Endoscopic Submucosal Dissection as Total Excisional Biopsy for Clinical T1 Colorectal Carcinoma

Abstract

Background/Aims: Only the depth of submucosal invasion can be estimated prior to determining the indications for endoscopic submucosal dissection (ESD) as a curative treatment for colorectal carcinoma (CRC). Here we evaluated the outcomes of ESD for clinical T1 CRCs. Methods: Of 660 patients who underwent ESD for CRC at the Hiroshima University Hospital between June 2003 and December 2013, we examined the outcomes of 37 (6%; 26 men, 11 women; mean age ± SD, 68 ± 12 years) who underwent ESD as total excisional biopsy for various reasons, in spite of an endoscopic diagnosis of T1 CRC. Results: The mean lesion size was 25 ± 14 mm; 14 lesions were protruding and 23 were superficial. The en bloc resection rate was 100% (37/37). The histological en bloc resection rate was 92% (34/37). ESD resulted in a positive vertical margin in 3 cases. Deep submucosal invasion was seen in 3 cases, 2 of which had severe submucosal fibrosis. Although severe submucosal fibrosis was not found in other cases, pathologic examination of the deepest invasive portion of the tumor revealed poorly differentiated adenocarcinoma. The rates of post-ESD bleeding and perforation were 8% (3/37) and 5% (2/37), respectively. All patients recovered under conservative therapy. No cases of recurrence were noted in patients without additional surgical resection when the lesions satisfied the curative conditions listed in the 2014 Japanese Society for Cancer of the Colon and Rectum guidelines. Conclusion: En bloc resection by ESD as total excisional biopsy for clinical T1 CRC is a highly effective treatment and establishes a precise histological diagnosis.

Perforation and Postoperative Bleeding Associated with Endoscopic Submucosal Dissection in Colorectal Tumors: An Analysis of 398 Lesions Treated in Saga, Japan

“…The risk factor for perforation was a prolonged procedure time, and the risk factors for postoperative bleeding were a prolonged procedure time, tumor location in the rectum, and definitive colon cancer with a pathological diagnosis. Previous studies indicated several risk factors for serious complications with the colorectal ESD including the tumor location, fibrosis of the lesion, difficult endoscopic operability, and rich vascularity (27,40,47,51,54-62) The present retrospective study did not indicate these factors to be risk factors for serious complications, so further studies may be required to assess the reasons for the discrepancies in these findings. A prolonged procedure time being recognized as a risk factor in the present study was probably due to the difficulties associated with ESD, including those based on the tumor location, fibrosis, and difficult endoscopic operability, as previously reported.…”

Endoscopic Submucosal Dissection in Patients with Ulcerative Colitis

“…ESD for circumscribed dysplasia in ulcerative colitis can spare patients from unnecessary surgery. ESD can also be performed for curative purposes, as well as for diagnosis [20,21]. ESD is still a technically demanding technique compared with EMR and requires intensive training [22].…”

Endoscopic Submucosal Dissection and Endoscopic Mucosal Resection for Non-Ampullary Superficial Duodenal Tumor

“…It is therefore important to consistently achieve R0 resection and provide therapy to prevent recurrence. This concept is similar to the therapeutic strategy of colorectal ESD [24]. In addition, even though EMR is technically easier to perform than ESD, ESD should be indicated when tumors are depressed lesions, which could not achieve good mucosal elevation by submucosal injection even if they are small, and when treatment conditions are poor due to, for example, poor endoscopic maneuverability.…”