Endoscopic mucosal resection of colorectal tumors: Our first experience

Abstract

Background/Aim. Endoscopic mucosal resection (EMR) or mucosectomy is an interventional procedure for minimal invasive endoscopic removal of benign and malignant digestive tract tumors. Mucosectomy removes flat and sessile neoplasms, early colorectal cancer (CRC) confined to mucosa or submucosa and lateral spreading tumors. The aim of the study was to show our first experience in application of this procedure in everyday practice in regarding completeness and efficacy of the procedure, complication rate and incidence of recurrent adenomas. Methods. In the prospective study 51 colorectal adenomas were removed in 44 patients by EMR. Results. Single mucosectomy was done in 43 patients, while multiple (8) in one patient. Complete resection was obtained in all procedures. In 36 (68.62%) procedures ?en block? resection was done, but in 15 (31.37%) procedures ?piece meal? resection was performed. Synchronous colorectal tumors (benign or malignant) were detected in 20 (45.45%) patients. Moderate dysplasia was found in 30 (58.82%) adenomas, but high grade dysplasia in 9 (17.64%) of adenomas. Intramucosal CRC was detected in 11.77% of adenomas. A total of 37 (72.54%) advanced adenomas were removed. There were 3 (5.88%) of recurrent adenomas, 6-30 months after the EMR. Only one (2.2%) case of post procedure bleeding was observed. Conclusion: EMR is a safe and efficious method for removal of flat, sessile adenomas, as well as early CRC. EMR is a routine endoscopic procedure in everyday practice of interventional endoscopist.Uvod/Cilj. Endoskopska mukozna resekcija (EMR) ili mukozektomija je interventna procedura za minimalno invazivno endoskopsko uklanjanje benignih i malignih tumora digestivnog trakta. Mukozektomijom se uklanjaju zaravnjene i sesilne neoplazme, rani kolorektalni karcinomi (CRC) ograniceni na mukozu ili submukozu i tumori koji se lateralno sire. Cilj ovog rada bio je da se pokazu nasa prva iskustva u primeni ove metode u svakodnevnoj praksi, koja se odnose na kompletnost i efikasnost procedure, stopu komplikacija i incidenciju rekurentnih adenoma. Metode. Prospektivnom studijom obuhvacena su 44 bolesnika oba pola, kod kojih je metodom EMR uklonjen 51 kolorektalni adenom. Rezultati. Kod 43 bolesnika uradjena je jedna mukozektomija, a kod jednog bolesnika 8 mukozektomija. U svim procedurama postignuta je potpuna resekcija tumora. U 36 (68,62%) procedura uradjena je ?en block? resekcija, a u 15 (31,37%) ?piece meal? (?deo po deo?) resekcija. Kod 20 (45,45%) bolesnika otkriveni su sinhroni kolorektalni tumori (benigni ili maligni). Najveci broj adenoma bio je sa displazijom umerenog (30 ili 58.82%), i teskog (9 ili 17,64%) stepena. Intramukozni CRC otkriven je kod sest (11,77%) adenoma. Kod pet (11,36%) bolesnika mukozektomirano je sest intramukoznih CRC. Uklonjeno je 37 (72,54%) uznapredovalih adenoma. U vremenskom periodu od 6 do 30 meseci od mukozektomije recidivirala su tri (5,88%) adenoma. Krvarenje kao komplikacija mukozektomije verifikovano je kod jednog (2,2%) bolesnika. Zakljucak. EMR je sigurna i bezbedna za uklanjanje zaravnjenih i sesilnih adenoma, kao i ranih CRC, i predstavlja rutinsku endoskopsku proceduru u svakodnevnoj praksi interventnog endoskopiste. PR Projekat Ministarstva nauke Republike Srbije, br. III44004