Endoscopic Submucosal Dissection (ESD) for Large Laterally Spreading Tumors in the Rectum: Experience in 30 Cases

Endoscopic submucosal dissection (ESD) provides an "en bloc" specimen of even large laterally spreading mucosal tumors. 30 patients, with a single flat or elevated polyp over 2 cm in the rectum were treated by ESD. Results: 27 of 30 lesions could macroscopically be resected as "en bloc" specimen (90%). Relevant complications occurred in 2 patients (6.6%; 1 delayed perforation with subsequent vacuum sponge treatment, 1 delayed bleeding after 11 days). In 3 patients mild complications occurred (10%). All could be treated conservatively. Procedure related mortality was 0%. However, 1 patient with severe co-morbidity encountered a stroke and died 4days after the procedure. After a median follow-up period of 199days (9-1418days) one possible recurrence close to the scar in the rectum was detected and successfully resected (R0). ESD offers not only in Japan but also. in the Western World a reliable treatment option even for large laterally spreading rectal polyps. It seems also suitable for patients at elevated surgical risk. Due to the retrieval of an "en bloc" specimen and because of the low local recurrence rate ESD seems to be the oncologically by far preferrable procedure over standard "piecemeal" resection especially because of the high rate of early cancers in large rectal polyps.