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Efficacy of Endoscopic Mucosal Resection With Circumferential Incision for Patients With Large Colorectal Tumors

https://doi.org/10.1016/j.cgh.2011.10.007Get rights and content

Background & Aims

Treatment of large colorectal neoplasms (>20 mm in diameter) by conventional endoscopic mucosal resection (EMR) often results in piecemeal resection that requires further intervention. We evaluated the efficacy of EMR with circumferential incision (CEMR).

Methods

From March 2008–July 2009, we resected 24 large colorectal neoplasms measuring 20–40 mm in diameter by using the CEMR technique. CEMR was performed by using a ball-tip bipolar needle knife with a snaring technique. After the injection of glycerol into the submucosal layer, a circumferential incision was made, and the neoplasm was resected by snaring. All lesions that showed a noninvasive pattern were diagnosed by magnifying chromoendoscopy as adenomas or intramucosal or submucosal superficial cancers. The number of en bloc resections and complications and the overall procedure time were determined.

Results

The proportions of en bloc and 2-piece resections by CEMR were 67% (16/24) and 17% (4/24), respectively. The median (interquartile range) time for CEMR completion was 40 minutes (30–63 minutes). No postsurgery complications occurred in any patient.

Conclusions

CEMR might provide acceptable clinical outcomes for patients with large colorectal neoplasms. It results in a low incidence of incomplete treatments and low risk of complications.

Section snippets

Methods

We retrospectively analyzed the data of all patients undergoing endoscopic treatment for neoplastic lesions >20 mm in size at the National Cancer Center Hospital from March 2008–July 2009. Written informed consent to participate was obtained from all patients who underwent colonoscopy examination or any form of treatment. CEMR was performed at our institution according to the following inclusion criteria, which partially overlap with those for ESD: lesions with a diameter of 20–40 mm

Results

The clinicopathologic features and outcomes are summarized in Tables 1 and 2, respectively. Of the 24 patients, 10 (42%) were men, and the median (IQR) age was 69 years (59–75 years). Three lesions were located in the cecum, 6 in the ascending colon, 3 in the transverse colon, 3 in the descending colon, 4 in the sigmoid colon, and 5 in the rectum. Morphologically, 11 were polypoid (0-Is, Is+IIa), and 12 were elevated (0-IIa, IIa+IIc) and depressed (0-IIc). Of all the patients, only 1 (4%) was

Discussion

Here we assessed the clinical outcome of CEMR in patients with relatively large neoplasms. The advantages of using this procedure over conventional EMR for large sessile lesions has already been reported by Moss et al.24 In that study, the rate of en bloc resection (70%) reflected the convenience of its use for imaginary lesions of porcine colon sized 40 × 40 mm. In our study, the en bloc resection rate was unexpectedly low (68%), yet the objective lesions were relatively smaller than those of

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    Conflicts of interest The authors disclose no conflicts.

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