Safety and efficacy of endoscopy therapy for early colorectal carcinoma

Objective To evaluate safety and efficacy of endoscopy therapy for early colorectal carcinoma of different types. Methods Clinical data of 113 patients with early colorectal carcinoma who were treated with different endoscopic therapies including polypectomy, EMR and ESD (ESD with snare and standard ESD) were retrospectively analyzed. The size, en bloc resection rate, curative resection rate, procedure time, associated complications and recurrence rate were compared among groups. Results Eleven pedunculated lesions were treated with polypectomy or EMR, which were en bloc resected and curative resected with no complication or local recurrence. Nineteen semi-pedunculated lesions were treated with EMR or ESD with no complications. Lesions treated with EMR were smaller than those of ESD(P=0.026), and had a lower en bloc resection rate[77.8% (14/18)VS 1/1, P=1.000]. The difference of curative resection rate and recurrence rate between groups was not significant (P>0.05). Eighty-three sessile lesions were treated with all three procedures. Lesions treated with ESD were larger than EMR (P=0.000), with a higher curative resection rate than EMR[95.5% (42/44) VS 77.8%(28/36), P=0.041] and a longer procedure time than EMR (P=0.000). There were no significant difference in severe complications[9.1%(4/44) VS 0], en bloc resection rates and recurrence rates(P>0.05). Ten lesions treated with ESD-S had a medium size between EMR and standard ESD group, with a significant shorter procedure time than standard ESD group (36.9±24.7 min VS 120.4±152.3 min, P=0.004). They were en bloc resected and complete resected. Conclusion Endoscopic treatment is safe and effective for early stage colorectal carcinoma. In order to get en bloc curative resection, endoscopists should carefully choose a suitable technique based on the macroscopic morphology of lesions. ESD-S can be used as a transitional method from EMR to ESD. Key words: Endoscopic therapy; Early colorectal carcinoma; Endoscopic submucosal dissection; Endoscopic mucosal resection; Polypectomy