Endoscopic submucosal dissection for colorectal lesions with fibrosis. It's possible?

Abstract

Introduction: Endoscopic submucosal dissection (DSE) is an endoscopically laborious technique. Submucosal fibrosis (FSM) makes it even more complex. The literature is limited. Objective: To evaluate the efficacy and safety of DSE in colorectal lesions (LCR) with FSM. Materials and methods: Prospective study (December 2010 to October 2014). We included 16 of 51 patients with colorectal lesions of whom 13 had been referred for surgery and 3 for probable endoscopic therapy. In 8 there was previous biopsy, partial endoscopic mucosal resection (EMR) in 7 and post-EMR recurrence in 1. The lesions were evaluated with NBI and endoscopic ultrasound (4). The Olympus UCR CO2 pump was used. DSE was done with: IT Knife (5), Hybrid Knife (11). FSM criteria: absence of a lifting sign, yellowish submucosa and desmoplastic reaction. Results: There were 16 patients who underwent DSE (9 women-7 men), mean age 63.13 years (48 -81). Location of the lesion: splenic angle (1), rectosigmoid (3), descending colon (1), rectum (11). Sign of the total lifting in 9 and partial in 7. DSE was technically possible with block resection and free margins of lesion in all patients. Average dissected mucosal diameter: 40.8 x 36.9mm (20 x 20 – 70 x 60). Endoscopic time: 155.31min (100-230). Histology: intramucosal ADC (4), villous adenoma-high grade dysplasia (HGD) (7), villous-HGD-ADC (1), flat tubular adenoma-HGD (1), flat tubular adenoma HGD-ADC (3). Complications: microperforation (2) resolved endoscopically, pain (1). There was no mortality. Hospital stay average 48 hours (24-96). Follow-up 48 months, controls every 3 months, without recurrence. Conclusions: Our preliminary results suggest that premalignant or malignant colorectal lesions with submucosal fibrosis can be resected by DSE safely and with margins free of lesion, avoiding surgery.