First experience of one and two-step endoscopic submucosal dissection of colorectal neoplasms

I M Sayfutdinov; Сайфутдинов Ильяс Маратович; L E Slavin; Славин Лев Ефимович; R N Khayrullin; Хайруллин Рустем Наилевич; M S Mukharyamov; Мухарямов Мурат Наилевич; R T Zimagulov; Зимагулов Рустем Талгатович; A I Ivanov; Иванов Алексей Игоревич; M V Panasyuk; Панасюк Михаил Валентинович; D I Sayfutdinova; Сайфутдинова Дина Ильясовна; I A Ivanov; Иванов Игорь Алексеевич

doi:10.17816/KMJ2020-446

First experience of one and two-step endoscopic submucosal dissection of colorectal neoplasms

Authors: Sayfutdinov IM¹, Slavin LE¹^,2, Khayrullin RN¹, Mukharyamov MS¹^,3, Zimagulov RT¹, Ivanov AI²^,4, Panasyuk MV¹, Sayfutdinova DI³, Ivanov IA⁵
Affiliations:
1. Interregional Clinical-Diagnostic Center
2. Kazan State Medical Academy
3. Kazan State Medical University
4. Tatarstan Cancer Center
5. Kazan (Volga region) Federal University
Issue: Vol 101, No 3 (2020)
Pages: 446-451
Section: Clinical experiences
URL: https://bakhtiniada.ru/kazanmedj/article/view/19443
DOI: https://doi.org/10.17816/KMJ2020-446
ID: 19443

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Abstract

Aim. To analyze the results of one and two-step endoscopic submucosal dissection in the treatment of colorectal neoplasms.

Methods. Between 2018 and 2019, 17 patients (6 men and 11 women) aged 33 to 79 years underwent 21 endoscopic submucosal dissections of colorectal neoplasms ranging in size from 1.0 to 6.0 cm. Submucosal fibrosis was identified in 2 (11.8%) patients, epithelial neoplasms in 15 (88.2%) patients including laterally spreading tumors in 9 (60%), and large sessile colorectal polyps in 6 (40%) patients. Histological examination revealed a carcinoid tumor (11.8%), adenoma with low-grade (64.7%) and high-grade (23.5%) intraepithelial neoplasia. 13 patients were subjected to the one-step operation, and 4 patients required the two-step operation with a 1-day interval. Follow-up examinations after the operation were performed, on average, between 2 and 6 months.

Results. En bloc endoscopic submucosal dissection was performed in 11 (64.7%) patients, 4 of them in combination with mucosal resection. Endoscopic piecemeal resection of the neoplasia was performed in 6 (35.3%) patients. The average operative time was 155±73 minutes (range 40–320 min). Intraoperative complications, which were eliminated endoscopically, occurred during 8 (38.1%) of 21 operations: intensive bleeding in 6 (75%) patients, diastasis of muscle fibers in 1 (12.5%) patient, perforation of the intestinal wall in 1 (12.5%) patient. At the follow-up at 6 months, all patients formed the scar at the surgical area, while 3 patients required endoscopic removal of residual adenoma 2 months after the operation.

Conclusion. Endoscopic submucosal dissection is an effective method for removing colorectal neoplasms, while two-step dissection is a promising approach to the development of the technique.Keywords: one and two-step dissection, endoscopic submucosal dissection (ESD), colorectal neoplasms.

Keywords

one and two-step dissection, endoscopic submucosal dissection (ESD), colorectal neoplasms

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References

Piessevaux H. How to predict and achieve success with a very long procedure in an endoscopy unit: Is it time for a break? Endosc. Int. Open. 2019; 7 (9): E1097–E1098. doi: 10.1055/a-0889-7945.
Watanabe T., Itabashi M., Shimada Y. et al. Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines 2014 for treatment of colorectal cancer. Int. J. Clin. Oncol. 2015; 20 (2): 207–239. doi: 10.1007/s10147-15-0801-z.
Kiriyama S., Saito Y., Yamamoto S. et al. Comparison of endoscopic submucosal dissection with laparoscopic-assisted colorectal surgery for early-stage colorectal cancer: a retrospective analysis. Endoscopy. 2012; 44 (11): 1024–1030. doi: 10.1055/s-0032-1310259.
Еmmanuel A., Gulati S., Burt M. et al. Сolorectal endoscopic submucosal dissection: patient selection and special considerations. Clin. Exp. Gastroenterol. 2017; 10: 121–131. doi: 10.2147/CEG.S120395.
Hotta K., Fujii T., Saito Y., Matsuda T. Local recurrence after endoscopic resection of colorectal tumors. Int. J. Colorectal. Dis. 2009; 24 (2): 225–230. doi: 10.1007/s00384-008-0596-8.
Hotta K., Oyama T., Shinohara Y. et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig. Endosc. 2010; 22 (4): 302–306. doi: 10.1111/j.1443-1661.2010.01005.x.
Sakamoto T., Saito Y., Fukunaga S. et al. Learning curve associated with colorectal endoscopic submucosal dissection for endoscopists experienced in gastric endoscopic submucosal dissection. Dis. Colon Rectum. 2011; 54 (10): 1307–1312. doi: 10.1097/DCR.0b013e3182282ab0.
Hisabe T., Nagahama T., Hirai F. et al. Clinical outcomes of 200 colorectal endoscopic submucosal dissections. Dig. Endosc. 2012; 24 (1): 105–109. doi: 10.1111/j.1443-1661.2012.01267.x.
Nishiyama H., Isomoto H., Yamaguchi N. et al. Endoscopic submucosal dissection for laterally spreading tumors of the colorectum in 200 consecutive cases. Surg. Endosc. 2010; 24 (11): 2881–2887. doi: 10.1007/s00464-010-1071-5.
Yoshida N., Wakabayashi N., Kanemasa K. et al. Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy. 2009; 41 (9): 758–761. doi: 10.1055/s-0029-1215028.
Tanaka S., Toyonaga T., Morita Y. et al. Feasibility and safety of endoscopic submucosal dissection for large colorectal tumors. Surg. Laparosc. Endosc. Percutan. Tech. 2015; 25 (3): 223–228. doi: 10.1097/SLE.0000000000000135.
Jung D.H., Youn Y.H., Kim J.H., Park H. Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: is it feasible? Gastrointest. Endosc. 2015; 81 (3): 614–620. doi: 10.1016/j.gie.2014.09.001.
Kawaguti Fabio S., Okazaki Ossamu, Miyajima Nelson T. et al. Two-step ESD: an option for en-bloc resection of extensive colorectal laterally spreading tumors. Endosc. Int. Open. 2019; 7 (9): E1092–E1096. doi: 10.1055/a-0887-4294.