Nozomu Kobayashi1, Yoji Takeuchi2, Ken Ohata3, Masahiro Igarashi4, Masayoshi Yamada5, Shinya Kodashima6, Kinichi Hotta7, Keita Harada8, Hiroaki Ikematsu9, Toshio Uraoka10,11, Naoto Sakamoto12, Hisashi Doyama13, Takashi Abe14,15, Atsushi Katagiri16, Shinichiro Hori17, Tomoki Michida2,18, Takehito Yamaguchi19,20, Masakatsu Fukuzawa21, Shinsuke Kiriyama22, Kazutoshi Fukase23,24, Yoshitaka Murakami25, Hideki Ishikawa26, Yutaka Saito5. 1. Department of Gastroenterology, Tochigi Cancer Center, Tochigi, Japan. 2. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan. 3. Department of Gastroenterology, NTT Medical Center, Tokyo, Japan. 4. Division of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan. 5. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan. 6. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 7. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan. 8. Department of Gastroenterology, Okayama University Hospital, Okayama, Japan. 9. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan. 10. Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan. 11. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Gunma, Japan. 12. Department of Gastroenterology, Juntendo University Hospital, Tokyo, Japan. 13. Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan. 14. Department of Gastroenterology, Hanwa Sumiyoshi General Hospital, Osaka, Japan. 15. Department of Gastroenterology, Takarazuka Municipal Hospital, Hyogo, Japan. 16. Division of Gastroenterology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan. 17. Department of Gastroenterology, NHO Shikoku Cancer Center, Ehime, Japan. 18. Department of Internal Medicine, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan. 19. Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan. 20. Department of Internal Medicine, Japan Community Healthcare Organization Funabashi Central Hospital, Chiba, Japan. 21. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 22. Department of Surgery, Gunma Chuo General Hospital, Gunma, Japan. 23. Department of Internal Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan. 24. Department of Internal Medicine, Yamagata Prefectural Kahoku Hospital, Yamagata, Japan. 25. Department of Medical Statistics, Toho University, Tokyo, Japan. 26. Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Abstract
OBJECTIVES: Endoscopic mucosal resection (EMR) is the gold standard for the treatment of noninvasive large colorectal lesions, despite challenges associated with nonlifting lesions and a high rate of local recurrence. Endoscopic submucosal dissection (ESD) offers the possibility of overcoming these EMR limitations. However, a higher risk of complications and longer procedure time prevented its dissemination. As ESD now provides more stable results because of standardized techniques compared with those used earlier, this study aimed to quantify the rates of en bloc and curative resections, as well as ESD complications, in the present situation. METHODS: A multicenter, large-scale, prospective cohort trial of ESD was conducted at 20 institutions in Japan. Consecutive patients scheduled for ESD were enrolled from February 2013 to January 2015. RESULTS: ESD was performed for 1883 patients (1965 lesions). The mean procedure time was 80.6 min; en bloc and curative resections were achieved in 1759 (97.0%) and 1640 (90.4%) lesions, respectively, in epithelial lesions ≥20 mm. Intra- and postprocedural perforations occurred in 51 (2.6%) and 12 (0.6%) lesions, respectively, and emergency surgery for adverse events was performed in nine patients (0.5%). CONCLUSIONS: This trial conducted after the standardization of the ESD technique throughout Japan revealed a higher curability, shorter procedure time, and lower risk of complications than those reported previously. Considering that the target lesions of ESD are more advanced than those of EMR, ESD can be a first-line treatment for large colorectal lesions with acceptable risk and procedure time. (Clinical Trial Registration: UMIN000010136).
OBJECTIVES: Endoscopic mucosal resection (EMR) is the gold standard for the treatment of noninvasive large colorectal lesions, despite challenges associated with nonlifting lesions and a high rate of local recurrence. Endoscopic submucosal dissection (ESD) offers the possibility of overcoming these EMR limitations. However, a higher risk of complications and longer procedure time prevented its dissemination. As ESD now provides more stable results because of standardized techniques compared with those used earlier, this study aimed to quantify the rates of en bloc and curative resections, as well as ESD complications, in the present situation. METHODS: A multicenter, large-scale, prospective cohort trial of ESD was conducted at 20 institutions in Japan. Consecutive patients scheduled for ESD were enrolled from February 2013 to January 2015. RESULTS: ESD was performed for 1883 patients (1965 lesions). The mean procedure time was 80.6 min; en bloc and curative resections were achieved in 1759 (97.0%) and 1640 (90.4%) lesions, respectively, in epithelial lesions ≥20 mm. Intra- and postprocedural perforations occurred in 51 (2.6%) and 12 (0.6%) lesions, respectively, and emergency surgery for adverse events was performed in nine patients (0.5%). CONCLUSIONS: This trial conducted after the standardization of the ESD technique throughout Japan revealed a higher curability, shorter procedure time, and lower risk of complications than those reported previously. Considering that the target lesions of ESD are more advanced than those of EMR, ESD can be a first-line treatment for large colorectal lesions with acceptable risk and procedure time. (Clinical Trial Registration: UMIN000010136).