Efficacy of endoscopic mucosal resection with circumferential incision for patients with large colorectal tumors.

BACKGROUND & AIMS: Treatment of large colorectal neoplasms (>20 mm in diameter) by conventional endoscopic mucosal resection (EMR) often results in piecemeal resection that requires further intervention. We evaluated the efficacy of EMR with circumferential incision (CEMR).

METHODS: From March 2008-July 2009, we resected 24 large colorectal neoplasms measuring 20-40 mm in diameter by using the CEMR technique. CEMR was performed by using a ball-tip bipolar needle knife with a snaring technique. After the injection of glycerol into the submucosal layer, a circumferential incision was made, and the neoplasm was resected by snaring. All lesions that showed a noninvasive pattern were diagnosed by magnifying chromoendoscopy as adenomas or intramucosal or submucosal superficial cancers. The number of en bloc resections and complications and the overall procedure time were determined.

RESULTS: The proportions of en bloc and 2-piece resections by CEMR were 67% (16/24) and 17% (4/24), respectively. The median (interquartile range) time for CEMR completion was 40 minutes (30-63 minutes). No postsurgery complications occurred in any patient.

CONCLUSIONS: CEMR might provide acceptable clinical outcomes for patients with large colorectal neoplasms. It results in a low incidence of incomplete treatments and low risk of complications.