| Theme |
Forefront of endoscopic treatment in early colorectal cancer |
| Title |
Strategy for residual/recurrent colorectal tumors |
| Author |
Hiro-o Matsushita |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Hiro-o Yamano |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Yasushi Imai |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Masaru Nakazato |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Satoshi Maeda |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Kentaro Sato |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Kazuhiko Fujita |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Yasuo Yamanaka |
Devision of Gastroenterology, Akita Red Cross Hospital |
| Author |
Hideo Ono |
Devision of Gastroenterology, Akita Red Cross Hospital |
| [ Summary ] |
It is generally known the decision to perform complete resection during endoscopic therapy is made on the basis of pathological diagnoses of the fact that resected specimens contain normal glands. In such cases the margins of the resected specimen may be said to be "negative". But occasionally, we encounter cases of pathologically in complete resection which have been followed up clinically for over long periods and have not resulted in recurrence. We suggest that there is a difference between pathological diagnoses and clinical diagnoses in cases of complete resection, and that in vivo estimations of the margin after endoscopic resection are important. We have studied the surface structure of colorectal neoplasms (pit pattern) and by using magnifying endoscopy we are able to assert that pit pattern provides useful diagnostic clues, indicating the probability of recurrence or non-recurrence. This study was carried out to evaluate the therapeutic efficacy of using magnifying endoscopy for endoscopic resection. From July 1998 to January 2003, 2,151 endoscopic mucosal resections (EMR) and endoscopic piecemeal mucosal resections (EPMR) were performed. In this study, we analyzed 1,013 cases (EMR 935, EPMR 78), which could be sufficiently evaluated in relation to recurrence and residues, for a period of over six months. The results related to the rate of recurrence were 2.1% for EMR, and 15.4% for EPMR. With EMR, the accuracy using magnifying endoscopy in vivo was 98.4%, and 96.9% for ordinary endoscopy. On the other hand, with EPMR, the accuracy rate using magnifying endoscopy in vivo is 93.3%, and for ordinary endoscopy was 69.2%.
In conclusion, it is important that we perform not only EPMR but also EMR, and use magnifying endoscopy to observe the margins of the resection. |