Outcomes of 601 Colorectal Endoscopic Submucosal Dissections in a Single Western Center: Is Right Colon Location Still a Major Concern?

Abstract

Background: Endoscopic submucosal dissection (ESD), as a minimally invasive procedure for removal of early gastrointestinal neoplasms, is a standard approach in Asian countries. Outcomes of ESD in Western European countries significantly differ, which makes it more difficult to apply this procedure to daily-basis clinical routine. The aim of this study is to analyze the safety and efficiency of colorectal ESD based on a large series of cases performed by a single operator after finishing the learning curve period in a western referral center. Materials and Methods:We retrospectively studied 601 patients who underwent ESD procedure for colorectal neoplasm from January 2016 to December 2019 in a tertiary colorectal ESD center in Poland. Results:The overall en bloc resection was achieved in 88.02%. Complete histologic resection rate (R0) was reported at a level of 86.36%. Lesions located in the right colon were characterized by statistically lower en bloc, R0 resection, and success rate (73.95%, 71.43%, 69.75%, respectively). In 9.82% (n = 59) of cases, the ESD procedure-related complications have been observed. Post-ESD bleeding occurred in 23 patients (3.83%) and perforation in 32 patients (5.32%). Twenty-seven patients were treated endoscopically (4.49%) and 5 required surgery (0.83%). Analysis of complications showed that tumors located within the right colon were characterized by the highest perforation rate at 10.92%. Within the rectum there were minimal number of perforations (2.69%), whereas the bleeding rate was 4.48%.Conclusions: Our results represent the largest material concerning ESD of colorectal lesions in the West and show that ESD is characterized by a high rate of successful resections with a low risk of complications. Thus, confirming that it is possible to obtain results similar to Asian centers and that colorectal ESD procedures can be implemented in clinical routine in western countries. Nevertheless, ESD in the right colon is still related with high rate of complications, so qualification for the ESD procedure should be very careful and discussed with the patient and should be performed by an experienced endoscopist after the learning curve.

Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern Taiwan

“…105 minutes, with a median lesion size of 26 mm in 2011 [29]. Another recent study in a western country showed a median time of 82.7 minutes for ESD, with a median lesion diameter of 44.3 mm [30]. This study's average ESD procedure time was 51.9 minutes, with a median size of 7.83 cm 2 , consistent with the study in a Northeast Asian country.…”

Clinical outcomes of colon endoscopic submucosal dissection for colonic neoplasms: A single center experience in South Taiwan

“…[28] Another recent study in western country showed median time of 82.7 minutes for ESD with median lesion diameter of 44.3 mm. [29] Our average ESD procedure time was 51.9 minutes with median size of 7.83 cm 2 , which was more consistent with experience in country of Northeast Asia.…”

Risk of residual neoplasia after a noncurative colorectal endoscopic submucosal dissection for malignant lesions: a multinational study

“…João Santos-Antunes (MD, MSc) 1,2 , Mathieu Pioche (MD, PhD) 3 , Felipe Ramos-Zabala (MD, PhD) 4 , Paolo Cecinato (MD) 5 , Francisco Gallego (MD) 6 , Pedro Barreiro (MD) 7,8 , Catarina Félix (MD), 7 Sandro Sferrazza (MD) 9 , Frieder Berr (MD) 10 , Andrej Wagner (MD) 10 , Arnaud Lemmers (MD, PhD) 11 , Mariana Figueiredo (MD) 11 , Eduardo Albéniz (MD) 12 , Hugo Uchima (MD) 13,14 , Ricardo Küttner-Magalhães (MD) 15 , Carlos Fernandes (MD) 16 , Rui Morais (MD) 1 , Sunil Gupta (MD) 17 , Daniel Martinho-Dias 18 (MD), Elisabete Rios (MD) 19 , Isabel Faria-Ramos (MD, PhD) 2 , Margarida Marques (MD) 1 , Michael J Bourke (MBBS) 17 , Guilherme Macedo (MD, PhD) 1 95% confidence intervals for bootstrapping analyses were 1.5-13.7% and 7.7-53.8% for NC-Lymph Score 0 and 1 respectively. For scores 2 and 3, 95% confidence intervals were 0-62.5% and 0-100% respectively due to the limited number of patients in these subgroups.…”

“…Even though the majority of colorectal lesions can still be managed by EMR [5], the role of ESD in this context has been growing in the West [6,7], particularly in lesions with higher risk of harboring malignancy, such as non-granular lateral spreading tumors (LSTs) [8] and large granular mixed-type LSTs [9,10], as well as all of those presenting other high-risk features upon endoscopic evaluation [8].…”

“…In the last decades, ESD has been applied with very good outcomes, not only in stomach but also in the esophagus, colon, and rectum [2][3][4]. Even though the majority of colorectal lesions can still be managed by EMR [5], the role of ESD in this context has been growing in the West [6,7], particularly in lesions with a higher risk of harboring malignancy, such as nongranular laterally spreading tumors (LSTs) [8] and large granular mixed-type LSTs [9,10], as well as all those that present with other high risk features on endoscopic evaluation [8]. Nevertheless, ESD is technically challenging, with a long learning curve [11].…”