Document Detail

High efficacy of endoscopic submucosal dissection for rectal laterally spreading tumors larger than 3 cm.
MedLine Citation:
PMID:  23261098     Owner:  NLM     Status:  In-Data-Review    
BACKGROUND: Endoscopic submucosal dissection (ESD) was recently developed to allow en bloc resection of early neoplasia of the GI tract, including colorectal neoplasia. The endoscopic technique is technically demanding and not yet standardized, and new devices are needed.
OBJECTIVE: This study aimed to evaluate the efficacy and safety of a new device that combines the functions of injection and cutting.
DESIGN: Prospective, pilot, single-arm study.
METHODS: Consecutive patients with rectal laterally spreading tumors (LSTs) 3 cm or larger unsuitable for en bloc resection were enrolled. ESD was performed with a new device that allows cutting and coagulation as well as a needleless, tissue-selective mucosal and submucosal elevation through an axial water-jet channel.
MAIN OUTCOME MEASUREMENT: The primary endpoint of the study was the en bloc resection rate achieved with ESD in a Western hospital setting.
RESULTS: Overall, ESD was attempted in 40 consecutive patients (27 male, mean age 65.3 years) with rectal LSTs larger than 3 cm (72.5% LSTs, nongranular type, 5% depressed type, 22.5% protruding type). The mean lesion size was 46.8 ± 10.9 mm (range 33-80 mm). The mean procedure time was 86.1 ± 35.5 minutes (range 40-190 minutes). The en bloc resection rate was 90% (36/40). In the remaining patients, resection was completed with a piecemeal approach. The rate of curative resection (R0) was 32 of 40 LSTs (80%). Two patients with submucosal invasion were referred for surgery. Perforation occurred in 1 patient (2.5%), which was managed conservatively. Postoperative bleeding occurred in 2 patients (5%) and was treated by endoscopic hemostasis.
LIMITATIONS: Single-center study with a relatively small number of patients.
CONCLUSIONS: ESD is a safe and effective method to provide en bloc and curative resection of large rectal LSTs. The operating time and adverse event rate were comparable to those of previously published data from Japanese experts.
Alessandro Repici; Cesare Hassan; Nico Pagano; Giacomo Rando; Fabio Romeo; Paola Spaggiari; Massimo Roncalli; Elisa Ferrara; Alberto Malesci
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  77     ISSN:  1097-6779     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  96-101     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.
Department of Gastroenterology, IRCCS Istituto Clinico Humanitas, Milan, Italy.
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