The Clinical Study Of Endoscopic Submucosal Dissection In The Treatment Of Laterally Developmental Tumors Of The Large Intestine

Objective:To compare the clinical efficacy of endoscopic submucosal dissection(ESD)and endoscopic submucosal dissection combined with snare(ESD-S)in the treatment of colorectal laterally spreading tumors(LST).Methods:Study the patients of LST retrospectively.Record patients'basic information and analyze the relationship between their age,gender,diseased region,the size of nidus and morphological classification,Pit pattern classification and the histological type.To compare the curative effect of ESD and ESD-S,the operation time,en bloc resection rate,complete excision rate,bleeding rate,punching rate,recurrence rate were compared.Results:(1)?.Sex and Age:A total of 82 LST patients were included.There were 39(23 female)patients aged 62±10.5 in the group of ESD.Forty-three patients(22 female)aged 61.1 ± 10.6 were in the group of ESD-S.?.Size of the lesion:The size of the lesion in group ESD was 1.2 cm to 6.0 cm(2.84 + 0.94cm)while the ESD-S group was 1.5cm to 7.0cm(2.91+ 1.09cm).There were no statistical difference between the two groups of the size of the lesion(P = 0.929)and the pathomorphology of the pathological tissue.?.Location:41.4%were rectum,20.7%were ascending colon,13.8%were descending colon,11.5%were transverse colon and 12.6%were sigmoid colon.?Morphological classification:In the cases of 87 LST patients,65 patients(74.7%)were LST-G,3 patients(3.4%)were LST-NG-PD.?Histological type:37 cases of LST lesions were tubular adenoma,of which 42.5%were intraepithelial neoplasia in the low grade of tissue heterotypic.In the lesion of villous adenoma,66.7%lesions were in high grade.There was significant difference between the histological types of LST-G and LST-NG(P<0.05).?.Pit pattern:Overall,most were type ? L(26/87)and type ?(42/87)while there were only 8 and 6 cases in type ?s and ? respectively.In type?L,tubular adenomas accounted for 61.5%.In type ?,mixed adenoma and villous adenoma were in large proportion.? Canceration:The rate of LST canceration in these 87 cases were 3.4%.Among the four subtypes of gross morphological classification,the rate of canceration of pseudo depressed type is 33%.In the four type of histological type,the canceration rate of the false depression was 33%.The cancerous lesions were all pit pattern V type,and the corresponding histology were villous adenoma.(2)Curative effect:there were no statistically significance between the two groups of their age,sex,lesion location,lesion size,morphological classification,Pit patterns,tissue types.?Operation time:two groups did not have statistical differences(t =3.110,P = 0.003).When the lesion diameter were<3cm,the operation time were 63.1 + 18.5 and 39 + 12((t<3cm = 5.202,P<0.05));when the lesions were>3cm,two groups of operation time had no significant difference(t>3cm= 1.629,P>0.05).?.The total resection rate,complete resection rate,bleeding rate,perforation rate and recurrence rate were not statistically significant(P>0.05)when the diameter of the lesions were less than 3cm.The complete resection rate of ESD group was superior to that of the ESD-S group and the differences are statistically significant P = 0.035,while in the en bloc resection rate,bleeding rate,perforation rate,recurrence rate between the two groups were not statistically significant(P>0.05).?.The location of the lesion was not statistically significant for the treatment of ESD and ESD-S.Conclusion(s):LST is a special type of colorectal tumor,which closely related to the occurrence of large intestine cancer.LST is easier to attack the rectum and mostly are LST-G.There were significant differences in clinicopathological differences between the subtypes.LST-G is most tubular adenoma while LST-NG is more common in mixed adenoma and villous adenoma.Especially pseudo depressed type,it has a higher rate of malignant transformation and a higher degree of malignancy,and it is easily missed diagnosis,so it is worth clinical attention.Endoscopic treatment of LST is an effective treatment.Although ESD has high operative risk and need long operation time,it is a safe and effective method for the treatment of colorectal LST lesions,especially for large diameter lesions.For the LST lesions<3cm,ESD-S can achieve similar effect to ESD,and can reduce the operation time and operation difficulty,which can be a selective endoscopic treatment of LST lesions for young endoscope physicians to do endoscopic treatment.