ENDOSCOPIC AND HISTOPATHOLOGICAL CHARACTERISTICS AND TREATMENT OUTCOMES OF LARGE COLORECTAL POLYPS AND EARLY COLORECTAL CANCER USING ENDOSCOPIC SUBMUCOSAL DISSECTION IN CAN THO CITY, 2024–2026
Main Article Content
Abstract
Background: Large colorectal polyps have a high risk of harboring advanced neoplasia and early colorectal cancer. Endoscopic submucosal dissection (ESD) allows en bloc resection of lesions and accurate histopathological assessment. The JNET classification supports the prediction of histopathological characteristics before intervention; however, its clinical applicability in Vietnam has not been fully evaluated. Objectives: To describe the endoscopic characteristics, histopathological findings, and treatment outcomes of ESD, and to evaluate the predictive value of the JNET classification for histopathological diagnosis in large colorectal polyps. Materials and methods: A cross-sectional descriptive study was conducted on 42 large colorectal polyps treated with ESD. Results: The mean age was 60.7 ± 13.7 years, and males accounted for 52.4%. The most common lesion location was the rectum (28.6%), followed by the hepatic flexure (19.0%) and sigmoid colon (16.7%). Laterally spreading tumors (LSTs) accounted for 52.4% of lesions. According to the JNET classification, JNET 2A and JNET 2B accounted for 61.9% and 38.1%, respectively. Histopathological examination revealed tubular adenoma in 50.0%, tubulovillous adenoma in 26.2%, villous adenoma in 4.8%, and carcinoma in 19.0%. JNET 2B predicted precancerous lesions and early colorectal cancer with a sensitivity of 80.0%, specificity of 85.2%, positive predictive value of 75.0%, negative predictive value of 88.5%, and accuracy of 83.3%. The mean procedure time was 72.98 ± 38.15 minutes. The en bloc resection rate was 97.6%. Intra-procedural bleeding occurred in 9.5% of cases, with no intra-procedural perforation. Post-procedural perforation occurred in one case (2.4%) and was successfully managed by laparoscopic surgery. Conclusion: ESD is an effective and safe treatment for large colorectal polyps, with a high en bloc resection rate and an acceptable complication rate. The JNET classification is useful in supporting the prediction of precancerous lesions and early colorectal cancer before intervention; however, post-ESD histopathological examination remains the gold standard for definitive diagnosis.
Keywords
large colorectal polyps, early colorectal cancer, endoscopic submucosal dissection (ESD), JNET classification, magnifying endoscopy
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