대한대장항문학회

Purpose : Endoscopic mucosal resection (EMR) or endoscopic piecemeal mucosal resection<br>(EPMR) is a useful method for treating benign neoplastic lesions and selected cases of early<br>colorectal cancers, especially those cancers with flat or depressed shapes. However, clinical<br>data concerning EMR or EPMR are still lacking. Accordingly, we designed this study to<br>review and analyze our cases for more information and in order to achieve more adequate and<br>prudential application. Methods : We performed 2609 colonoscopic polypectomies from January<br>1997 to December 1998. Among those, 77 lesions (3.0%) were treated by using the EMR or<br>the EPMR technique. We analyzed those 77 lesions with special reference to size,<br>configuration, and histologic diagnosis. Results : The most common age group was the 5th<br>decade. The male-to-female ratio was 1.75：1. The most common sites of the lesions were<br>the rectum and the sigmoid colon. Most of the lesions were equal to or smaller than 15 mm<br>in size (97.4%). Flat, elevated lesions were the most common type (39%), followed by sessile<br>(31.2%) and depressed (18.2%) lesions in order. Adenomas and adenocarcinomas accounted<br>for 51.9% (40/77) of the lesions and the malignancy rate was 9.1% (7/77). Three were<br>submucosal cancers. Seventy-one percent of the carcinomas were less than 10 mm in size,<br>and the only submucosal cancer was below 5 mm in size and was a depressed lesion.<br>Carcinoid tumors accounted for 15.6% of the lesions, and chronic nonspecific inflammation for<br>9.1%. An EPMR was performed on 4 lesions which were larger than 10 mm. There were no<br>complications such as bleeding, perforation, or recurrence. Conclusions : EMR and EPMR are<br>useful endoscopic resection techniques, especially for sessile, flat, and depressed neoplastic<br>lesions. Lesions up to 15∼20 mm in size are good candidates for EMR and those up to 40<br>mm for EPMR. At the same time, a carefully performed procedure is mandatory to prevent<br>recurrence or complications such as bleeding or perforation.<br>