Original Article
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World J Gastroenterol. Apr 7, 2011; 17(13): 1701-1709
Published online Apr 7, 2011. doi: 10.3748/wjg.v17.i13.1701
Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers
Sadettin Hulagu, Omer Senturk, Cem Aygun, Orhan Kocaman, Altay Celebi, Tolga Konduk, Deniz Koc, Goktug Sirin, Ugur Korkmaz, Ali Erkan Duman, Neslihan Bozkurt, Gokhan Dindar, Tan Attila, Yesim Gurbuz, Orhan Tarcin, Cem Kalayci
Sadettin Hulagu, Omer Senturk, Cem Aygun, Orhan Kocaman, Altay Celebi, Tolga Konduk, Deniz Koc, Goktug Sirin, Ugur Korkmaz, Ali Erkan Duman, Neslihan Bozkurt, Gokhan Dindar, Division of Gastroenterology, Kocaeli University Medical School, Kocaeli 41000, Turkey
Tan Attila, Division of Gastroenterology, American Hospital, Istanbul 34365, Turkey
Yesim Gurbuz, Department of Pathology, Kocaeli University Medical School, Kocaeli 41000, Turkey
Orhan Tarcin, Division of Gastroenterology, Derince State Hospital, Kocaeli 41900, Turkey
Cem Kalayci, Division of Gastroenterology, Marmara University School of Medicine, Altunizade, Istanbul 34662, Turkey
Author contributions: Hulagu S performed all ESD procedures; Senturk O assisted during the ESD procedure and literature review; Aygun C assisted during the ESD procedure, data collection and statistical analysis; Kocaman O, Celebi A, Konduk T, Koc D, Sirin G, Korkmaz U, Duman AE, Bozkurt N and Dindar G assisted during the ESD procedure and data collection; Attila T, Tarcin O and Kalayci C performed the endosonographic evaluation of patients; Gurbuz Y performed the histologic examination of ESD specimens.
Correspondence to: Dr. Sadettin Hulagu, Division of Gastroenterology, Kocaeli University Medical School, Kocaeli 41000, Turkey. shulagu@hotmail.com
Telephone: +90-532-3252996 Fax: +90-262-3038003
Received: October 21, 2010
Revised: November 20, 2010
Accepted: November 27, 2010
Published online: April 7, 2011
Abstract

AIM: To investigate the indication, feasibility, safety, and clinical utility of endoscopic submucosal dissection (ESD) in the management of various gastrointestinal pathologies.

METHODS: The medical records of 60 consecutive patients (34 female, 26 male) who underwent ESD at the gastroenterology department of Kocaeli University from 2006-2010 were examined. Patients selected for ESD had premalignant lesions or non-invasive early cancers of the gastrointestinal tract and had endoscopic and histological diagnoses. Early cancers were considered to be confined to the submucosa, with no lymph node involvement by means of computed tomography and endosonography.

RESULTS: Sixty ESD procedures were performed. The indications were epithelial lesions (n = 39) (33/39 adenoma with high grade dysplasia, 6/39 adenoma with low grade dysplasia), neuroendocrine tumor (n = 7), cancer (n = 7) (5/7 early colorectal cancer, 2/7 early gastric cancer), granular cell tumor (n = 3), gastrointestinal stromal tumor (n = 2), and leiomyoma (n = 2). En bloc and piecemeal resection rates were 91.6% (55/60) and 8.3% (5/60), respectively. Complete and incomplete resection rates were 96.6% (58/60) and 3.3% (2/60), respectively. Complications were major bleeding [n = 3 (5%)] and perforations [n = 5 (8.3%)] (4 colon, 1 stomach). Two patients with colonic perforations and two patients with submucosal lymphatic and microvasculature invasion (1 gastric carcinoid tumor, 1 colonic adenocarcinoma) were referred to surgery. During a mean follow-up of 12 mo, 1 patient with adenoma with high grade dysplasia underwent a second ESD procedure to resect a local recurrence.

CONCLUSION: ESD is a feasible and safe method for treatment of premalignant lesions and early malignant gastrointestinal epithelial and subepithelial lesions. Successful en bloc and complete resection of lesions yield high cure rates with low recurrence.

Keywords: Endoscopic submucosal dissection; Premalignant gastrointestinal lesion; Noninvasive early gastrointestinal cancer; Neuroendocrine tumor; Gastrointestinal stromal tumor