Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion

Abstract

Introduction: Endoscopic submucosal dissection (ESD) is potentially a curative treatment of T1 colorectal cancer in certain condition. The aim of the study was to evaluate the feasibility and effectiveness of ESD on lesions with suspicion of focal deep invasion. Methods: In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying focal (< 15 mm) deep invasive patterns (FDIP) treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures). Results: A total of 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 (95.2%) cases. When possible, En bloc and R0 resection rate were respectively 95.8% (115/120) and 76.7% (92/120). Thirty-three (26.2%) resections were treated curatively for very low risk tumors and 38 (30.2%) were considered as low risk. Non-curative R0 resections concerned lesions with lymphatic or vascular invasion (LVI) (n=8), or significant budding (n=9), and LVI + budding association (n=4). Conclusion: ESD is feasible and safe for colorectal lesions with FDIP ≤ 15 mm. It cured 26.2% of patients and could be a valid option for 30.2% of additional patients with low-risk T1 cancers, especially for fragile patients with comorbidities.

Multipolar adaptive traction allows diagnostic endoscopic submucosal dissection for colonic lesions with focal invasive area

“…Endoscopic submucosal dissection (ESD) has become the gold standard for superficial colorectal neoplasia resection. As recently reported, diagnostic ESD is also feasible and safe for colorectal lesions with a focal deep invasive pattern of less than 15 mm [1]. But the R0 resection rate for these T1 cancers could be improved on the vertical margin.…”

Endoscopic submucosal dissection assisted by adaptive traction: results of the first 54 procedures

“…No failed ESD was reported. Among the noncurative procedures, one lesion was invading the lateral margins, one diagnostic dissection was made for a lesion harboring a focal deep invasive pattern [12], and two lesions were invading the vertical margins. Four patients (7.7 %) required post-ESD surgery for noncurative resections.…”

Endoscopic intermuscular dissection of rectal T1 cancer with adaptive traction: use of additional loops to improve traction directly on the circular muscular layer

“…Endoscopic submucosal dissection (ESD) has become the reference technique for removal of superficial colorectal neoplasia; however, the R0 resection rate for T1 cancers harboring focal invasive patterns is far from perfect on the vertical margin 1 . Recently, endoscopic intermuscular dissection (EID) has been described as a method of achieving free vertical margins by dissecting more deeply, between the two muscular layers 2 .…”