Department of Gastroenterology, Klinikum Augsburg, Stenglinstrasse 2, Augsburg, Germany.
Endoscopy. 2012 Jul;44(7):660-7. doi: 10.1055/s-0032-1309403. Epub 2012 Apr 23.
Endoscopic submucosal dissection (ESD) in the colorectum is not currently a standard procedure. Few data are available from the Western world. The aim of the present study was to report on the first experiences and the learning curve of colorectal ESD in a European center.
A total of 82 rectosigmoid lesions were referred for ESD. Lesion characteristics, resection rates, procedure times, complications, and recurrences were recorded prospectively. Results were compared between three consecutive study periods in order to determine the learning curve.
Lesions were located in the rectum (86.6 %) and the sigmoid colon (13.4 %). Median diameter was 45.5 mm. Lesions were of Paris type 0-Is with pit pattern type V (n = 8), 0-IIa (n = 33), 0-IIa + Is (n = 36), and 0-IIa + IIc (n = 5). The malignancy rate in these groups was 100 %, 0 %, 14 %, and 20 %, respectively. ESD was possible in 76 lesions (92.7 %). En bloc resection rate and R0 resection rate were 81.6 % and 69.7 %, respectively. Median procedure time was 176 minutes. Between the three consecutive study periods, en bloc resection rate increased (60.0 %, 88.0 %, 96.2 %), R0 resection rate increased (48.0 %, 76.0 %, 84.5 %; P < 0.001), and procedure time decreased (200, 193, 136 minutes; P = 0.027). The perforation and bleeding rates were 1.3 % and 7.9 %, respectively. Recurrence risk was 0 % after R0 en bloc resection and 41.7 % after piecemeal resection (P < 0.05). Median follow-up was 23.6 months.
In the European setting, ESD in the distal colon is feasible with acceptable complication risks. Resection rates were not as high as those from Japanese studies; however, a clear learning curve could be shown. Colorectal ESD needs to be further evaluated, particularly in Europe where ESD experience is low.
内镜黏膜下剥离术（ESD）在结直肠中目前不是标准程序。来自西方世界的数据很少。本研究的目的是报告在一个欧洲中心的结直肠 ESD 的初步经验和学习曲线。
共有 82 例直肠乙状结肠病变被推荐进行 ESD。前瞻性记录病变特征、切除率、手术时间、并发症和复发情况。为了确定学习曲线，将结果与连续三个研究期间进行比较。
病变位于直肠（86.6%）和乙状结肠（13.4%）。中位直径为 45.5mm。病变为巴黎分型 0-Is 伴 pit 模式 V（n=8）、0-IIa（n=33）、0-IIa+Is（n=36）和 0-IIa+IIc（n=5）。这些组的恶性率分别为 100%、0%、14%和 20%。76 例（92.7%）病变可进行 ESD。整块切除率和 R0 切除率分别为 81.6%和 69.7%。中位手术时间为 176 分钟。在连续三个研究期间，整块切除率增加（60.0%、88.0%、96.2%），R0 切除率增加（48.0%、76.0%、84.5%；P<0.001），手术时间减少（200、193、136 分钟；P=0.027）。穿孔和出血率分别为 1.3%和 7.9%。R0 整块切除后的复发风险为 0%，而分片切除后的复发风险为 41.7%（P<0.05）。中位随访时间为 23.6 个月。
在欧洲环境中，远端结直肠 ESD 是可行的，并发症风险可接受。切除率不如日本研究高；然而，能够明显地显示出学习曲线。结直肠 ESD 需要进一步评估，特别是在 ESD 经验较低的欧洲。
