Premium
Salvage endoscopic submucosal dissection for residual or local recurrent intraepithelial neoplasia in the colorectum: a prospective analysis
Author(s) -
Hurlstone D. P.,
Shorthouse A. J.,
Brown S. R.,
Tiffin N.,
Cross S. S.
Publication year - 2008
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2008.01510.x
Subject(s) - medicine , surgery , intraepithelial neoplasia , prospective cohort study , salvage therapy , endoscopic submucosal dissection , stage (stratigraphy) , dissection (medical) , resection , cancer , chemotherapy , prostate , paleontology , biology
Abstract Objective A prospective technical feasibility study of cap assisted ESD for ‘curative intent’ in patients with residual or local neoplastic recurrence following EMR. Primary end points were second stage R0 resection rate, safety and recurrence. Method Salvage ESD was performed using the Olympus GIF‐XQ240 gastroscope and KD‐630L insulation tipped knife. Thirty‐day mortality, re‐admission rates, complications and histological resection status were collected prospectively up to 9 months following index resection. Results Thirty patients met eligibility criteria. Index R0 resection was achieved in 25/30 (83%) lesions. One patient underwent surgical excision with a second receiving a curative second stage dissection. Ninety‐six per cent (29/30) patients were discharged within 24 h of the procedure with a 0% 30‐day mortality and re‐admission rate. Bleeding occurred in 5/30 (16%) treated successfully with endoluminal haemostasis. There were no perforations. Overall ‘cure’ rates at short‐term follow‐up [median 6/12 (range; 3–18)] was 96%. Conclusion This novel application of ESD for first line ‘salvage’ therapy in treating residual or locally recurrent neoplastic disease may be a safe, minimally invasive and cost effective alternative to direct surgical resection in a select patient cohort.