Endoscopic therapy of adenomatous polyps and early-stage carcinomas of the colon and rectum / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To assess the clinical efficacy of endoscopic treatment for colorectal adenomatous polyps and early-stage carcinomas.</p><p><b>METHODS</b>Between January 2006 and October 2007, 245 patients with colorectal adenomatous polyps and early-stage carcinomas with lifting sign(+) were treated by such endoscopic techniques as polypectomy, endoscopic mucosal resection (EMR), endoscopic piecemeal mucosal resection (EPMR) and endoscopic submucosal dissection (ESD).</p><p><b>RESULTS</b>Two hundred and fifty-three lesions ranged from 0.5 to 8.5 cm and the mean resected size was 2.3 cm, of which 157 were smaller than 2 cm and 96 larger than 2 cm. Confirmed pathologically, 249 lesions were successfully resected and the resection rate was 98.4% (249/253). None of patients had massive hemorrhage during the procedure and 2 had delayed bleeding. 1 had a little free air in abdominal cavity, 2 patients had subcutaneous emphysema due to deep tearing of the muscle layer, all 3 recovered after several days' conservative treatment. Visible perforation occurred in 4 cases during the dissection, of which 3 were typically closed with metallic endo-clip without surgical treatment, and 1 was managed surgically with obvious distention and much abdominal free air. The rate of resectional complication was judged to be 3.6% (9/253). Eight cases were transferred to surgery altogether after endoscopic procedure. Two hundred and thirty-one cases were followed up with confirmed healing of the large artificial ulcer after ESD except for local recurrence in 3 cases after EPMR.</p><p><b>CONCLUSIONS</b>Endoscopic resection appears to be an efficacious procedure to treat adenomatous polyp and early-stage carcinoma and provide pathological information about the whole lesion. Measures should be taken to reduce the complication rate of endoscopic resection in the future.</p>