Abstract
Background To evaluate and compare the safety, efficacy and cost of endoscopic submucosal snaring with circumferential mucosal incision (ESS-CMI) with endoscopic submucosal dissection (ESD) in various types of colonic neoplasms. Methods Patients who were admitted in our endoscopic center for colonic neoplasm therapy were screened, with the Chinese item of “endoscopic submucosal dissection” and the English abbreviation of ESD, for the period between January 2011 and December 2017. Initially enrolled patients were further categorized into ESD and ESS-CMI groups after careful assessment of detailed operation procedures. Data on patients’ and colonic neoplasm’s characteristics, recurrence, treatment, follow-up and disease status were collected after medical records review. Further cost-effective analysis includes two main aspects: treatment effect and complication as well as the cost and efficiency. Results A total of 278 patients was selected. Though there were no significant differences in basic anthropometric and disease status data such as age, gender, neoplasm type, degree and the method of follow up, the location of rectum, the longest side and the surface area were significantly higher in ESD group than those in ESS-CMI group. For ESS-CMI, further cost-effective study showed the similar treatment effect and complication rate but significantly decreased cost, operation time and average hospital stay, when compared with ESD. Further subgroup analysis showed that there were no significant differences between the ESS-CMI successful and failure groups. Conclusion ESS-CMI might become a new and better choice for colonic neoplasm therapy, based on its decreased operation cost but similar treatment efficacy and complication rate as ESD.
A rare colonic neoplasm with submucosal bulge successfully treated by endoscopic submucosal dissection
