| Part one:Endoscopic submucosal dissection for colorectal neoplasms in elderly patientsObjective:To investigate the safety and effectiveness of endoscopic submucosal dissection in elderly patients(?65 years old) with colorectal neoplasms.Methods:Patients adimitted from May 2013 to June 2015 who were found to have colorectal mucosal lesions by colonoscopy and underwent ESD treatment were retrospectively studied. All the 102 patients were divided into two groups according to age:the elderly group (?65 years old) and the non-elderly group(<65 years old), and the characteristics of patients and lesions (age, sex, symptoms, comorbidity, lesion size, lesion location and pathological diagnosis), the outcome of ESD (en bloc resection rate, curative resection rate, complication rates including perforation and bleeding), and the outcome of follow-up (post-ESD ulcer-healing, local recurrence and residual) were compared between the elderly group and the non-elderly group.Results:1.Forty-one cases were classified as elderly, and Sixty-one cases were classified as non-elderly. The average ages of the elderly group and the non-elderly group were (72.0±5.7) and (51.7±10.1) years respectively, and there was significant difference between the two groups(P<0.001). The total incidence of comorbidities, the incidence of hypertension, and the incidence of diabetes in the elderly group were significantly higher than those in the non-elderly group (P<0.05). There were no statistical differences between the two groups in sex ratio, symptoms, lesion location, lesion size and pathological diagnosis (P>0.05).2. En bloc resection rates were 92.7%(38/41) in elderly group and 96.9%(63/65) in non-elderly group, and the difference was not significant statistically (P=0.594). Curative resection rates were 85.4%(35/41) in elderly group and 86.1%(56/65) in non-elderly group respectively, and there were no statistical differences between the two groups (P= 0.910). Postoperative bleeding occurred in 3 patients in the elderly group and 5 patients in the non-elderly group, and the rates were 7.3% and 7.7% respectively. In the elderly group, perforation occurred in 3 cases with 1 perforation during ESD procedure and 2 perforation after ESD, and the perforation rate was 7.3%. In the non-elderly group, perforation occurred in 2 cases with 1 perforation during ESD procedure and 1 perforation after ESD, the perforation rate was 3.0%. Postoperative infection occurred in 1 case in elderly group with the rate of 2.4%, and 1 case in the non-elderly group with the rate of 1.5%. There were no statistical differences between the two groups in postoperative bleeding rate, perforation rate and postoperative infection rate (P>0.05). There was no ESD-related death in both groups. One of the postoperative bleeding cases was treated with endoscopic hemostatic clips, and the others were all treated conservatively. All perforations were managed successfully with endoscopic treatment. All postoperative infection was treated conservatively.3. The follow-up rates were 90.2%(37/41) in the elderly group and 95.1%(58/61) in the non-elderly group. There was no significant difference between two groups (P=0.584). The mean time of follow-up were (8.3±0.9) months in elderly group and (8.0±1.3) months in non-elderly group, and there was no significant difference between two groups(P=0.238). During the follow-up, post-ESD ulcer-healing rates were 100% in both elderly group and non-elderly group. No residual lesion or recurrent lesion was found through the follow-up in both groups.Conclusion:Endoscopic submucosal dissection is a safe and effective treatment for the elderly patients (?65 years old) with colorectal lesion.Part two:Risk factors for complication of endoscopic submucosal dissection for colorectal neoplasmsObjective:To investigate the risk factors for complication of endoscopic submucosal dissection for colorectal neoplasms.Methods:One hundred and two patients adimitted from May 2013 to June 2015 who were found to have colorectal mucosal lesions by colonoscopy and underwent ESD treatment were retrospectively studied. The potential risk factors for ESD-related perforation and postoperative bleeding including age, sex, symptoms, comorbidity, lesion size, lesion location, pathological diagnosis and en bloc resection were analyzed respectively by univariate analysis. Logistic regression analysis was used to assess the independent risk factors for perforation and postoperative bleeding of endoscopic submucosal dissection for colorectal neoplasms.Results:1. Perforation was found in 5 patients, and the rate was 4.9%. Two of them occurred during ESD procedure and 3 occurred after ESD. There were 8 cases of delayed bleeding after ESD and the bleeding rate was 7.8%.2. Univariate analysis revealed that the factors including age, sex, the total incidence of comorbidities, the incidence of hypertension, the incidence of cardiac disease, the incidence of diabetes, lesion size, lesion located in left colon or rectum, pathological diagnosis and en bloc resection were not significantly associated with perforation of colorectal ESD(P>0.05). Lesion located in right colon and more than two comorbidities were significantly associated with perforation (P<0.05), increasing the risk of perforation. Logistic regression analysis revealed that more than two comorbidities was an independent risk factor for perforation of colorectal ESD (B= 2.055, OR= 7.807, 95% CI:1.097?55.546, P=0.040).3. Univariate analysis revealed that the factors including age, sex, the incidence of comorbidities, lesion size, lesion location, pathological diagnosis and en bloc resection were not significantly associated with postoperative bleeding of colorectal ESD(P>0.05)Conclusion:Lesion located in right colon and more than two comorbidities were significantly associated with perforation, increasing the risk of perforation. And more than two comorbidities was an independent risk factor for perforation of colorectal ESD. |
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