Endoscopic submucosal dissection for local residual and recurrent lesions in digestive tract after endoscopic mucosal resection / 中华消化内镜杂志

ABSTRACT

Objective To determine the efficacy and safety of endoscopic submucosal dissection(ESD) for local residual and recurrent lesions in digestive tract after endoscopic mucosal resection (EMR).Methods From June 2006 to November 2007, 15 patients with local residual and recurrent lesions of digestive tract after EMR underwent ESD. The procedures of ESD were as follows normal saline was injected into the sub-to elevate the lesions from the muscle layer, and the mucosa around the lesions were pre-cut, then the connective tissue of the submucosa beneath the lesions was dissected, and the scar beneath the lesion was re-sected along the plane of the submucosa with a Hook-knife. Results The mean diameter of 15 residual and re-current lesions after EMR were 2. 3 era(0.8 ～ 3. 5 cm), of which 6 lesions were located in stomach, 3 in colon and 6 in rectunm. All cases showed negative lifting sign due to scar formation. Fourteen lesions were completely re-sected and the overall resection rate was 93.3%(14/15). It was pathologically confirmed that 13 cases showed no tumor involvement in lateral and basal resection margins, and the complete resection rate was 86.7% (13/15).The mean operation time was 87 min(ranging from 60 to 155 min). Minor bleeding occurred during ESD in all ca-ses, but there was no postoperative bleeding. Two cases had free air in abdominal cavity due to deep dissection,but recovered with conservative treatment after ESD without surgical involvement. The perforation rate was 13.3%(2/15). The mean follow-up period was 13 months and no recurrence was recorded. Conclusion ESD proves to be a novel, safe and effective procedure for local residual and recurrent lesions after previous EMR, which makes it possible to resect the lesions completely and provide precise pathological information.