• Eui-Gon Youk, Dae Kyng Sohn, Chang Won Hong, Seong Dae Lee, Kyung Su Han, Byung Chang Kim, Hee Jin Chang, and Mi-Jung Kim.
• 1 Department of Surgery, Daehang Hospital, Seoul, Korea 2 Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea 3 Department of Pathology, Daehang Hospital, Seoul, Korea.
• Dis. Colon Rectum. 2016 May 1; 59 (5): 403-10.

BackgroundAlthough endoscopic submucosal dissection has been shown to be safe and effective for colorectal tumors, its clinical outcomes vary.ObjectiveThe aim of this study is to assess the outcomes of endoscopic submucosal dissection according to clinical indications.DesignThis is a prospective, multicenter, single-arm study.SettingThe study was conducted at special hospitals for colorectal diseases and cancers.PatientsThe study population included consecutive patients aged 20 to 80 years who underwent colorectal endoscopic submucosal dissection for 1) early colorectal cancer, 2) laterally spreading tumors ≥2 cm in diameter, and 3) submucosal tumors.InterventionsProcedures were performed by experienced colonoscopists.Main Outcome MeasuresThe primary end points were en bloc and curative resection rates. En bloc resection was defined as endoscopic one-piece resection without tumor fragmentation. Curative resection was defined as en bloc resection and no pathologic requirement for additional surgery. Secondary end points included procedure time, complications, and hospital stay.ResultsOf 321 patients, 317 (98.8%) underwent en bloc resection and 231 (72.0%) underwent curative resection. The mean procedure time was 46.2 minutes. Mean hospital stay after the procedure was 3.1 days. Perforation occurred in 2 patients (0.6%), and bleeding occurred in 10 (3.1%) patients. All patients with complications were treated by endoscopic clipping or nonoperative management. Fifteen patients (4.7%) underwent additional radical surgery owing to the risks of lymph node metastasis. Although tumor size was smaller and procedure time shorter in the submucosal tumor group than in the laterally spreading tumor or early colorectal cancer group, there were no differences in clinical outcomes including en bloc and curative resection rates. Submucosal fibrosis was the only factor affecting endoscopic submucosal dissection procedure-related complications.LimitationsEarly outcomes in a limited population and the potential for selection bias were limitations of this study.ConclusionsOutcomes of colorectal endoscopic submucosal dissection were acceptable in selected patients, with no difference in outcomes according to clinical indications. Because submucosal fibrosis can increase complications, it should be minimized before endoscopic submucosal dissection.

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