The Feasibility And Safety Of The Endoscopic Submucosal Dissection Of Gastrointestinal Neoplastic Lesions

Objective：1.To evaluate the efficacy and safety of endoscopic submucosal dissection(ESD)in treatment of patients with superficial digestive tract neoplastic lesions.2. Toevaluate the risk factors of complications of endoscopic submucosal dissection (ESD)intreatment of patients with superficial digestive tract neoplastic lesions. Methods BetweenJanuary2010and October2011, a total of154consecutive patients (mean age59.8±10.5years) who underwent ESD for superficial digestive tract neoplastic lesionswere analyzed. First, incidence rate and clinical course of complications were evaluated.Second, patient-related variables (age, sex, history of aspirin or antiplatelet agents, andcomorbidity), endoscopic variables (tumor size, location, and type), procedure-relatedvariables (procedure time, one-piece resection，histologically completeresection),pathologic diagnosis and the post-ESD ulcer-healing and local reeurrance wereanalyzed.Result The overall en bloc resection rate was100.0%(145/145). The histologicallycomplete resection rate was99.3%(144/145).6patients had acute massive bleedingduring the ESD procedure and2of them accept surgery. One patient had delayed bleeding（0.7%1/145)．Perforation occurred in4out of154patients (2.6%4/154) and2patients could be successfully treated conservatively. Post-ESD epigastric pain was foundin65patients(42.2%65/154). The size,the location (at the cardia-fundus)of the lesionwere associated with higher frequency of compliactions (all P <0.05). The medianoperation time was(50.0±45.7) minutes．The post-ESD ulcer-healing was achieved in100%(145/145)8weeks after esomeprazole treatment．During follow-up of10．6months(rangedfrom8to18months)，no residual or local recurrence was seen.Conclusion ESD is a effective and safe procedure in treatment of superficial digestivetract neoplastic lesions.The complications of ESD are preventable and curable.Restrictedlycontrolling operation indications,individual treatment and the operation skills ofphysicians are the key of success or failure.