Therapeutic effect analysis of colorectal polyps with diameter≥2.5cm treated by endoscopic submucosal dissection: A report of 567 cases / 中国实用外科杂志

ABSTRACT

OBJECTIVE: To evaluate the effectiveness of endoscopic submucosal dissection(ESD) in treating colorectal polyps with diameter≥2.5 cm. METHODS: The clinical data of 567 cases of colorectal polyps with diameter≥2.5 cmtreated by ESD at Endoscopy Center,Zhongshan Hospital,Fudan University between January 2007 and November 2016 were analyzed retrospectively. The data included clinical and pathological characteristics, complications and follow-up.RESULTS: Of all lesions, the median diameter was 3.0 cm(2.5 to 15.0). Among them, 448 lesions(79.0%)were high grade intraepithelial neoplasia, and the other 119 lesions(21.0%)were intra-adenoma adenocarcinoma, focal cancerization or adenocarcinoma. The complete resection rate during operation was 99.1%(562/567). The en bloc resection rate was 78.3%(444/567), and the curative resection rate was 90.8%(515/567). Additional surgeries or endoscopic treatment were performed in 31 cases after ESD treatment. Postoperative bleeding occurred in 3.7%(21/567) of all cases. Penetration and electrocoagulation syndrome after ESD occurred in 1.2%(7/567) and 5.3%(30/567) of casesrespectively. The median length of follow-up was 40(12-90) months, with a local recurrence rate of 1.1%(6/536). Intraoperative complications were related to lesions ≥5.0 cm(P<0.001) and non-en bloc resection(P=0.034).Electrocoagulation syndrome was related to lesions ≥5.0 cm(P=0.004). Postponed bleeding after ESD was related to hypertension (P=0.008). Local recurrence was related to lesions ≥5.0 cm (P=0.037). CONCLUSION: Treating colorectal polyps ≥2.5 cm with ESD is safeand feasible, resulting in high rate of curative resection and an extremely low local-recurrencerate. However, polyps≥5.0 cm showld be cautionly evaluated before ESD.