Single-center implementation of endoscopic submucosal dissection (ESD) in colorectum: Low recurrence rate after intention-to-treat ESD

Abstract

Objectives

Colorectal endoscopic submucosal dissection (ESD) shows higher R0 resection and lower local recurrence rates than endoscopic mucosal resection (EMR) in Japan. In Europe, independent learning of ESD in colorectum is feasible, but yet to be analyzed for curative resection and recurrence rates.

Methods

After experimental training under supervision by Japanese experts (T.O., N.Y.), three endoscopists independently performed 83 ESD procedures intention-to-treat for lesions in the entire colorectum of 67 patients in a prospective registry (Nov. 2009 to June 2016).

Results

ESD was feasible in 80 (96%) of colorectal neoplasias (mean diameter 33.6 (±1.8) mm), and three more required conversion to piecemeal EMR. The lesions were adenomas, in 66% with low-grade intraepithelial neoplasia (LGIN), 29% with high-grade intraepithelial neoplasia, and 5% with carcinomas (G2, pT1). ESD had to be facilitated by the final use of snaring (Hybrid-ESD, n=45), especially in the initial learning period. The en-bloc resection rate was 85%. Complications were microperforations (7% - conducive to one hemicolectomy), and delayed bleeding (1%) without mortality or long-term morbidity. Residual adenomas with LGIN (5%) after Hybrid-ESD did not again recur after endoscopic ablation. All malignant neoplasias (34%) were curatively resected without recurrence after a mean follow-up of 19.5 (± 3.2) months.

Conclusions

During independent ESD learning in colorectum, ESD intention-to-treat showed low recurrence rate after appropriate training, and Hybrid-ESD acceptable complication and recurrence rates - justifying Hybrid-ESD as strategy for self-completion and rescue.

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