| Theme | Selection of the therapeutic methods (EMR or ESD) for colorectal tumor | |
|---|---|---|
| Title | Overcoming ESD colorectal tumor complications | |
| Publish Date | 2010/03 | |
| Author | Yoshiro Tamegai | Department of Gastroenterology, Kohnodai Hospital, International Medical Center of Japan |
| Author | Keiko Kudo | Department of Gastroenterology, Kohnodai Hospital, International Medical Center of Japan |
| Author | Takashi Koike | Department of Gastroenterology, Kohnodai Hospital, International Medical Center of Japan |
| Author | Yukio Saito | Department of Surgery, Toyama Hospital, International Medical Center of Japan |
| Author | Hideaki Yano | Department of Surgery, Toyama Hospital, International Medical Center of Japan |
| Author | Emiko Takeshita | Department of Surgery, Toyama Hospital, International Medical Center of Japan |
| Author | Haruo Nishino | 3Matsushima Clinic |
| Author | Hiroshi Nozawa | 3Matsushima Clinic |
| Author | Hideyuki Henmi | 3Matsushima Clinic |
| [ Summary ] | INTRODUCTION : We have successfully performed ESD for colorectal tumors without severe complications (perforation or postoperative bleeding). The likelihood of complications related to ESD depends on the presence of fibrosis in the submucosal (SM) layer. We report on a safe ESD technique and a countermeasure to avoid complications. AIMS AND METHODS : ESD was performed in 236 cases with 230 having colorectal neoplasms （male : female=141 : 89 ; mean age, 67.0 years) of these cases, 39 also had sm fibrosis. This study analyzed these lesions in order to establish a safe therapeutic strategy. RESULTS : In ESD cases, the average lesion size was 31.8 mm (range : 5-145 mm). We had only one case with a micro-perforation (0.4%), which was treated with clipping. Out of the 39 cases with SM fibrosis, 15 cases were considered to be related to cancer invasion, and 24 cases were considered to be unrelated to cancerous invasion. We classified the endoscopic findings as being 'string-like' or 'rope-like' with a mild degree of severity. 'Band-like' lesions were classified as moderate. Those considered to be 'screen-like' were thought to constitute severe degree fibrosis. White or brown areas, as well as abnormal vessels were identified in cases with SM cancer invasion. In cases accompanied by mild to moderate fibrosis, lesions should be dissected carefully just above the muscle layer. In cases considered severe, ESD is more difficult to treat because of the risk of perforation. CONCLUSION : The level of difficulty for performing ESD for colorectal tumor treatment depends on the degree of the fibrosis in the SM layer. In these cases, we must establish a therapeutic strategy in order to avoid complications related to ESD. |
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