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내시경점막하박리법을 이용한 대장 종양의 치료: 260예의 초기 성적

Endoscopic Submucosal Dissection for Colorectal Neoplasia: Early Outcomes After 260 Cases

대한대장항문학회지 2009년 25권 3호 p.157 ~ 164
이은정 ( Rhee Eun-Jung ) - 대항병원 외과

이재범 ( Lee Jae-Bum ) - 대항병원 외과
이두한 ( Lee Doo-Han ) - 대항병원 외과
김도선 ( Kim Do-Sun ) - 대항병원 외과
육의곤 ( Youk Eui-Gon ) - 대항병원 외과
이숙희 ( Lee Sook-Hee ) - 대항병원 병리과

Abstract


Purpose: Endoscopic submucosal dissection (ESD), a recently introduced endoscopic technique, makes it possible to perform an en-bloc resection of a lesion regardless of its size. The aim of this study was to report early experiences with colorectal ESD performed in our hospital.

Methods: Between October 2006 and December 2008, we performed an ESD for 260 consecutive cases of colorectal neoplasia in 255 patients. We evaluated the clinical outcomes, except for two failure cases of bowel perforation.

Results: The mean resected tumor size was 24.2±9.8 (5-60) mm. Our overall endoscopic en-bloc resection rate was 93.0% (240/258). and the pathologically margin free rate was 91.5% (236/258). Perforation occurred in 7.7% (20/260) of the cases. In 17 patients, perforation was managed by endoscopic clipping without salvage surgery; the other three patients underwent a laparoscopic operation. Pathological examination showed an adenocarcinoma in 35.4% of the cases (92/260). We recommended additional radical surgery in 13 cases (submucosal invasion less than 1 mm with unfavorable pathology: 1 case; unknown depth of submucosal invasion: 1 case; submucosal invasion ≥1 mm: 9 cases; invasion to proper muscle: 2 cases). We were able to check the recurrence rate through colonoscopy for 125 patients. During the mean follow-up period of 8.0±4.3 (3-21) mo, there were no recurrences.

Conclusions: ESD was technically difficult, had a substantial risk of perforation, and needed a long procedure time. However, ESD enabled en-bloc resection of large colorectal tumors. As experience with the technique increases, ESD might gradually replace piecemeal endoscopic mucosal resection (EMR) and radical colon resection in the treatment of colorectal tumors.

키워드

내시경점막하박리법;내시경점막절제술;대장직장 종양;내시경적 치료
Endoscopic submucosal dissection;Endoscopic mucosal resection;Colorectal tumor;Endoscopic treatment
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