Colorectal endoscopic submucosal dissection: Systematic review of mid‐term clinical outcomes

Abstract

With a drive towards minimally invasive surgery, endoscopic submucosal dissection (ESD) is now gaining popularity. In a number of East Asian countries, ESD is now the treatment of choice for early non-metastatic gastric cancer, but the outcomes of ESD for colorectal lesions are unclear. The present review summarizes the mid-term outcomes of colorectal ESD including complication and recurrence rates. A systematic literature search was done in May 2014, identifying 20 publications reporting the outcomes of colorectal ESD which were included in this review. En-bloc resection rates, complete (R0) resection rates, endoscopic clearance rates, complication and recurrences rates were analyzed. Statistical pooling was done to calculate weighted means using random effects modeling. Twenty studies reporting the outcomes of 3060 colorectal ESD procedures were reported. Overall weighted en-bloc resection rate was 89% (95% CI: 83-94%), R0 resection rate 76% (95% CI: 69-83%), endoscopic clearance rate 94% (95% CI: 90-97%) and recurrence rate 1% (95% CI: 0.5-2%). Studies that followed up patients for over 1 year were found to have an en-bloc resection rate of 91% (95% CI: 86-96%), R0 resection rate of 81% (95% CI: 75-88%), endoscopic clearance rate 93% (95% CI: 90-97%) and recurrence rate of 0.8% (95% CI: 0.4-1%). Colorectal ESD can be carried out effectively and safely with a 1% recurrence rate. Further studies with longer follow-up periods are required to determine whether colorectal ESD is a viable alternative to conventional surgical therapy.

Outcomes of ulcerative colitis‐associated dysplasia patients referred for potential endoscopic submucosal dissection

“…Three recent studies on ESD for UC‐associated dysplasia have reported en bloc resection rates of 80–100% and R0 resection rates of 70–76% . These results are comparable with the outcomes summarized in the systematic reviews of ESD for almost exclusively sporadic CRN ( en bloc resection rates of 89–92% and R0 resection rates of 76–83%) . However, the R0 resection rate for ESD of UC‐associated dysplasia seems relatively lower than the pooled R0 resection rate of 85.6% reported previously in an Asian subgroup .…”

Case of pediatric traditional serrated adenoma resected via endoscopic submucosal dissection

“…The Japanese Colorectal ESD Standardization Implementation Working Group recommends the following indications for colorectal ESD: large lesions (> 20 mm) suspicious for high-grade intraepithelial neoplasia or early cancer, lesions that display fibrosis including sporadic adenomas in chronic inflammation or residual carcinoma after previous endoscopic therapy[12]. Patel et al[13] reviewed the outcomes of colorectal ESD and found that it results in en bloc resection, complete resection, and recurrence rates of 89%, 76%, and 1%, respectively.…”

Retrieval of a large rectal endoscopic submucosal dissection specimen using bowel preparation after unsuccessful rectal enema: First report of a novel technique

“…Endoscopic submucosal dissection (ESD) is an effective procedure for the treatment of large colorectal lesions, with excellent en‐bloc resection and local recurrence rates . In large and bulky lesions, however, retrieval of the specimen may be challenging.…”

“…is an effective procedure for the treatment of large colorectal lesions, with excellent en-bloc resection and local recurrence rates. 1 In large and bulky lesions, however, retrieval of the specimen may be challenging. Various approaches have been advocated for this situation including use of a small grip-seal plastic bag, 2 or defecation by rectal enema.…”