1% epinephrine
was used. We used hyaluronic acid27 in cases where fibrosis was severe. We injected a solution containing 1% xylocaine with glycerol or hyaluronic acid for painful lesions at the anal verge. ESD was usually Ridaforolimus concentration performed under conscious sedation using diazepam (5–10 mg/body), pethidine hydrochloride (35–70 mg/body), or both. The ESD procedure was performed as described in previous publications.13,14 In cases when a Dual knife was used, incisions were made in the ‘dry cut’ mode (30 W, effect 2) using the VIO300 electrosurgical unit, or ‘endocut’ mode (40 W, effect 2) using the ICC200 electrosurgical unit. Marking of the incision was not usually necessary, since the border between the tumor and normal tissue is quite clear in colorectal tumors after spraying indigocarmine. After adequate submucosal injection, the knife was applied gently on the incision line and an incision was made. Dissection was performed with the ‘swift coagulation’ effect (30 W, effect 4) using VIO300, or ‘forced coagulation’ effect (30 W) using ICC200. First, we dissected into the interior of the tumor. Once adequate space was made under the tumor for the tip hood, the submucosal layer under the tumor could be directly observed. http://www.selleckchem.com/products/LDE225(NVP-LDE225).html Also, if appropriate traction is made by the tip hood under the tumor, the effectiveness of dissection can be increased. An appropriate change of positioning evaginated the dissected tumor, increasing dissection efficiency. Fibrotic parts
needed careful dissection
(Fig. 1). Clinicopathological characteristics of patients are presented in Table 2. Groups did not differ by sex, age, or tumor location. Evaluation of previous histological reports in the residual/locally recurrent group identified 19 cases of adenoma, 12 cases of intramucosal carcinoma (lamina propria invasion). Three cases were unknown diagnoses, because of incomplete mention of the previous endoscopic therapy or inarticulate memory of the treatment history of the patients. Histological evaluation of margins indicated five positive (including residuum), two negative, and 24 unclear margins. In three lesions, previous histological evaluation was unavailable. Clinical outcomes are summarized in Table 3. Mean MCE procedure duration for ESD tended to be slightly longer in the residual/locally recurrent group than in the control group (P = NS). Rate of en bloc resection did not differ between groups (P = NS). In the residual/locally recurrent group, 30 of 34 lesions (88.2%) had histologically confirmed R0 resection in both vertical and lateral margins, while four lesions had Rx due to the presence of severe electro-diathermy injury. No submucosal cancer invasion was apparent in the residual/locally recurrent group. Rate of curative resection tended to be slightly higher in the residual/locally recurrent group (P = NS). Perforation rate was significantly higher in the residual/locally recurrent group than in controls (14.7% [5/34]vs 4.4% [17/384], P < 0.05).