The Value Of Endoscopic Submucosal Dissection In The Treatment Of Gastrointestinal Mucosal And Submucosal Lesions

Objective:To evaluate the efficacy and safety.of endoscopic submucosaldissection(ESD) in the treatment of Gastrointestinal mucosal and submucosal lesions.Methods:ESD was applied to remove46lesions in41patients，The study wasretrospectively evaluated in the First Affiliated Hospital of Dalian Medical Universityduring February2011to February2013.The following factors were recorded.Patient-related characteristics(sex,age,concomitant diseases and history of antiplateletagents),lesion-related characteristics (location, size,endoscopic findings,preoperativepathological types)and procedure-related factors (procedure time,incidence rate ofIntraoperative and postoperative complications、 pathologic diagnosis, follow-up,etc.).En-bloc resection rate, curative resection rate, immediate bleeding rate, delayedbleeding rate, perforation rate, recurrence rate and residual rate were analyzed. Thegeneral information,en-bloc resection rate and curative resection rate,the rates ofcomplications were be described and measured by SPSS16.0.Results:1、ESD was porformed in41patientes.The en-bloc resection rate of stomach ESD andcolorectumESD was88.8%、78.5%respectively the histologically curative resectionrate of stomach and colorectum was61.1%、71.4%respectively， non-curativeresection rate was32.6%.including lateral edge of the positive in seven cases and basalpositive in one case.Compared with ESD postoperative pathology,diagnostic accordancerate was46.2%.postoperative pathology is serious in13cases compared withpreoperative pathology, and slighter in one case compared withpreoperative level.2. The most common complications of ESD are bleeding and perforation.Nine patiantshad bleeding during ESD or after ESD,bleeding rate was21.9%.Among whom eight patients had little bleeding during ESD(19.5%),one occurred bleeding on the seventhday afer ESD(2.4%),all cases were confirmed by endoscopic successfulhemostasis.Three patients occurred perforation during ESD(7.3%),among whom onepatient occurred in stomach(6.2%),two patients occurred in colorectum(8.0%)，twopatients were enclosed successfully by clips，while one patient was cured by surgery.Atprerent there was no case of gastrointestinal stenosis,postoperative aspirationpneumonia,air embolism and cases of deep vein thrombosis.3.The average age of the patients in the study is65.7years.The patients were classifiedan elderly group(age≥65years)and a nonelderly group (age＜65years).The elderlygroup included22patients(59%).In the elderly group,63.6%had a pre-exitingcomorbidity(hypertension,heart diseases and cerebrovascular diseases etc.),whereasin the nonelderly group,31.5%had a pre-exiting comorbidity,P＜0.05. The en-blocresection rate and curative resection rate were84.6%、65.4%respectively in the elderlypatients， while90%、70%in the nonelderly patients;the rates of bleeding andperforation were31.8%、4.5%in the elderly group,while they were both10.5%in thenonelderly group;Average duration of hospitalization was8.63days in the elderlygroup,while it was8.16days,P＞0.05.Overall, the two groups had significant differencein their pre-exiting comorbidity in the nonelderly group,however,the two groups had nosignificant difference in the en-bloc resection rate and curative resection rate、the rateof complication、average duration of hospitalization. This study demonstrates thatthere was no increased risk of surgery in elderly patients,so ESD theatment is safe andeffective in the elderly patients.4.Thirty-six of fourty-one patients were followed up for two months to twoyears(average11.4months),the rate of follow up is87.8%.One case (2.7%) had,localrecurrence six months later after ESD, no residual and metachronous lesions wasfounded,there is not distant metastases and deaths.Conclusion:ESD is an importent treatment in gastrointestinal mucosal and submucosallesions for its high rate of en-bloc resection and histological curative resection rate,thelower incidence rate of complications such as hemorrhage, perforation，low-residue andrecurrence rate; meanwhile small trauma、quickly recovery、maximum limit retainedgastrointestinal structure and function，multiple lesions were performed by ESD,the caseswere experienced several ESD.Once complications appear such as bleeding、 perforation，most of them can be cured by endoscopy.ESD was proved a safe andeffective treatment method in patients older than65years..