Digestive Diseases and Sciences

, Volume 64, Issue 10, pp 2972–2981 | Cite as

Effect of Preceding Biopsy on the Results of Endoscopic Submucosal Dissection for Colorectal Laterally Spreading Tumor

  • Sang Pyo Lee
  • In-Kyung SungEmail author
  • Jeong Hwan Kim
  • Sun-Young Lee
  • Hyung Seok Park
  • Chan Sup Shim
Original Article



Forceps biopsies are usually performed before endoscopic submucosal dissection (ESD) for colonic laterally spreading tumors (LSTs). However, preceding biopsy is commonly believed to possibly inhibit complete tumor resection by causing blurring of tumor borders and tissue fibrosis.


The aims were to investigate whether the preceding biopsy of colorectal LST affects the complete endoscopic tumor resection and increases the risk of complications.


We retrospectively reviewed the medical records of patients with colorectal LSTs who underwent ESD at our center during an 8-year period. Patients were divided into two groups according to whether they underwent biopsy of the tumor before ESD. In addition, the characteristics of patients and tumors, including the completeness of tumor resection, were investigated.


Of 288 patients (174 men) enrolled in this study, 194 (67.4%, preceding biopsy group) underwent biopsies before ESD, whereas 94 (32.6%, no biopsy group) did not. There were no significant differences in age, sex, comorbidity, medication history, tumor location, and final pathologic result between both groups. Tumor size was larger (p = 0.002) and LST-G tumor was more common (p = 0.003) in the preceding biopsy group than in the no biopsy group. No significant difference was seen in ESD outcomes, including procedure time, hospitalization period, incidence of complications, en bloc resection rate, resection margin status, and incidence of surgical operation, between both groups.


Biopsy of LST is commonly performed before endoscopic resection. Contrary to popular belief, it does not increase the incomplete tumor resection rate and incidence of complications.

Trial registration



Laterally spreading tumor Endoscopic submucosal dissection Biopsy Colorectal neoplasms 



Laterally spreading tumor


Endoscopic submucosal dissection


Endoscopic mucosal resection


Author’s contribution

SPL contributed to study concept, design, analysis of data, and drafting of the manuscript. IKS contributed to study concept, interpretation of data, and drafting of the manuscript. JHK, SYL, HSP, and CSS acquired the data and critically revised the manuscript.


This work was supported by Konkuk University Medical Center Research Grant 2016.

Compliance with ethical standards

Conflict of interest

All authors disclose no financial relationships relevant to this publication.

Ethics approval

The study protocol was approved by the Institutional Review Board of Konkuk University Medical Center (KUH1010861).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineHallym University Dongtan Sacred Heart Hospital, Hallym University College of MedicineHwaseongKorea
  2. 2.Department of Internal Medicine, Digestive Disease CentreKonkuk University School of MedicineSeoulKorea

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