Introducere: 40-57 % din neoplaziile mucoasei rectocolonului sunt non-polipoide, histologic în majoritate adenome.
CCR neinvaziv are o ratã nulã sau practic nulã de afecåiune limfaticã. REM æi DES reprezintã tratamentul miniminvaziv
radical al lor. Scopul studiului: Implementarea practicã a tehnologiilor avansate în tratamentul neoplaziilor
precanceroase æi a CCR neinvaziv. Aprecierea fezabilitãåii æi eficacitãåii mucozectomiei endoscopice (ME).
Pacienåi æi metode: Am tratat (aa.2006-2011) endoscopic 40 pacienåi cu 49 neoplazii a colonului şi rectului. În studiu
s-au inclus neoplaziile 0-Ip dificile (n=3), 0-Is (n=24); 0-IIa(n=14), 0-IIb(n=3), 0-IIc+IIa(n=3) æi 0-IIa+Is(n=2)
(Paris 2002), cu lifting-semn pozitiv. Neoplaziile >20 mm în colonul ascensdent, transvers, descendent şi cecum,
polipectomia clasicã în neoplaziile Ip nu au fost incluse în studiu. Dimensiunile neoplaziilor: 3-20mm(n=27), 21-
40mm(n=17), 41-56mm(n=5). REM – 44, DES - 5. REM B(prin bandare) - 14, REM DC(dublu canal) - 12, REM
A(cu ansa) -18.
Rezultate: ME en bloc - 31(63,3%). R0 - 32 (65,3%), Rx – 16(32,6%), recidivã (n=1). R1 – un caz (2,0%), recidivã
(n=1). Ambele tratate prin reME. 12 luni supraveghere - rerecidivã abs. Dificultãåi tehnice: neoplaziile ce implicã
valvula Baughin (n=1), canalul rectal (n=2), multiple (n=4) şi recidivante (n=2). DES en bloc (R0) s-a obåinut în
4 cazuri, pe fragmente (R0) în 1 caz. Complicaåii: hemoragii intraoperatorii 6(4(DES); 2(REM DC)), stopate
endoscopicã: clampare (n=4), electrocoagulare şi injectare localã de trombinã umanã (n=2); perforaåii – 2, tratate
intraoperator prin clampare.
Concluzii: 1. ME este o alternativã sigurã de tratament a neoplaziilor precanceroase şi CCR neinvaziv. 2. În neoplaziile
neinvazive >20 mm este indicatã DES. 3. REM A este aplicabilã pe tot traseul colonului, induce o ratã
sporitã a ME pe fragmente. 4. REM B este sigurã pentru aplicare în regiunea ampulei rectale şi intestinului
sigmoid. 5. REM DC este sigurã, bine controlatã, dar implicã artefacte în analiza histologicã.
 

Introduction: 40 to 57% of precancerous neoplasms in the colon and rectum are non-polipoid, histological they are
adenomas. Non-invasive early colorectal cancer has a 0 or almost 0 rate of lymphatic affection. EMR and ESD
represent radical, minim-invasive treatment of them. Aim: The implementation of advanced technologies in the
treatement of precancerous neoplasms and ECC. Assessing the fesability and efficacity of the endoscopic mucosectomy(
EM).
Patients and methods: We treated endoscopicaly 40 pts with 49 neoplasms of the colon and rectum (years 2006-
2011). In the present study included only 0-Is difficult (n=3), 0-Is (n=24); 0-IIa (n=14), 0-IIb (n=3), 0-IIc+IIa
(n=3) and 0-IIa+Is (n=2) (Paris 2002), with positive lifting sign. Neoplasms >20 mm in the ascendant, transverse
colon and cecum, the classical polypectomy in Ip neoplasms were not included in the study. Dimensions
of neoplasms: 3-20 mm (n=27), 21-40 mm (n=17), 41-56 mm (n=5). EMR–44. ESD-5. EMR B (banding)-14,
EMR DC (dual channel) -12. EMR S(with snare) -18.
Results: En bloc ME - 31(63,3%) . R0 resection was achieved in 32 (65,3%) cases, Rx - 16(32,6%), recidiv (n=1),
R1 – 1(0,2%), recidiv (n=1). Both were treated with reME. Technical difficulties: neoplasms involving the
Baughin valve (n=1), rectal canal (n=2), multiple (n=4) recurrent (n=2). ESD en bloc (R0) was obtained in 4
cases, by fragments(R0) in 1case. Complications: Intraoperative bleeding - 6 (4(ESD), 2( EMR DC)), all stopped
endoscopically (4 clipping, 2 electrocoagulation and local injection of human thrombin), perforation - 2, both
treated by clipping.
Conclusions: 1.ME is the safe alternative treatment of precancerous neoplasms and non-invasive ECC. 2. For
neoplasis >20 mm ESD is indicated. 3.EMR A is applicable for the entire way of the colon, induces a big rate
of ME by fragments. 4. EMR B is safe for application in rectum and sigmoid intestine. 5.EMR CD is a safe, well
controlled, but has artefacts in the histological analysis.