Chapter 8

Efficacy and Safety of Endoscopic Submucosal Dissection Using A Scissors-Type Knife for Early Colorectal Neoplasms

Toshio Kuwai, Toshiki Yamaguchi, Atsushi Yamaguchi, Hirotaka Kouno and Hiroshi Kohno

Abstract

To reduce the risk of adverse events related to colorectal endoscopic submucosal dissection (ESD) using a conventional knife, we used a scissors-type knife (SB Knife Jr.) that allowed us to prevented unexpected muscular-layer injury.

The aims of our study were to evaluate the efficacy and safety of ESD using a SB Knife Jr. for early colorectal neoplasms. 121 lesions in 115 patients (M: F=63: 52; median age=68) were resected with ESD using a SB Knife Jr. from October 2010 to March 2014. We evaluated en bloc resection rate, complete resection rate, size of tumor, adverse events and local recurrence rate.

The sites of the neoplasms included the following: 39 lesions were located in the right colon; 38 in the left colon; and 44 in the rectum. By histological examination, 57 lesions were intramucosal cancers, 14 slightly submucosal cancers (<1,000 μm), 15 massively submucosal invasive cancers (>1,000 μm), and 35 tubular adenomas. All lesions were treated safely without unexpected incision. The en bloc resection rate was 96.7% (117/121), and the complete resection rate was 95.0% (115/121). The mean size of the resected tumors was 32.1 mm (range, 7-120 mm), respectively. With regard to adverse events, there were no perforations, and postoperative bleeding occurred in 5 cases (4.1%). All cases were controlled by endoscopic hemostasis. During a median follow-up duration of 15.5 months, local recurrence rate was 0% (0/121).

ESD using a SB Knife Jr. can be adequately adopted as a technically efficient method for resecting early colorectal neoplasms.

Total Pages: 73-79 (7)

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