Department of General Surgery, Khoo Teck Puat Hospital, Singapore.
Singapore Med J. 2019 Oct;60(10):508-511. doi: 10.11622/smedj.2019130.
Endoscopic submucosal dissection (ESD) in the colon and rectum has been developed with good reported outcomes. The main advantage of ESD is the ability to perform en bloc resection, which has implications for complete excision and pathological analysis. Locally, the use of ESD in colonic lesions has seen recent traction. Our study aimed to review the outcomes of the first 50 cases of endoscopic excision of advanced colonic lesions using ESD at our institution.
This was a retrospective study of all patients who underwent ESD at our institution from September 2010 to October 2016. Data collected included patient demographics, resection technique, conversion rate and morbidity.
51 patients underwent ESD during the study period. All patients were of American Society of Anesthesiologists (ASA) class 1-3. Their median age was 60.0 years and the majority (n = 36) were male. The mean procedure time was 80.9 minutes. 36 (76.6%) of cases underwent en bloc resection. 4 (7.8%) cases required conversion to surgery, mainly due to difficulty in raising the colonic lesions. 3 (5.9%) patients had malignancy as the final histology. 2 (4.3%) patients had recurrence during surveillance scope. No cases of early mortality were reported.
Our results suggest that ESD for advanced colonic lesions can be safely performed. Expertise needs to be developed to achieve satisfactory en bloc resection rates.
内镜黏膜下剥离术（ESD）在结肠和直肠的应用已经取得了良好的效果。ESD 的主要优势在于能够进行整块切除，这对完全切除和病理分析有重要意义。在局部，ESD 在结肠病变中的应用最近受到了关注。我们的研究旨在回顾我们机构 50 例内镜切除高级结肠病变的结果。
这是一项对我们机构 2010 年 9 月至 2016 年 10 月期间所有接受 ESD 的患者的回顾性研究。收集的数据包括患者人口统计学、切除技术、转化率和发病率。
研究期间共有 51 例患者接受了 ESD。所有患者均为美国麻醉医师协会（ASA）分级 1-3 级。他们的中位年龄为 60.0 岁，大多数（n=36）为男性。平均手术时间为 80.9 分钟。36（76.6%）例患者行整块切除。4（7.8%）例患者需要转为手术，主要是因为结肠病变难以抬起。3（5.9%）例患者的最终组织学为恶性。2（4.3%）例患者在监测内镜时有复发。无早期死亡病例报告。
我们的结果表明，ESD 可安全用于高级结肠病变。需要发展专业技能以达到令人满意的整块切除率。
