto, T., Uraoka, T., Nakajima, T., Fujii, T., Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection (2010) Surgical Endoscopy and Other Interventional Techniques, 24 (2), pp. 343-352. , 2-s2.0-77649168148 10.1007/s00464-009-0562-8; Axon, A., Diebold, M.D., Fujino, M., Fujita, R., Genta, R.M., Gonvers, J.J., Guelrud, M., Yoshida, S., Update on the Paris classification of superficial neoplastic lesions in the digestive tract (2005) Endoscopy, 37 (6), pp. 570-578. , DOI 10.1055/s-2005-861352; Matsuda, T., Fujii, T., Saito, Y., Nakajima, T., Uraoka, T., Kobayashi, N., Ikehara, H., Fujimori, T., Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms (2008) American Journal of Gastroenterology, 103 (11), pp. 2700-2706. , 2-s2.0-51249085302 10.1111/j.1572-0241.2008.02190.x; Park, H.W., Byeon, J.S., Park, Y.S., Yang, D.H., Yoon, S.M., Kim, K.J., Ye, B.D., Kim, J.H., Endoscopic submucosal dissection for treatment of rectal carcinoid tumors (2010) Gastrointestinal Endoscopy, 72 (1), pp. 143-149. , 2-s2.0-77954083332 10.1016/j.gie.2010.01.040; Kim, H.H., Park, S.J., Lee, S.H., Park, H.U., Song, C.S., Park, M.I., Moon, W., Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: Analysis of 100 cases (2012) Digestive Endoscopy, 24 (3), pp. 159-163. , 2-s2.0-79960472056 10.1111/j.1443-1661.2011.01190.x; Hotta, K., Oyama, T., Shinohara, T., Miyata, Y., Takahashi, A., Kitamura, Y., Tomori, A., Learning curve for endoscopic submucosal dissection of large colorectal tumors (2010) Digestive Endoscopy, 22 (4), pp. 302-306. , 2-s2.0-77957269018 10.1111/j.1443-1661.2010.01005.x",
year = "2013",
doi = "10.1155/2013/891565",
language = "English",
volume = "2013",
journal = "Gastroenterology Research and Practice",
issn = "1687-6121",
publisher = "Hindawi Publishing Corporation",

}

TY - JOUR

T1 - Endoscopic submucosal dissection for early colorectal neoplasms: Clinical experience in a tertiary medical center in Taiwan

AU - Tseng, Mei-Yu

AU - Lin, Jung-Chun

AU - Huang, Tien-Yu

AU - Shih, Yu-Lueng

AU - Chu, Heng-Cheng

AU - Chang, Wei-Kuo

AU - Hsieh, Tsai-Yuan

AU - Chen, Peng-Jen

N1 - 被引用次數:8 Export Date: 22 March 2016 通訊地址: Chen, P.-J.; Division of Gastroenterology, Tri-Service General Hospital, National Defence Medical Center, Neihu, Taipei 114, Taiwan; 電子郵件: endoscopy@ndmctsgh.edu.tw 參考文獻: Liou, J.-M., Lin, J.-T., Huang, S.-P., Chiu, H.-M., Wang, H.-P., Lee, Y.-C., Lin, J.-W., Wu, M.-S., Screening for colorectal cancer in average-risk Chinese population using a mixed strategy with sigmoidoscopy and colonoscopy (2007) Diseases of the Colon and Rectum, 50 (5), pp. 630-640. , DOI 10.1007/s10350-006-0857-y; Cunningham, D., Atkin, W., Lenz, H.J., Lynch, H.T., Minsky, B., Nordlinger, B., Starling, N., Colorectal cancer (2010) The Lancet, 375 (9719), pp. 1030-1047. , 2-s2.0-77949437015 10.1016/S0140-6736(10)60353-4; Saito, Y., Uraoka, T., Yamaguchi, Y., Hotta, K., Sakamoto, N., Ikematsu, H., Fukuzawa, M., Saito, D., A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video) (2010) Gastrointestinal Endoscopy, 72 (6), pp. 1217-1225. , 2-s2.0-78649496657 10.1016/j.gie.2010.08.004; Tanaka, S., Oka, S., Kaneko, I., Hirata, M., Mouri, R., Kanao, H., Yoshida, S., Chayama, K., Endoscopic submucosal dissection for colorectal neoplasia: Possibility of standardization (2007) Gastrointestinal Endoscopy, 66 (1), pp. 100-107. , DOI 10.1016/j.gie.2007.02.032, PII S0016510707003355; Taku, K., Sano, Y., Fu, K.-I., Saito, Y., Matsuda, T., Uraoka, T., Yoshino, T., Yoshida, S., Iatrogenic perforation associated with therapeutic colonoscopy: A multicenter study in Japan (2007) Journal of Gastroenterology and Hepatology, 22 (9), pp. 1409-1414. , DOI 10.1111/j.1440-1746.2007.05022.x; Yoshida, N., Yagi, N., Naito, Y., Yoshikawa, T., Safe procedure in endoscopic submucosal dissection for colorectal tumors focused on preventing complications (2010) World Journal of Gastroenterology, 16 (14), pp. 1688-1695. , 2-s2.0-77950992651 10.3748/wjg.v16.i14.1688; Lee, D.S., Jeon, S.W., Park, S.Y., Jung, M.K., Cho, C.M., Tak, W.Y., Kweon, Y.O., Kim, S.K., The feasibility of endoscopic submucosal dissection for rectal carcinoid tumors: Comparison with endoscopic mucosal resection (2010) Endoscopy, 42 (8), pp. 647-651. , 2-s2.0-77955127879 10.1055/s-0030-1255591; The Paris endoscopic classification of superficial neoplastic lesions: Esophagus, stomach, and colon (2002) Gastrointestinal Endoscopy, 58 (6 SUPPLEMENT), pp. S3-S4; Kudo, S.-E., Tamura, S., Nakajima, T., Yamano, H.-O., Kusaka, H., Watanabe, H., Diagnosis of colorectal tumorous lesions by magnifying endoscopy (1996) Gastrointestinal Endoscopy, 44 (1), pp. 8-14; Uraoka, T., Saito, Y., Matsuda, T., Ikehara, H., Gotoda, T., Saito, D., Fujii, T., Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum (2006) Gut, 55 (11), pp. 1592-1597. , DOI 10.1136/gut.2005.087452; Kitajima, K., Fujimori, T., Fuji, S., Takeda, J., Ohkura, Y., Kawamata, H., Kumamoto, T., Nagasako, K., Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: A Japanese collaborative study (2004) Journal of Gastroenterology, 39 (6), pp. 534-543; Ueno, H., Mochizuki, H., Hashiguchi, Y., Shimazaki, H., Aida, S., Hase, K., Matsukuma, S., Bekku, S., Risk factors for an adverse outcome in early invasive colorectal carcinoma (2004) Gastroenterology, 127 (2), pp. 385-394. , DOI 10.1053/j.gastro.2004.04.022, PII S0016508504007176; Saito, Y., Uraoka, T., Matsuda, T., Emura, F., Ikehara, H., Mashimo, Y., Kikuchi, T., Saito, D., Endoscopic treatment of large superficial colorectal tumors: A case series of 200 endoscopic submucosal dissections (with video) (2007) Gastrointestinal Endoscopy, 66 (5), pp. 966-973. , DOI 10.1016/j.gie.2007.02.053, PII S0016510707004166; Fujishiro, M., Yahagi, N., Kakushima, N., Kodashima, S., Muraki, Y., Ono, S., Yamamichi, N., Omata, M., Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases (2007) Clinical Gastroenterology and Hepatology, 5 (6), pp. 678-683. , DOI 10.1016/j.cgh.2007.01.006, PII S154235650700064X; Nishiyama, H., Isomoto, H., Yamaguchi, N., Fukuda, E., Ikeda, K., Ohnita, K., Mizuta, Y., Shikuwa, S., Endoscopic submucosal dissection for colorectal epithelial neoplasms (2010) Diseases of the Colon and Rectum, 53 (2), pp. 161-168. , 2-s2.0-77449128259 10.1007/DCR.0b013e3181b78cb6; Tanaka, S., Tamegai, Y., Tsuda, S., Saito, Y., Yahagi, N., Yamano, H.O., Multicenter questionnaire survey on the current situation of colorectal endoscopic submucosal dissection in Japan (2010) Digestive Endoscopy, 22 (1), pp. S2-S8. , 2-s2.0-77952233238 10.1111/j.1443-1661.2010.00952.x; Hotta, K., Saito, Y., Matsuda, T., Shinohara, T., Oyama, T., Local recurrence and surveillance after endoscopic resection of large colorectal tumors (2010) Digestive Endoscopy, 22, pp. S63-S68. , supplement 1 2-s2.0-77952210189 10.1111/j.1443-1661.2010.00965.x; Saito, Y., Fukuzawa, M., Matsuda, T., Fukunaga, S., Sakamoto, T., Uraoka, T., Nakajima, T., Fujii, T., Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection (2010) Surgical Endoscopy and Other Interventional Techniques, 24 (2), pp. 343-352. , 2-s2.0-77649168148 10.1007/s00464-009-0562-8; Axon, A., Diebold, M.D., Fujino, M., Fujita, R., Genta, R.M., Gonvers, J.J., Guelrud, M., Yoshida, S., Update on the Paris classification of superficial neoplastic lesions in the digestive tract (2005) Endoscopy, 37 (6), pp. 570-578. , DOI 10.1055/s-2005-861352; Matsuda, T., Fujii, T., Saito, Y., Nakajima, T., Uraoka, T., Kobayashi, N., Ikehara, H., Fujimori, T., Efficacy of the invasive/non-invasive pattern by magnifying chromoendoscopy to estimate the depth of invasion of early colorectal neoplasms (2008) American Journal of Gastroenterology, 103 (11), pp. 2700-2706. , 2-s2.0-51249085302 10.1111/j.1572-0241.2008.02190.x; Park, H.W., Byeon, J.S., Park, Y.S., Yang, D.H., Yoon, S.M., Kim, K.J., Ye, B.D., Kim, J.H., Endoscopic submucosal dissection for treatment of rectal carcinoid tumors (2010) Gastrointestinal Endoscopy, 72 (1), pp. 143-149. , 2-s2.0-77954083332 10.1016/j.gie.2010.01.040; Kim, H.H., Park, S.J., Lee, S.H., Park, H.U., Song, C.S., Park, M.I., Moon, W., Efficacy of endoscopic submucosal resection with a ligation device for removing small rectal carcinoid tumor compared with endoscopic mucosal resection: Analysis of 100 cases (2012) Digestive Endoscopy, 24 (3), pp. 159-163. , 2-s2.0-79960472056 10.1111/j.1443-1661.2011.01190.x; Hotta, K., Oyama, T., Shinohara, T., Miyata, Y., Takahashi, A., Kitamura, Y., Tomori, A., Learning curve for endoscopic submucosal dissection of large colorectal tumors (2010) Digestive Endoscopy, 22 (4), pp. 302-306. , 2-s2.0-77957269018 10.1111/j.1443-1661.2010.01005.x

PY - 2013

Y1 - 2013

N2 - Objectives. Endoscopic submucosal dissection (ESD) is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1) lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG) ≧20 mm and laterally spreading tumors-granular type (LST-G) ≧30 mm; (2) lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3 ± 12.9 years, and the male-female ratio was 1.8: 1. The mean tumor size was 37.2 ± 17.9 mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0%) and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD. © 2013 Mei-Yu Tseng et al.

AB - Objectives. Endoscopic submucosal dissection (ESD) is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1) lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG) ≧20 mm and laterally spreading tumors-granular type (LST-G) ≧30 mm; (2) lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3 ± 12.9 years, and the male-female ratio was 1.8: 1. The mean tumor size was 37.2 ± 17.9 mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0%) and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD. © 2013 Mei-Yu Tseng et al.

KW - adult

KW - aged

KW - article

KW - blood vessel clip

KW - cancer recurrence

KW - cancer surgery

KW - colonoscopy

KW - colorectal tumor

KW - distant metastasis

KW - endoscopic submucosal dissection

KW - female

KW - follow up

KW - histopathology

KW - human

KW - major clinical study

KW - male

KW - postoperative hemorrhage

KW - surgical technique

KW - Taiwan

KW - tumor localization

KW - tumor volume

U2 - 10.1155/2013/891565

DO - 10.1155/2013/891565

M3 - Article

VL - 2013

JO - Gastroenterology Research and Practice

JF - Gastroenterology Research and Practice

SN - 1687-6121

ER -