%0 Journal Article
%T Clinical Practice of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms by a Colonoscopist with Limited Gastric Experience
%A Wen-Hsin Hsu
%A Meng-Shun Sun
%A Hoi-Wan Lo
%A Ching-Yang Tsai
%A Yu-Jou Tsai
%J Gastroenterology Research and Practice
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/262171
%X Objectives. Endoscopic submucosal dissection (ESD) for early colorectal neoplasms is regarded as a difficult technique and should commence after receiving the experiences of ESD in the stomach. The implementation of colorectal ESD in countries where early gastric cancer is uncommon might therefore be difficult. The aim is to delineate the feasibility and the learning curve of colorectal ESD performed by a colonoscopist with limited experience of gastric ESD. Methods. The first fifty cases of colorectal ESD, which were performed by a single colonoscopist between July 2010 and April 2013, were enrolled. Results. The mean of age was 64 (¡À9.204) years with mean size of neoplasm at 33 (¡À12.63)£¿mm. The mean of procedure time was 70.5 (¡À48.9)£¿min. The rates of en bloc resection, R0 resection, and curative resection were 86%, 86%, and 82%, respectively. Three patients had immediate perforation, but no patient developed delayed perforation or delayed bleeding. Conclusion. Our result disclosed that it is feasible for colorectal ESD to be performed by a colonoscopist with little experience of gastric ESD through satisfactory training and adequate case selection. 1. Introduction Endoscopic submucosal dissection for early colorectal neoplasm has been gradually utilized and its safety and effectiveness have been shown in Japan, other Asian countries, and in the West [1¨C4]. Compared with endoscopic mucosal resection (EMR), ESD could be used to resect larger lesions in a whole piece and, therefore, affords more accurate pathological examination and less local recurrence rate [5, 6]. The development of ESD technique arose from the stomach and esophagus and finally to the colorectum and received consequent approval for the medical procedure from the Japanese insurance system. Compared with ESD in the stomach and esophagus, colorectal ESD is regarded as more risky and difficult. Therefore, it is recommended that at least 30 cases of gastric ESD should be completed before colorectal ESD is attempted [7, 8]. However, early gastric cancer cases are few in countries outside of Japan. Colorectal cancer remains one of the most common malignancies in the word. In Taiwan, it has been the cancer with highest incidence for the fifth consecutive year [9]. It is quite essential to use a less invasive technique to manage large adenomatous polyps or superficially invasive carcinoma of the colorectum. If the experience of gastric ESD is mandatory for colorectal ESD learning, it would be difficult for a colonoscopist outside of Japan to master this technique. We report our result of
%U http://www.hindawi.com/journals/grp/2013/262171/