Endoscopic submucosal dissection (ESD) for large laterally spreading tumors in the rectum: Experience in 30cases [Endoskopische submukosadissektion (ESD) bei großflächigen polypen im rektum: Erfahrungen an 30fällen]
Kruse E.,University of Gottingen |
Sochiera K.,University of Gottingen |
Burrig K.-F.,Institute For Pathologie Hildesheim |
Menke D.,University of Gottingen |
And 5 more authors.
Endoskopie Heute | Year: 2010
Endoscopic submucosal dissection (ESD) provides an en bloc specimen of even large laterally spreading mucosal tumors. 30patients, with a single flat or elevated polyp over 2cm in the rectum were treated by ESD. Results: 27 of 30lesions could macroscopically be resected as en bloc specimen (90%). Relevant complications occurred in 2patients (6.6%; 1delayed perforation with subsequent vacuum sponge treatment, 1delayed bleeding after 11days). In 3patients mild com-plications oc-curred (10%). All could be treated conserva-tively. Procedure related mortality was 0%. How-ever, 1patient with severe co-morbidity encountered a stroke and died 4days after the procedure. After a median follow-up period of 199days (91418days) one possible recurrence close to the scar in the rectum was detected and successfully resected (R0). ESD offers not only in Japan but also in the Western World a reliable treatment option even for large laterally spread-ing rectal polyps. It seems also suitable for pa-tients at elevated surgical risk. Due to the re-trieval of an en bloc specimen and because of the low local recurrence rate ESD seems to be the onco-logically by far preferrable procedure over standard piecemeal resection especially be-cause of the high rate of early cancers in large rectalpolyps. © Georg Thieme Verlag KG Stuttgart.