Department of Clinical Sciences, Section of Surgery, Malmö, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden.
Gastroenterol Res Pract. 2013;2013:758202. doi: 10.1155/2013/758202. Epub 2013 Jun 27.
Objectives. Endoscopic submucosal dissection (ESD) is an effective method for en bloc removal of large colorectal tumors in Japan, but this technique is not yet widely established in western countries. The purpose here was to report the experience of implementing colorectal ESD in Sweden. Methods. Twenty-nine patients with primarily nonmalignant and early colorectal neoplasms considered to be too difficult to remove en bloc with EMR underwent ESD. Five cases of invasive cancer underwent ESD due to high comorbidity excluding surgical intervention or as an unexpected finding. Results. The median age of the patients was 74 years. The median tumor size was 26 mm (range 11-89 mm). The median procedure time was 142 min (range 57-291 min). En bloc resection rate was 72% and the R0 resection rate was 69%. Two perforations occurred amounting to a perforation rate of 6.9%. Both patients with perforation could be managed conservatively. One bleeding occurred during ESD but no postoperative bleeding was observed. Conclusion. Our data confirms that ESD is an effective method for en bloc resection of large colorectal adenomas and early cancers. This study demonstrates that implementation of colorectal ESD is feasible in Sweden after proper training, careful patient selection, and standardization of the ESD procedure.
目的。内镜黏膜下剥离术（ESD）是日本整块切除大肠肿瘤的有效方法，但该技术在西方国家尚未广泛建立。本研究旨在报告在瑞典实施结直肠 ESD 的经验。方法。29 例主要为非恶性和早期结直肠肿瘤的患者，因考虑到内镜黏膜切除术（EMR）整块切除难度较大而接受 ESD。5 例浸润性癌因高合并症排除手术干预或作为意外发现而接受 ESD。结果。患者的中位年龄为 74 岁。肿瘤的中位大小为 26mm（范围 11-89mm）。中位手术时间为 142 分钟（范围 57-291 分钟）。整块切除率为 72%，R0 切除率为 69%。发生 2 例穿孔，穿孔率为 6.9%。所有穿孔患者均经保守治疗。1 例在 ESD 期间发生出血，但术后无出血。结论。我们的数据证实 ESD 是整块切除大肠腺瘤和早期癌症的有效方法。本研究表明，在适当的培训、仔细的患者选择和 ESD 操作标准化的基础上，结直肠 ESD 在瑞典是可行的。
