Endoscopic Submucosal Dissection (ESD) in Colorectal Tumors

BACKGROUND Endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment for early gastric cancer, however, it is not widely used in the colorectum because of its technical difficulty. OBJECTIVE To determine the feasibility of using ESD for treating large superficial colorectal tumors. PATIENTS A total of 400 consecutive patients were treated by ESD for 405 lesions at National Cancer Center Hospital, Tokyo, Japan. INTERVENTIONS Endoscopic submucosal dissection procedures were performed using a bipolar needle knife (B-knife) or an insulation-tip knife (IT knife). RESULTS The en-bloc resection rate was 87% and the curative resection rate was 86% among the 405 ESDs: 101 involved tubular adenomas, 255 intramucosal cancers and minute submucosal cancers, 46 submucosal deep cancers and 3 others (MALT and carcinoid tumors). The median operation time was 90 minutes and the mean size of resected specimens was 40 mm (range: 15 mm-150 mm). Perforations occurred in 14 (3.5%) cases and postoperative bleeding in four (1%) cases, but only one perforation case needed emergency surgery because endoscopic clipping was ineffective. LIMITATIONS Conducted at single center. CONCLUSIONS Endoscopic submucosal dissection is a feasible technique for treating large superficial colorectal tumors because it provides a higher en-bloc resection rate and is less invasive than surgical resection.