Clinical Evaluation Of Endoscopic Submucosal Dissection In Treatment Of Colorectal Lateral Spreading Tumor

Objective: To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD)in treatment of specific subtypes of colorectal laterally spreading tumor(LST).Methods: The clinical data of 154 patients with colorectal LST who treated with ESD at Shengjing Hospital’s Endoscopic Diagnosis and Treatment Center from January 2018 to December 2019 were collected.According to the endoscopic morphology,they were divided into granular type group(LST-G)and non-granular type group(LST-NG).Gender,age,tumor location,size,histopathology and ESD parameters were compared between the two groups.Results: A total of 154 cases of LST,including 94 in the LST-G group and 60 in the LST-NG group,with an average age of 62.91 ± 8.55 years;44 males and 50 females in the LST-G group,with an average age of 62.55 ± 8.34 years;31 males and 29 females in the LST-NG group,with an average age of 63.47 ± 8.91 years.There was no significant difference in gender and age between the two groups.The LST-G group was distributed in 11 cases of ileocecal section,28 cases of ascending colon,9 cases of transverse colon,3 cases of descending colon,6 cases of sigmoid colon,and 37 cases of rectum.The average tumor size was 2.35 ± 0.98 cm.The LST-NG group was distributed in 9 cases of ileocecal section,14 cases of ascending colon,7 cases of transverse colon,4 cases of descending colon,7 cases of sigmoid colon,and 19 cases in the rectum.The average tumor size was 2.17 ± 0.98 cm.There was no significant difference in the location of tumors and tumor size between the two groups.Adenoma,high-grade intraepithelial neoplasia(HGIN),and submucosal cancer in the LST-G group were 76,17,and 1 cases;adenoma,high-grade intraepithelial neoplasia,and submucosal cancer in the LST-NG group were 42 cases,11 cases and 7 cases.The incidence of submucosal cancer was significantly different between the two groups(P <0.05).The average procedure time of 154 cases of LST was 50.19 ± 48.48 min.There were 6 cases of bleeding(3.90%),9 cases of abdominal pain(5.84%),and no perforation occurred.The average procedure time in the LST-G group was 42.68 ± 37.59 min,1 cases of bleeding and 5 cases of abdominal pain occurred;the average procedure time in the LST-NG group was 62.05 ± 60.28 min,5 cases of bleeding occurred and 4 cases of abdominal pain occurred;.There were significant differences between the two groups in procedure time and bleeding complications(P <0.05).The LST-G group was fasted for an average of 2.74 ± 0.84 days after ESD,and antibiotics were used for 2.39 ± 1.19 days;the LST-NG group was fasted for an average of 2.70 ± 0.87 days after ESD,and antibiotics were used for 2.20 ± 1.26 days.There was no significant difference.The en bloc resection rate and en bloc R0 resection rate were 97.87%,96.81% in the LST-G group and 98.33%,91.67% in the LST-NG group.There was no significant difference between the two groups in the parameters of en bloc resection rate and complete resection rate.Conclusion: ESD is safe and effective in treatment of LST.However,the degree of technical difficulty appears higher for LST-NG than for LST-G,as shown by the longer procedure time and higher bleeding complications.ESD for LST-NG should probably be performed by an experienced endoscopic physician.