Endoscopy 2019; 51(04): S190
DOI: 10.1055/s-0039-1681734
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: Colon ESD 3 ePoster Podium 1
Georg Thieme Verlag KG Stuttgart · New York

OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) AT THE ANO-RECTAL JUNCTION AND ILEOCECAL VALVE

F Iacopini
1   UOC Gastroenterology & Endoscopy, Ospedale dei Castelli, Ariccia, Rome, Italy
,
C Grossi
1   UOC Gastroenterology & Endoscopy, Ospedale dei Castelli, Ariccia, Rome, Italy
,
Y Saito
2   Endoscopy Department, National Cancer Center Hospital, Tokyo, Japan
,
W Elisei
1   UOC Gastroenterology & Endoscopy, Ospedale dei Castelli, Ariccia, Rome, Italy
,
T Gotoda
3   Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan
,
G Costamagna
4   Surgical Endoscopy Unit, Policlinico Gemelli Foundation IRCCS, Catholic University Rome, Roma, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

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Aims:

Endoscopic resection difficulty of superficial neoplasms at the perineal rectum is related to the narrowness of the anal canal and high intraoperative bleeding. Resection at the ileocecal valve (ICV) is difficult due to the variable anatomy and the possible neoplasm extension into the terminal ileum. Aim was to assess ESD outcomes of neoplasms at the perineal rectum and ICV.

Methods:

Prospective study (January 2012 to March 2018) in a single center. All consecutive superficial neoplasms > 20 mm in the perineal rectum (margin < 30 mm from the anorectal junction, ARJ) and on ICV lips scheduled for ESD were included. Controls: neoplasms > 20 mm in the pelvic rectum and cecum/ascending colon, respectively. ESD was performed by the standard technique. Follow-up was scheduled at 3 and every 6 months.

Results:

Perineal Rectum. 32 neoplasms in the perineal rectum were compared to 63 controls. ARJ involvement was observed in 14 (44%) perineal cases; a circumferential extension ≥50% in 15 (47%) perineal cases and 4 (7%) controls (P < 0.0001).

ICV: 14 neoplasms at ICV were compared to 96 and 39 in the ascending colon and cecum, respectively. Neoplastic ileal extension was observed in 5 (36%) ICV cases. ESD technical and clinical outcomes are reported in the Table. Adverse events were not different according to location. Perforations occurred in 1 (2.5%) case in the cecum, 2 (2%) in the ascending colon, and 2 (3%) in the pelvic rectum. Residual rate for neoplasms at the ICV and in the cecum was significantly higher than in the ascending colon (P = 0.014 and P = 0.064, respectively). Residual rate for neoplasms in the perineal rectum was higher than in pelvic rectum (P = 0.072).

Conclusions:

ESD at the ICV and perineal rectum is effective but R0 resection rate are < 80% in the cecum and in the perineal rectum. A careful endoscopic follow-up is mandatory.