Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Feasibility and safety of endoscopic submucosal dissection for lesions in proximity to a colonic diverticulum

  • Nobuaki Ikezawa (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Takashi Toyonaga (Department of Endoscopy, Kobe University Hospital) ;
  • Shinwa Tanaka (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Tetsuya Yoshizaki (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Toshitatsu Takao (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Hirofumi Abe (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Hiroya Sakaguchi (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Kazunori Tsuda (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Satoshi Urakami (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Tatsuya Nakai (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Taku Harada (Department of Gastroenterology, Teine Keijinkai Hospital) ;
  • Kou Miura (Department of Gastroenterology, Yoka Municipal Hospital) ;
  • Takahisa Yamasaki (Department of Gastroenterology, Yoka Municipal Hospital) ;
  • Stuart Kostalas (Department of Gastroenterology, Port Macquarie Base Hospital) ;
  • Yoshinori Morita (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University) ;
  • Yuzo Kodama (Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University)
  • Received : 2021.09.28
  • Accepted : 2021.12.24
  • Published : 2022.05.30
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Abstract

Background/Aims: Endoscopic submucosal dissection (ESD) for diverticulum-associated colorectal lesions is generally contraindicated because of the high risk of perforation. Several studies on patients with such lesions treated with ESD have been reported recently. However, the feasibility and safety of ESD for lesions in proximity to a colonic diverticulum (D-ESD) have not been fully clarified. The aim of this study was to evaluate the feasibility and safety of D-ESD. Methods: D-ESD was defined as ESD for lesions within approximately 3 mm of a diverticulum. Twenty-six consecutive patients who underwent D-ESD were included. Two strategic approaches were used depending on whether submucosal dissection of the diverticulum-related part was required (strategy B) or not (strategy A). Treatment outcomes and adverse events associated with each strategy were analyzed. Results: The en bloc resection rate was 96.2%. The R0 and curative resection rates were 76.4% and 70.6% in strategy A and 88.9% and 77.8% in strategy B, respectively. Two cases of intraoperative perforation and one case of delayed perforation occurred. The delayed perforation case required emergency surgery, but the other cases were managed conservatively. Conclusions: D-ESD may be a feasible treatment option. However, it should be performed in a high-volume center by expert hands because it requires highly skilled endoscopic techniques.

Keywords

References

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