Endoscopic Diagnosis And Treatment’s Analysis Of 403 Cases Of Laterally Spreading Tumor

Objective:To explore the clinical and pathological features of laterally spreading tumor(LST)and the efficacy and safety of endoscopic submucosal dissection(ESD).Methods:403 cases of LST were found through colonoscopy during 33 months in our hospital,and we observed their sites,sizes and classified them according to the shape.Among them,160 lesions in 143 patients were resected by endoscopic treatment [including endoscopic mucosal resection(EMR),endoscopic piecemeal mucosal resection(EPMR)and ESD].The pit pattern of the lesions that resected by endoscopic treatment were all observed.The resections of the lesions were sent for pathological examination.The patients were followed up at regular intervals after resection.Results:There are 376 patients with 403 lesions in 33 months.A total of 168 LST lesions were located in the rectum,39 lesions were located in the sigmoid colon,15 lesions were located in the descending colon,77 lesions were located in the transverse colon,104 lesions were located in the ascending colon and caecum.A total of 150 lesions LST are in the diameter of 10-20 mm,117 lesions are in the diameter of 20-30 mm,59 lesions are in the diameter of 30-40 mm,77 lesions are exceeding 40 mm.There were 56 for homogeneous granular type,203 for nodular-mixed type,131 for flat elevated type,13 for pseudo depressed type.24 lesions were inflammatory hyperplastic polyps,11 were serrated adenoma,264 were low-grade neoplasia,66 were high-grade neoplasia,38 were early stage carcinoma.Among 376 cases with 403 lesions,143 cases of 160 patients were treated endoscopically,128 cases of 145 patients of which were treated by ESD,5 cases of 5 patients of which were treated by EPMR,10 cases of 10 patients of which were treated by EMR.11 lesions were of type IIIs-pit pattern,26 lesions were of type IIIL-pit pattern,113 lesions were of type IV-pit pattern,7 lesions were of type VI-pit pattern,3 lesions were of type VN-pit pattern.The 128 patients who were treated by ESD were followed up on a regular basis,113 of them were regularly reviewed,15 of them were lost.2 patients relapsed among patients who were followed up regularly.Others whose wounds didn’t relapse healed well.Conclusion:The main lesion location of LST is rectum.Lesions in the diameter of 10-20 mm are the most.Nodular-mixed type is the main morphologic type,with the increasing of diameter of LST lesion,its malignant potential rose.Low-grade adenoma is the main pathological type.Compared with LST-G,LST-NG has higher pathology malignant potential.IV-type pit pattern of the LST lesions are the most.The canceration rate of LST lesions with V-type pit pattern is the highest.With the escalation of pit pattern of LST cases,malignant degree of pathology and penetration degree of cancer showed an increasing trend.No postoperative complications occurred in patients treated with ESD,and the prognosis of short-term follow-up was good.The recurrence rate of it is low,so it is an effective and safe way to treat LST.