Endoscopy 2014; 46(08): 670-676
DOI: 10.1055/s-0034-1365810
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic submucosal dissection for superficial rectal tumors: prospective evaluation in France

Gabriel Rahmi
1  Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
2  Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
,
Bilal Hotayt
1  Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
2  Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
,
Stanislas Chaussade
2  Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
3  Department of Gastroenterology and Digestive Endoscopy, Cochin Hospital, Gastroenterology Department, Assistance Publique – Hôpitaux de Paris, Paris, France
,
Vincent Lepilliez
4  Department of Gastroenterology and Digestive Endoscopy, Edouard Herriot Hospital, Lyon, France
,
Marc Giovannini
5  Department of Digestive Endoscopy, Institut Paoli-Calmettes, Marseille, France
,
Dimitri Coumaros
6  Department of Gastroenterology and Digestive Endoscopy, Nouvel Hôpital Civil, Strasbourg, France
,
Antoine Charachon
7  Department of Gastroenterology and Digestive Endoscopy, Henry Mondor Hospital, Paris, France
,
Franck Cholet
8  Department of Gastroenterology and Digestive Endoscopy, Centre Hospitalier Régional de Brest, Brest, France
,
Arthur Laquière
9  Department of Gastroenterology and Digestive Endoscopy, Saint Joseph Hospital, Marseille, France
,
Elia Samaha
1  Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
2  Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
,
Frédéric Prat
2  Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
3  Department of Gastroenterology and Digestive Endoscopy, Cochin Hospital, Gastroenterology Department, Assistance Publique – Hôpitaux de Paris, Paris, France
,
Thierry Ponchon
4  Department of Gastroenterology and Digestive Endoscopy, Edouard Herriot Hospital, Lyon, France
,
Erwan Bories
5  Department of Digestive Endoscopy, Institut Paoli-Calmettes, Marseille, France
,
Michel Robaszkiewicz
8  Department of Gastroenterology and Digestive Endoscopy, Centre Hospitalier Régional de Brest, Brest, France
,
Christian Boustière
9  Department of Gastroenterology and Digestive Endoscopy, Saint Joseph Hospital, Marseille, France
,
Christophe Cellier
1  Department of Gastroenterology and Digestive Endoscopy, Georges Pompidou European Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France
2  Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France
› Author Affiliations
Further Information

Publication History

submitted 18 October 2013

accepted after revision 24 March 2014

Publication Date:
30 June 2014 (eFirst)

Background and study aims: Endoscopic submucosal dissection (ESD) provides a high en bloc resection rate for superficial colorectal tumors. The aims of this study were to assess the feasibility of ESD in France and to evaluate the complete resection rate at 1 year.

Patients and methods: Patients with superficial rectal tumors ≥ 10 mm in size were prospectively included in the study at nine French expert centers between February 2010 and June 2012. The study was stopped temporarily because of a high complication rate. Study recruitment resumed following remedial action.

Results: A total of 45 patients were included (mean age 67 years; 24 males). The immediate perforation rate was 18 % (n = 8), and salvage surgery was not required. Six patients (13 %) had late bleeding, which was treated endoscopically in five patients and surgically in one patient who had required blood transfusion. The mortality rate was zero. The en bloc resection rate was 64 % (29/45), and the curative R0 resection rate was 53 % (24/45). Three patients (7 %) had an invasive tumor (two sm1, one T2). At 1-year follow-up, endoscopic examinations showed complete resection in 38 /43 patients (88 %). At the end of the study, after the remedial action, the en bloc resection rate had increased from 52 % to 82 %, and the perforation rate had decreased significantly from 34 % to 0 %.

Conclusions: The study reflects the initial prospective experience of ESD in France, and suggests that curative R0 resection rates should increase and complication rates should decrease with experience and corrective actions.