Skip to main content
Springer Nature Link
Log in

The feasibility of endoscopic submucosal dissection for colorectal lesions larger than 10 cm

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Although endoscopic submucosal dissection (ESD) enables en bloc removal of colorectal neoplasms, its effectiveness for larger lesions (≥ 10 cm in diameter) is undetermined. We aimed to investigate the feasibility and safety of ESD for colorectal lesions ≥ 10 cm wide.

Methods

This retrospective study included 3591 consecutive colorectal lesions managed with ESD from June 2012 through December 2020. Clinicopathological characteristics and treatment outcomes were compared between lesions ≥ 10 cm wide and lesions 5–10 cm wide.

Results

There were 50 patients in the ≥ 10 cm group and 270 patients in the 5–10 cm group. Among patients in the ≥ 10 cm group, lesions were most often in the rectum (50.0%), and the laterally spreading tumor–granular nodular mixed type (LST-G-M) was most prevalent (41/50, 82%). Although patients in the ≥ 10 cm group a longer mean ESD procedure time (186.0 vs. 94.4 min, p < 0.001), the dissection speed was significantly higher in this group (0.50 vs. 0.41 cm2/min, p = 0.003). The en bloc and curative resection rates were comparable between the ≥ 10 cm and 5–10 cm groups (100% vs. 99.6% and 86.0% vs. 88.5%, respectively). Although the stenosis rate was higher in the ≥ 10 cm group (4% vs. 0%), the delayed bleeding and perforation rates were similar between the two groups.

Conclusions

ESD for colorectal lesions ≥ 10 cm wide is feasible and curative, even though it is associated with higher technical difficulty and longer procedure times compared with ESD for smaller lesions (Number: UMIN 000044313).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, Yoshida Y, Ikehara H, Otake Y, Nakajima T, Matsuda T, Saito D (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225

    Article  Google Scholar 

  2. Gorgun E, Benlice C, Abbas MA, Steele S (2018) Experience in colon sparing surgery in North America: advanced endoscopic approaches for complex colorectal lesions. Surg Endosc 32:3114–3121

    Article  Google Scholar 

  3. Sauer M, Hildenbrand R, Oyama T, Sido B, Yahagi N, Dumoulin FL (2016) Endoscopic submucosal dissection for flat or sessile colorectal neoplasia > 20 mm: a European single-center series of 182 cases. Endosc Int Open 4:E895–E900

    Article  Google Scholar 

  4. Chiba H, Tachikawa J, Kurihara D, Ashikari K, Goto T, Takahashi A, Sakai E, Ohata K, Nakajima A (2017) Safety and efficacy of simultaneous colorectal ESD for large synchronous colorectal lesions. Endosc Int Open 5:E595–E602

    Article  Google Scholar 

  5. Suzuki Y, Ohata K, Sakai E, Negishi R, Takita M, Minato Y, Muramoto T, Chiba H, Tsuji Y, Matsuhashi N (2021) Palisade technique as an effective endoscopic submucosal dissection tool for large colorectal tumors. Endosc Int Open 9:E210–E215

    Article  Google Scholar 

  6. Li B, Shi Q, Xu EP, Yao LQ, Cai SL, Qi ZP, Sun D, He DL, Yalikong A, Lv ZT, Zhou PH, Zhong YS (2021) Prediction of technically difficult endoscopic submucosal dissection for large superficial colorectal tumors: a novel clinical score model. Gastrointest Endosc 94:133–144

    Article  Google Scholar 

  7. Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguchi S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (2020) Japanese Society for cancer of the colon and rectum (JSCCR) Guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 25:1–42

    Article  Google Scholar 

  8. Antillon MR, Bartalos CR, Miller ML, Diaz-Arias AA, Ibdah JA, Marshall JB (2008) En bloc endoscopic submucosal dissection of a 14-cm laterally spreading adenoma of the rectum with involvement to the anal canal: expanding the frontiers of endoscopic surgery (with video). Gastrointest Endosc 67:332–337

    Article  Google Scholar 

  9. Jung DH, Youn YH, Kim JH, Park H (2015) Endoscopic submucosal dissection for colorectal lateral spreading tumors larger than 10 cm: is it feasible? Gastrointest Endosc 81:614–620

    Article  Google Scholar 

  10. Tanaka S, Kashida H, Saito Y, Yahagi N, Yamano H, Saito S, Hisabe T, Yao T, Watanabe M, Yoshida M, Saitoh Y, Tsuruta O, Sugihara KI, Igarashi M, Toyonaga T, Ajioka Y, Kusunoki M, Koike K, Fujimoto K, Tajiri H (2020) Japan Gastroenterological Endoscopy Society guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 32:219–223

    Article  Google Scholar 

  11. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 47:829–854

    Article  Google Scholar 

  12. Toyonaga T, Tanaka S, Man-I M, East J, Ono W, Nishino E, Ishida T, Hoshi N, Morita Y, Azuma T (2015) Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal dissection. Endosc Int Open 3:E246–E251

    Article  Google Scholar 

  13. Jung D, Young YH, Jahng J, Kim JH, Park H (2013) Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endoscopy 45:714–717

    Article  Google Scholar 

  14. Imai K, Hotta K, Ono H, Kakushima N, Tanaka M, Takizawa K, Kawata N, Matsubayashi H, Shimoda T, Mori K, Ono H (2016) Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc 83:954–962

    Article  Google Scholar 

  15. Chiba H, Tachikawa J, Arimoto J, Ashikari K, Kuwabara H, Nakaoka M, Goto T, Higurashi T, Muramoto T, Ohata K, Nakajima A (2021) Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study. Endoscopy 53:77–80

    Article  Google Scholar 

  16. Ohata K, Nonaka K, Misumi Y, Tsunashima H, Takita M, Minato Y, Tashima T, Sakai E, Muramoto T, Matsuyama Y, Hiejima Y, Matsuhashi N (2016) Usefulness of training using animal models for colorectal endoscopic submucosal dissection: is experience performing gastric ESD really needed? Endosc Int Open 4:E333-339

    Article  Google Scholar 

  17. Chiba H, Tachikawa J, Arimoto J, Ashikari K, Kuwabara H, Nakaoka M, Goto T, Ohata K, Nakajima A (2020) Predictive factors of mild and severe fibrosis in colorectal endoscopic submucosal dissection. Dig Dis Sci 65:232–242

    Article  CAS  Google Scholar 

  18. Chiba H, Ohata K, Takita M, Tachikawa J, Ashikari K, Goto T, Nakajima A (2018) Double-tunnel method for treatment of colorectal lesions with severe fibrosis with endoscopic submucosal dissection. Endoscopy 50:E168–E169

    Article  Google Scholar 

  19. Uraoka T, Saito Y, Matsuda T, Ikehara H, Gotoda T, Saito D, Fujii T (2006) Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut 55:1592–1597

    Article  CAS  Google Scholar 

  20. Hayashi T, Kudo SE, Miyachi H, Sakurai T, Ishigaki T, Yagawa Y, Toyoshima N, Mori Y, Misawa M, Kudo T, Wakamura K, Katagiri A, Baba T, Ishida F (2017) Management and risk factor of stenosis after endoscopic submucosal dissection for colorectal neoplasms. Gastrointest Endosc 86:358–369

    Article  Google Scholar 

  21. Yoshizaki T, Toyonaga T, Tanaka S, Ohara Y, Kawara F, Baba S, Tsubouchi E, Takihara H, Watanabe D, Ishida T, Hoshi N, Morita Y, Umegaki E, Azuma T (2016) Feasibility and safety of endoscopic submucosal dissection for lesions involving the ileocecal valve. Endoscopy 48:639–645

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the staff of the participating institutions for their support in recruiting eligible patients, and also the patients who participated in this study.

Funding

This study was not externally funded. There was no sponsor for this study.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1 Chuo, Ota-ku, Tokyo, 143-8527, Japan

    Hideyuki Chiba, Jun Tachikawa, Keiji Yamada, Naoya Okada, Jun Arimoto, Hiroki Kuwabara, Michiko Nakaoka & Toru Goto

  2. Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan

    Ken Ohata

  3. Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Keiichi Ashikari

  4. Department of Gastroenterology, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama, Kanagawa, 247-8581, Japan

    Eiji Sakai

Authors
  1. Hideyuki Chiba
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Ken Ohata
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Jun Tachikawa
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Keiji Yamada
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Naoya Okada
    View author publications

    You can also search for this author inPubMed Google Scholar

  6. Jun Arimoto
    View author publications

    You can also search for this author inPubMed Google Scholar

  7. Keiichi Ashikari
    View author publications

    You can also search for this author inPubMed Google Scholar

  8. Hiroki Kuwabara
    View author publications

    You can also search for this author inPubMed Google Scholar

  9. Michiko Nakaoka
    View author publications

    You can also search for this author inPubMed Google Scholar

  10. Eiji Sakai
    View author publications

    You can also search for this author inPubMed Google Scholar

  11. Toru Goto
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Hideyuki Chiba.

Ethics declarations

Disclosures

Hideyuki Chiba, Ken Ohata, Jun Tachikawa, Keiji Yamada, Naoya Okada, Jun Arimoto, Keiichi Ashikari, Hiroki Kuwabara, Michiko Nakaoka, Eiji Sakai, and Toru Goto have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 233148 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiba, H., Ohata, K., Tachikawa, J. et al. The feasibility of endoscopic submucosal dissection for colorectal lesions larger than 10 cm. Surg Endosc 36, 5348–5355 (2022). https://doi.org/10.1007/s00464-021-08916-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-021-08916-x

Keywords