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Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum

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Abstract

Background and aims

At specialized facilities, endoscopic submucosal dissection (ESD) has currently been performed even for difficult cases such as tumors extending to a diverticulum that previously required surgery. This study aims to classify the type of lesion according to the degree of infiltration to a diverticulum and assessed the safety and efficacy of ESD for each type of lesion.

Methods

We retrospectively reviewed ESD for lesions at NTT Medical Center Tokyo between January 2014 and April 2019. Lesions were classified as follows: Type 1: lesions in contact with or within 3 mm of the edge of a diverticulum; Type 2: lesions that partially infiltrated into a diverticulum; and Type 3: lesions that infiltrated into and completely covered the diverticulum. Furthermore, ESD strategies were divided into A and B, which indicates that a lesion was resected separately from the diverticulum and along the entire diverticulum, respectively. The clinicopathological characteristics and clinical outcomes were analyzed according to the strategy.

Results

A total of 47 lesions satisfied inclusion criteria (19 Type 1, 12 Type 2, and 16 Type 3 lesions). 19 Type 1 and 8 Type 2 lesions were resected using Strategy A, while 4 Type 2 and 16 Type 3 lesions were resected using Strategy B. En bloc resection was achieved in all cases. In Strategy A, the R0 resection rate was 96.3% and the curative resection rate was 88.9%. On the contrary, in Strategy B, the R0 resection rate was 95.0% and the curative resection rate was 90.0%. In Strategy B, one of the patients developed post-operative bleeding that required endoscopic hemostasis; another patient developed delayed perforation that required emergency surgery.

Conclusions

ESD for colorectal neoplasms in proximity or extending to a diverticulum is challenging, but this procedure can be a safe and effective therapeutic option.

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Authors and Affiliations

  1. Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan

    Takashi Muramoto, Ken Ohata, Eiji Sakai, Syunya Takayanagi, Yoshiaki Kimoto, Yuichiro Suzuki, Rindo Ishii, Keisuke Kanda, Ryoju Negishi, Maiko Takita & Yohei Minato

  2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Yosuke Tsuji

  3. Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan

    Hideyuki Chiba

  4. Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan

    Nobuyuki Matsuhashi

Authors
  1. Takashi Muramoto
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  2. Ken Ohata
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  3. Eiji Sakai
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  4. Syunya Takayanagi
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  5. Yoshiaki Kimoto
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Corresponding author

Correspondence to Ken Ohata.

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Disclosures

Takashi Muramoto, Ken Ohata, Eiji Sakai, Syunya Takayanagi, Yoshiaki Kimoto, Yuichiro Suzuki, Rindo Ishii, Keisuke Kanda, Ryoju Negishi, Maiko Takita, Yohei Minato, Yosuke Tsuji, Hideyuki Chiba and Nobuyuki Matsuhashi have no conflicts of interest or financial ties to disclose.

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Muramoto, T., Ohata, K., Sakai, E. et al. Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum. Surg Endosc 35, 3479–3487 (2021). https://doi.org/10.1007/s00464-020-07795-y

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  • DOI: https://doi.org/10.1007/s00464-020-07795-y

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