Endoscopic Treatment of Colorectal Submucosal Tumor:Analysis of 33 Cases / 中国微创外科杂志

ABSTRACT

Objective To discuss the indication,technique,effect,and safety of colonoscopic resection of colorectal submucosal tumor(SMT).Methods A total of 33 patients with SMT,which was diagnosed colonoscopically and pathologically,were treated by endoscopy.The sizes of the tumors were 0.2-2.2 cm in diameter,and 0.2-1.2 cm in the diameter of the roots.After injecting adequate adrenalin saline deeply into the root of SMT,the mass of those,who had negative nonlifting sign,was attracted,snared,and then cut using high frequency electrotome.In 7 cases of smaller SMT,the tumor was gripped.Results No perforation,large amount of hemorrhage,or burns of the colorectal wall was found.Complete resection was achieved(no tumor tissue was detected on the edge or bottom of the SMTs after endoscopic resection,or pathological examination found no tumor tissue after open surgery) in 29 cases,including 18 carcinoids,6 leiomyomas,2 hamartomas,2 lipomas,and 1 neurofibroma.Except 3 patients with leiomyoma were lost,26 of the patients were followed up for a median of 44.5 months(3 months to 12 years and 7 months).No recurrence was found during the follow-up.The 4 carcinoids were resected partially(there were tumor tissues remained on the edge or bottom of the SMTs after endoscopic resection,or the pathological examination after open surgery showed tumors).Two of the 4 were transferred to open surgery(one was followed up for 2 years and 3 months,the other was lost).The other two patients refused operation and received a followed-up of 5 months and 2 years and 4 month respectively.None of the 4 patients had recurrence during follow-up.Conclusions Colonoscopic treatment can be applied to the patients with SMT sized ≤1.2 cm at the root and negative nonlifting sign.The method is safe,effective,and minimal invasion.Pathological examination is recommended after the colonoscopic resection,open surgery is necessary for the partially resected SMTs.