Endoscopic submucosal dissection of colorectal neoplasms: an audit of its safety and efficacy in a single tertiary centre in Singapore.
- Author:
James Weiquan LI
1
;
Tiing Leong ANG
1
;
Lai Mun WANG
2
;
Andrew Boon Eu KWEK
1
;
Malcolm Teck Kiang TAN
1
;
Kwong Ming FOCK
1
;
Eng Kiong TEO
1
Author Information
- Publication Type:Journal Article
- Keywords: adverse effects; colorectal cancer; colorectal neoplasms; endoscopic submucosal dissection; treatment efficacy
- From:Singapore medical journal 2019;60(10):526-531
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Endoscopic submucosal dissection (ESD) provides a higher en bloc and R0 resection rate than endoscopic mucosal resection. Colorectal ESD is not widely used because of its technical difficulty and risk of complications, especially for right-sided colonic lesions. We audited the clinical outcomes of our initial experience with colorectal ESD.
METHODS:We reviewed data collected from a prospective registry of patients who underwent colorectal ESD from December 2014 to March 2018. Therapeutic outcomes and procedure-related complications were analysed.
RESULTS:A total of 41 patients (mean age 67.4 years, 21 male) underwent colorectal ESD. The distribution of the lesions was as follows: rectum (n = 9), sigmoid colon (n = 8), descending colon (n = 6), splenic flexure (n = 1), transverse colon (n = 5), ascending colon (n = 8) and caecum (n = 4). The mean size was 23 (range 12-50) mm. En bloc resection was achieved in 35 (85.4%) out of 41 patients, and R0 resection or clear resection margins was achieved in 33 (94.3%) of the en bloc resection patients. The lesion was upstaged in 14 (34.1%) patients after ESD. Colonic perforation occurred in 3 (7.3%) patients during ESD and was successfully treated with endoscopic clips. There was no procedure-related bleeding. No patient required surgery for management of complications. The median duration of hospitalisation was 1 (range 0-7) day. Four patients with lesions that were upstaged after ESD, from high-grade dysplasia to intramucosal carcinoma with deep submucosal invasion, were referred for colectomy.
CONCLUSION:Our early outcome data was comparable to that from large published series. ESD is an effective and feasible treatment for colorectal lesions.
