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- Title
Endoscopic submucosal dissection of colorectal neoplasms: an audit of its safety and efficacy in a single tertiary centre in Singapore.
- Authors
Weiquan Li, James; Tiing Leong Ang; Lai Mun Wang; Eu Kwek, Andrew Boon; Kiang Tan, Malcolm Teck; Kwong Ming Fock; Eng Kiong Teo; Li, James Weiquan; Ang, Tiing Leong; Wang, Lai Mun; Kwek, Andrew Boon Eu; Tan, Malcolm Teck Kiang; Fock, Kwong Ming; Teo, Eng Kiong
- Abstract
<bold>Introduction: </bold>Endoscopic submucosal dissection (ESD) provides a higher en bloc and R0 resection rate than endoscopic mucosal resection. Colorectal ESD is not widely used because of its technical difficulty and risk of complications, especially for right-sided colonic lesions. We audited the clinical outcomes of our initial experience with colorectal ESD.<bold>Methods: </bold>We reviewed data collected from a prospective registry of patients who underwent colorectal ESD from December 2014 to March 2018. Therapeutic outcomes and procedure-related complications were analysed.<bold>Results: </bold>A total of 41 patients (mean age 67.4 years, 21 male) underwent colorectal ESD. The distribution of the lesions was as follows: rectum (n = 9), sigmoid colon (n = 8), descending colon (n = 6), splenic flexure (n = 1), transverse colon (n = 5), ascending colon (n = 8) and caecum (n = 4). The mean size was 23 (range 12-50) mm. En bloc resection was achieved in 35 (85.4%) out of 41 patients, and R0 resection or clear resection margins was achieved in 33 (94.3%) of the en bloc resection patients. The lesion was upstaged in 14 (34.1%) patients after ESD. Colonic perforation occurred in 3 (7.3%) patients during ESD and was successfully treated with endoscopic clips. There was no procedure-related bleeding. No patient required surgery for management of complications. The median duration of hospitalisation was 1 (range 0-7) day. Four patients with lesions that were upstaged after ESD, from high-grade dysplasia to intramucosal carcinoma with deep submucosal invasion, were referred for colectomy.<bold>Conclusion: </bold>Our early outcome data was comparable to that from large published series. ESD is an effective and feasible treatment for colorectal lesions.
- Subjects
SINGAPORE; ENDOSCOPIC surgery; SIGMOID colon; SURGICAL complications; TUMORS; AHEAD of Time (Book)
- Publication
Singapore Medical Journal, 2019, Vol 60, Issue 10, p526
- ISSN
0037-5675
- Publication type
journal article
- DOI
10.11622/smedj.2019022