Abstract
Background
Endoscopic submucosal dissection (ESD) involves dissection of tumors and manipulation of them in an exposed condition for prolonged periods. A large number of tumor cells are exfoliated into the intestinal lumen after colorectal ESD. The aim of this study was to determine whether lavage volume has an influence on tumor cell clearance after colorectal ESD.
Methods
Twenty patients who underwent colorectal ESD at our hospital between July 2013 and December 2014 were studied. Cytological examination of intraluminal lavage samples associated incremental increases in lavage volume was collected. This prospective study was approved by the ethics committee of our hospital.
Results
No patients had exfoliated tumor cells in their samples before ESD. Four patients (20 %) had exfoliated tumor cells in their samples after lavage with 500 ml, while one patient (5 %) had exfoliated tumor cells after lavage with 1000 or 1500 ml.
Conclusion
Tumor cells are exfoliated into the intestinal lumen by tumor manipulation during colorectal ESD. There seems to be a risk for implantation after ESD, as well as rectal surgery. Sufficient intraluminal lavage of more than 1000 ml may be desirable to remove exfoliated tumor cells after colorectal ESD.
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We wish to express our sincere gratitude to the laboratory technicians for their assistance with histopathological analysis.
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Takashi Inoue, Hisao Fujii, Fumikazu Koyama, Shinji Nakamura, Takeshi Ueda, Naoto Nishigori, Keijiro Kawasaki, Shinsaku Obara, Takayuki Nakamoto, Kazuaki Uchimoto, Kohei Morita, Takeshi Nishikawa, Chiho Ohbayashi, and Yoshiyuki Nakajima have no conflicts of interest or financial ties to disclose.
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Inoue, T., Fujii, H., Koyama, F. et al. Intraluminal lavage to remove exfoliated tumor cells after colorectal endoscopic submucosal dissection. Surg Endosc 30, 2773–2778 (2016). https://doi.org/10.1007/s00464-015-4550-x
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DOI: https://doi.org/10.1007/s00464-015-4550-x