Colorectal lateral spreading tumor subtypes: clinicopathology and outcome of endoscopic submucosal dissection

Introduction. Endoscopic submucosal dissection (ESD) is a standard method of local excision of benign colon tumors. Nevertheless, it is not widely used because of its technical difficulty and risk of complication especially in right colon. The OBJECTIVE was to improve the results of treatment of patients with right colon neoplasms.Methods and materials. The results of 152 consecutive patients (median age 66 years, 88 female) with lateral spreading tumors (LST) were analyzed. Logistic regression was performed to evaluate risk factors of conversion and complications.Results. ESD as planned performed in 133 out of 152 patients. Conversion to bowel resection occurred in 19 cases. In the logistic regression model, lifting less than 3 mm (p=0.034) was independent risk factor of the conversion. Postoperative complications up to 30 days occurred in 5 out of 133 (3.8 %) of patients underwent ESD. There was no mortality after ESD. Severe fibrosis the base of the neoplasm was the only risk factor of postoperative complications (95 % CI=1.0—1.2; p=0.007). Final pathology revealed that 127 out of 133 patients (95.5 %) had adenomas and 6 out of 133 (4.5 %) patients had early adenocarcinomas. R0 resections was performed in 94/133 (70.7 %) cases.Conclusions. ESD is the safe and efficient method of local excision of benign right colon neoplasms. Unfavorable lifting (p=0.05) and submucosal fibrosis (p=0.007) are risk factors of ESD failure.

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Effectiveness of Inner Traction Facilitated Endoscopic Submucosal Dissection using Rubber Band and Clips for Colorectal Neoplasms: A Propensity Score-matched Study

10.21203/rs.3.rs-747559/v1 ◽

2021 ◽

Author(s):

Guanyi Liu ◽

Xinyue Guo ◽

Yunlong Cai ◽

Long Rong ◽

Weidong Nian ◽

...

Keyword(s):

Propensity Score ◽

Endoscopic Submucosal Dissection ◽

Propensity Score Matching ◽

Colorectal Neoplasms ◽

Rubber Band ◽

Lateral Spreading ◽

En Bloc ◽

Submucosal Dissection ◽

Colorectal Endoscopic Submucosal Dissection ◽

Matched Study

Abstract Background Colorectal endoscopic submucosal dissection (ESD) is a technically demanding but effective treatment for superficial neoplasms. We conducted a study to compare the effectiveness and safety of inner traction facilitated ESD using rubber band and clip (RAC-ESD) with conventional ESD.Methods We retrospectively evaluated 622 consecutive patients underwent colorectal ESD between January 2016 and December 2019. To overcome selection bias, we used propensity score matching (1:4) between RAC-ESD and conventional ESD. The frequency of en bloc resections, R0 resections, curative resections, procedure speed and complications were evaluated.Results After propensity score matching, 35 patients were included in RAC-ESD group and 140 were included in conventional ESD group. RAC-ESD resulted in a significant increase in resection speed (0.14 vs. 0.09 cm2/min; P=0.003). There were no significant differences in en bloc, R0 and curative resection rates between two groups. In subgroup analysis, the resection speed of RAC-ESD was significantly higher than conventional ESD when the lesions were equal to or larger than 2cm, macroscopically presenting as lateral spreading tumor, and located in transverse colon to ascending colon.Conclusions RAC-ESD is safe and effective in treating colorectal neoplasms, especially in lesions presenting particular difficulty.

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