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01.09.2013

Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan

verfasst von: Takeshi Nakajima, Yutaka Saito, Shinji Tanaka, Hiroyasu Iishi, Shin-ei Kudo, Hiroaki Ikematsu, Masahiro Igarashi, Yuusuke Saitoh, Yuji Inoue, Kiyonori Kobayashi, Takashi Hisasbe, Takahisa Matsuda, Hideki Ishikawa, Ken-ichi Sugihara

Erschienen in: Surgical Endoscopy | Ausgabe 9/2013

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Abstract

Background

Conventional endoscopic resection (CER) for early colorectal neoplasia (CRN) is widely accepted as a minimally invasive treatment. Endoscopic submucosal dissection (ESD) was developed in Japan to resect larger lesions, but ESD was not covered by the Japanese national health insurance until April 2012. In addition, treatment strategies vary considerably among medical facilities. To evaluate the current situation in Japan regarding endoscopic treatment of CRNs measuring ≥20 mm, we conducted a prospective multicenter study at 18 medium-volume and high-volume specialized facilities in cooperation with the Japan Society for Cancer of the Colon and Rectum (JSCCR).

Methods

The JSCCR conducted a multicenter, observational study of all patients treated by CER and ESD of CRNs measuring ≥20 mm.

Results

From October 2007 to December 2010, CERs and ESDs were performed on 1,845 CRNs (CERs 1,029; ESDs 816). Lesions diagnosed as protruded, flat, and depressed totaled 541, 1224, and 48, respectively. En bloc resection rates and mean procedure times for CER/ESD were 56.9 %/94.5 % (P < 0.01) and 18 ± 23 min/96 ± 69 min, respectively. The average ESD procedure time was 129 ± 83 min in the ≥40-mm group. As lesion size increased, the CER en bloc resection rate decreased significantly (trend P < 0.01), but the ESD en bloc resection rate remained over 93 %. Perforation and delayed bleeding rates of CER/ESD were 0.8 %/1.6 % (P < 0.05) and 2 %/2.2 % (P = 0.3), respectively.

Conclusions

The en bloc resection rate for ESD was significantly higher than for CER, although complication rates were fairly low. Despite a longer procedure time, safety of colorectal ESD has improved in various facilities in Japan. However, ESD for lesions measuring ≥40 mm must be performed by experienced endoscopists due to the longer procedure time.

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Titel: Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan
verfasst von: Takeshi Nakajima
Yutaka Saito
Shinji Tanaka
Hiroyasu Iishi
Shin-ei Kudo
Hiroaki Ikematsu
Masahiro Igarashi
Yuusuke Saitoh
Yuji Inoue
Kiyonori Kobayashi
Takashi Hisasbe
Takahisa Matsuda
Hideki Ishikawa
Ken-ichi Sugihara
Publikationsdatum: 01.09.2013
Verlag: Springer US
Erschienen in: Surgical Endoscopy / Ausgabe 9/2013
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-013-2903-x

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