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Surgical Endoscopy

, Volume 26, Issue 8, pp 2220–2230 | Cite as

Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection–precutting, and endoscopic submucosal dissection

  • Eun-Jung Lee
  • Jae Bum Lee
  • Suk Hee Lee
  • Eui Gon Youk
Article

Abstract

Background

Endoscopic mucosal resection (EMR) is a useful therapeutic technique for colorectal tumors. However, for tumors larger than 20 mm, the chance of piecemeal resection is high. Recently introduced endoscopic submucosal dissection (ESD) enables en bloc resection regardless of the tumor size. This study aimed to compare the effectiveness and outcomes of EMR, EMR-precutting (EMR-P), and ESD in the treatment of colorectal tumors 20 mm in size or larger.

Methods

This study reviewed 523 nonpedunculated colorectal tumors (499 patients) 20 mm or larger that received endoscopic treatment (EMR in 140 cases, EMR-P in 69 cases, and ESD in 314 cases) from January 2004 to November 2009.

Results

The mean sizes of the tumors were 21.7 ± 3.5 mm (EMR), 23.5 ± 5.6 mm (EMR-P), and 28.9 ± 12.7 mm (ESD). The ratios of adenocarcinomas were 15.7% (EMR), 29% (EMR-P), and 37.9% (ESD). The en bloc resection rates were 42.9% (EMR), 65.2% (EMR-P), and 92.7% (ESD), and the complete resection rates were 32.9% (EMR), 59.4% (EMR-P), and 87.6% (ESD). Perforation occurred in 2.9% of the EMR-P cases and 8% of the ESD cases. The recurrence rates were 25.9% (EMR; median follow-up period, 26 months), 3.2% (EMR-P; median follow-up period, 16 months), and 0.8% (ESD; median follow-up period, 17 months).

Conclusion

For the treatment of large, nonpedunculated colorectal tumors, ESD is more effective than either EMR or EMR-P. Although ESD is technically demanding, it has clinical significance by overcoming the limitations of both EMR and EMR-P.

Keywords

Colorectal tumors EMR (Endoscopic mucosal resection) EMR-P (Endoscopic mucosal resection–precutting) ESD (Endoscopic submucosal dissection) Endoscopic treatment 

Notes

Disclosures

Eun-Jung Lee, Jae Bum Lee, Suk Hee Lee, and Eui Gon Youk have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Eun-Jung Lee
    • 1
  • Jae Bum Lee
    • 1
  • Suk Hee Lee
    • 2
  • Eui Gon Youk
    • 1
  1. 1.Department of SurgeryDaehang HospitalSeoulKorea
  2. 2.Department of PathologyDaehang HospitalSeoulKorea

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