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- Title
Endoscopic submucosal dissection for colorectal neoplasms in proximity or extending to a diverticulum.
- Authors
Muramoto, Takashi; Ohata, Ken; Sakai, Eiji; Takayanagi, Syunya; Kimoto, Yoshiaki; Suzuki, Yuichiro; Ishii, Rindo; Kanda, Keisuke; Negishi, Ryoju; Takita, Maiko; Minato, Yohei; Tsuji, Yosuke; Chiba, Hideyuki; Matsuhashi, Nobuyuki
- Abstract
Background and aims: At specialized facilities, endoscopic submucosal dissection (ESD) has currently been performed even for difficult cases such as tumors extending to a diverticulum that previously required surgery. This study aims to classify the type of lesion according to the degree of infiltration to a diverticulum and assessed the safety and efficacy of ESD for each type of lesion. Methods: We retrospectively reviewed ESD for lesions at NTT Medical Center Tokyo between January 2014 and April 2019. Lesions were classified as follows: Type 1: lesions in contact with or within 3 mm of the edge of a diverticulum; Type 2: lesions that partially infiltrated into a diverticulum; and Type 3: lesions that infiltrated into and completely covered the diverticulum. Furthermore, ESD strategies were divided into A and B, which indicates that a lesion was resected separately from the diverticulum and along the entire diverticulum, respectively. The clinicopathological characteristics and clinical outcomes were analyzed according to the strategy. Results: A total of 47 lesions satisfied inclusion criteria (19 Type 1, 12 Type 2, and 16 Type 3 lesions). 19 Type 1 and 8 Type 2 lesions were resected using Strategy A, while 4 Type 2 and 16 Type 3 lesions were resected using Strategy B. En bloc resection was achieved in all cases. In Strategy A, the R0 resection rate was 96.3% and the curative resection rate was 88.9%. On the contrary, in Strategy B, the R0 resection rate was 95.0% and the curative resection rate was 90.0%. In Strategy B, one of the patients developed post-operative bleeding that required endoscopic hemostasis; another patient developed delayed perforation that required emergency surgery. Conclusions: ESD for colorectal neoplasms in proximity or extending to a diverticulum is challenging, but this procedure can be a safe and effective therapeutic option.
- Subjects
ENDOSCOPIC hemostasis; TUMORS; TREATMENT effectiveness; SURGICAL emergencies; DISSECTION; DIVERTICULUM
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2021, Vol 35, Issue 7, p3479
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-020-07795-y