Prospective Cohort Study for Endoscopic Treatment of Large Early Colorectal Neoplasia Conducted by the Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum Takeshi Nakajima 1,2 , Yutaka Saito 1,2 , Shinji Tanaka 1,3 , Hiroyasu Iishi 1 , Shin-ei Kudo 1 , Hiroaki Ikematsu 1 , Masahiro Igarashi 1 , Yusuke Saito 1 , Yuji Inoue 1 , Kiyonori Kobayashi 1 , Takashi Hisabe 1 , Hiro-o Yamano 1 , Osamu Tsuruta 1 , Yasushi Sano 1 , Seiji Shimizu 1 , Naohisa Yahagi 1 , Toshifumi Mitani 1 , Hisashi Nakamura 1 , Toshiaki Watanabe 1 , Takahiro Fujii 1 , Takahiro Fujimori 1 , Akinori Iwashita 1 , Yoichi Ajioka 1 , Hideki Ishikawa 1 , Takahisa Matsuda 1,2 , Kenichi Sugihara 1 1The Colorectal Endoscopic Resection Standardization Implementation Working Group in Japanese Society for Cancer of the Colon and Rectum, Tokyo 2Endoscopy Division, National Cancer Center Hospital, Tokyo 3Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan Keyword: EMR , endoscopic mucosal resection , ESD , endoscopic submucosal dissection , colorectal cancer , colorectal neoplasia pp.197-204
Published Date 2013/2/25
DOI https://doi.org/10.11477/mf.1403113726
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 CER(conventional endoscopic resection)for early CRN(colorectal neoplasia)is widely accepted as a minimally invasive treatment but has limitations when resecting large CRN en bloc. ESD(endoscopic submucosal dissection)was developed in Japan to resect larger lesions. In addition, treatment strategies vary considerably among medical facilities. To evaluate the current situation in Japan regarding endoscopic treatment of CRNs 20mm or larger, we conducted a prospective multicenter study at 18 specialized facilities in cooperation with JSCCR(Japan Society for Cancer of the Colon and Rectum). From October 2007 to December 2010, CERs and ESDs were performed on 1,845 CRNs(CERs, 1,029 ; ESDs, 816). En bloc resection rates and mean procedure times for CER/ESD were 56.9%/94.5%(<0.01)and 18±23min/96±69min, respectively. The average ESD procedure time was 129±83min in the≧40mm group. As lesion size increased, the CER en bloc resection rate decreased significantly(trend <0.01), but the ESD en bloc resection rate remained over 93%. Perforation and delayed bleeding rates of CER/ESD were 0.8%/1.6%(<0.05)and 2.0%/2.2%(=0.30), respectively. Despite longer procedure time, colorectal ESD was believed to improve safety in various facilities in Japan, but due to the longer procedure time, ESD for lesions 40mm and larger must be performed by experienced endoscopists.

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