Endoscopic Resection of Laterally Spreading Tumours of the Large Intestine Using a Distal Attachment

Background and Study Aims: Among colorectal neoplasms, laterally spreading tumors (LSTs) are lesions over 10 mm in diameter that are low in height and grow superficially. As most LSTs are adenomas or mucosal carcinomas, endoscopic resection is desirable, but this has been not easy because of their flat and wide shape. The aim of this study was to explore the usefulness of a distal attachment to the endoscope in the endoscopic resection of LSTs.

Patients and Methods: The study population consisted of 23 patients with an LST of the large intestine. Using a distal attachment fitted to the distal end of the endoscope, saline solution with a low concentration of epinephrine was injected underneath the lesion. The lesion was snared and drawn into the cap using the suction function of the endoscope, and then ligated and resected using electrocautery.

Results: The size of the lesions ranged from 1 cm to 5 cm. Endoscopic resection was completed in 22 of 23 patients. Resection in one segment was successful in 15 of 22 patients; in the remaining seven patients, piecemeal resection was done. Pathological investigation showed hyperplasia in one patient, adenoma in 20 (with mild atypia 1, moderate atypia 11, severe atypia 8), and mucosal carcinoma in one patient. Complications occurred in two patients, with one instance of perforation and another of bleeding. Both were successfully treated with endoscopic clipping. Recurrent adenoma was detected in one patient.

Conclusion: We conclude that the distal attachment was very useful for endoscopically resecting LSTs of the large intestine.

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