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.
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References
Conio M, Repici A, Demarquay JF, Blanchi S, Dumas R, Filiberti R (2004) EMR of large sessile colorectal polyps. Gastrointest Endosc 60:234–241
Fukami N, Lee JH (2006) Endoscopic treatment of large sessile and flat colorectal lesions. Curr Opin Gastroenterol 22:54–59
Brooker JC, Saunders BP, Shah SG, Thapar CJ, Suzuki N, Williams CB (2002) Treatment with argon plasma coagulation reduces recurrence after piecemeal resection of large sessile colonic polyps: a randomized trial and recommendations. Gastrointest Endosc 55:371–375
Gotoda T (2006) Endoscopic resection of early gastric cancer: the Japanese perspective. Curr Opin Gastroenterol 22:561–569
Kim JJ, Lee JH, Jung HY, Lee GH, Cho JY, Ryu CB, Chun HJ, Park JJ, Lee WS, Kim HS, Chung MG, Moon JS, Choi SR, Song GA, Jeong HY, Jee SR, Seol SY, Yoon YB (2007) EMR for early gastric cancer in Korea: a multicenter retrospective study Gastrointest Endosc 66:693–700
Lee JH, Kim JJ (2007) Endoscopic mucosal resection of early gastric cancer: experiences in Korea. World J Gastroenterol 13:3657–3661
Muto M, Miyamoto S, Hosokawa A, Doi T, Ohtsu A, Yoshida S, Endo Y, Hosokawa K, Saito D, Shim CS, Gossner L (2005) Endoscopic mucosal resection in the stomach using the insulated-tip needle-knife. Endoscopy 37:178–182
Tada M, Murakami A, Karita M, Yanai H, Okita K (1993) Endoscopic resection of early gastric cancer. Endoscopy 25:445–450
Takekoshi T, Baba Y, Ota H, Kato Y, Yanagisawa A, Takagi K, Noguchi Y (1994) Endoscopic resection of early gastric carcinoma: results of a retrospective analysis of 308 cases. Endoscopy 26:352–358
Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597
Fujishiro M, Yahagi N, Kakushima N, Kodashima S, Muraki Y, Ono S, Yamamichi N, Tateishi A, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683 quiz 45
Hurlstone DP, Atkinson R, Sanders DS, Thomson M, Cross SS, Brown S (2007) Achieving R0 resection in the colorectum using endoscopic submucosal dissection. Br J Surg 94:1536–1542
Saito Y, Uraoka T, Matsuda T, Emura F, Ikehara H, Mashimo Y, Kikuchi T, Fu KI, Sano Y, Saito D (2007) Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc 66:966–973
Tamegai Y, Saito Y, Masaki N, Hinohara C, Oshima T, Kogure E, Liu Y, Uemura N, Saito K (2007) Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy 39:418–422
Tanaka S, Oka S, Kaneko I, Hirata M, Mouri R, Kanao H, Yoshida S, Chayama K (2007) Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc 66:100–107
Yoshida N, Wakabayashi N, Kanemasa K, Sumisa Y, Hasegawa D, Inoue K, Morimoto Y, Kashiwa A, Konishi H, Yagi N, Naito Y, Yanagisawa A, Yoshikawa T (2009) Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy 41:758–761
Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352
Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Successful outcomes of a novel endoscopic treatment for GI tumors: endoscopic submucosal dissection with a mixture of high-molecular-weight hyaluronic acid, glycerin, and sugar. Gastrointest Endosc 63:243–249
Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy 38:493–497
Toyonaga T (2006) ESD atlas. Kanehara & Co., Ltd., Japan
Kobayashi N, Saito Y, Uraoka T, Matsuda T, Suzuki H, Fujii T (2009) Treatment strategy for laterally spreading tumors in Japan: before and after the introduction of endoscopic submucosal dissection. J Gastroenterol Hepatol 24:1387–1392
Toyonaga T, Man IM, Morita Y, Sanuki T, Yoshida M, Kutsumi H, Inokuchi H, Azuma T (2009) The new resources of treatment for early stage colorectal tumors: EMR with small incision and simplified endoscopic submucosal dissection. Dig Endosc 21(Suppl 1):S31–S37
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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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Lee, EJ., Lee, J.B., Lee, S.H. et al. Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection–precutting, and endoscopic submucosal dissection. Surg Endosc 26, 2220–2230 (2012). https://doi.org/10.1007/s00464-012-2164-0
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DOI: https://doi.org/10.1007/s00464-012-2164-0