Presentation Information
[SY8-3]Clinical Efficacy and Safety of Endoscopic Submucosal Dissection for Huge Rectal Tumors
*Takashi Akutagawa1, Daisuke Yamaguchi2, Ryo Shimoda1, Motohiro Esaki2 (1. Department of Endoscopic Diagnostics and Therapeutics, Saga University Hospital, Japan, 2. Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University)
Background: Advancements in minimally invasive colorectal treatments have expanded the boundaries of endoscopic and transanal approaches. Technical improvements in endoscopic submucosal dissection (ESD) have enabled the treatment of giant tumors. This study evaluated the safety and clinical characteristics of ESD for giant rectal tumors.
Methods: A total of 81 cases of rectal tumors treated with ESD at our institution between 2015 and 2025 were analyzed. Patients were divided into two groups based on lesion diameter: Group A (≤50 mm, n=56) and Group B (>50 mm, n=25). We compared the treatment outcomes, complications, and patient backgrounds between the two groups. All procedures in Group B were performed by experts with experience in more than 100 ESD cases.
Results: The median procedure time was significantly longer in Group B (187.0 min) than in Group A (56.0 min) (p < 0.001). Conversely, the median dissection speed was significantly higher in Group B (27.14 mm²/min) than in Group A (20.15 mm²/min) (p < 0.05), suggesting that technical proficiency allows for efficient dissection, even in giant lesions. Regarding safety, Group B had significantly higher rates of severe fibrosis (64.0%, p < 0.05) and intraoperative perforation (12.0%, p < 0.05); however, all perforations were successfully managed by endoscopic closure. No significant differences were observed in the depth of invasion or lymphovascular involvement. Regarding patient background, Group B was characterized by a significantly lower BMI (p < 0.05) and a higher rate of regular laxative use (p < 0.05).
Conclusion: ESD for giant rectal tumors remains a challenging owing to the increased risk of fibrosis and perforation. However, advancements in endoscopic closure techniques have allowed for the avoidance of surgical intervention in cases of complications. ESD serves as a potent bridge between endoscopic and surgical resection. For cases where extreme difficulty or severe fibrosis is anticipated, integrating advanced techniques such as per-anal endoscopic myotomy or transanal approaches may further optimize treatment.
Methods: A total of 81 cases of rectal tumors treated with ESD at our institution between 2015 and 2025 were analyzed. Patients were divided into two groups based on lesion diameter: Group A (≤50 mm, n=56) and Group B (>50 mm, n=25). We compared the treatment outcomes, complications, and patient backgrounds between the two groups. All procedures in Group B were performed by experts with experience in more than 100 ESD cases.
Results: The median procedure time was significantly longer in Group B (187.0 min) than in Group A (56.0 min) (p < 0.001). Conversely, the median dissection speed was significantly higher in Group B (27.14 mm²/min) than in Group A (20.15 mm²/min) (p < 0.05), suggesting that technical proficiency allows for efficient dissection, even in giant lesions. Regarding safety, Group B had significantly higher rates of severe fibrosis (64.0%, p < 0.05) and intraoperative perforation (12.0%, p < 0.05); however, all perforations were successfully managed by endoscopic closure. No significant differences were observed in the depth of invasion or lymphovascular involvement. Regarding patient background, Group B was characterized by a significantly lower BMI (p < 0.05) and a higher rate of regular laxative use (p < 0.05).
Conclusion: ESD for giant rectal tumors remains a challenging owing to the increased risk of fibrosis and perforation. However, advancements in endoscopic closure techniques have allowed for the avoidance of surgical intervention in cases of complications. ESD serves as a potent bridge between endoscopic and surgical resection. For cases where extreme difficulty or severe fibrosis is anticipated, integrating advanced techniques such as per-anal endoscopic myotomy or transanal approaches may further optimize treatment.