Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center

Abstract

Our outcomes are comparable with other studies in Western series. Studies addressing the cost effectiveness of ESD and comparing its long-term outcome with endoscopic mucosal resection in the West are needed.

Improving assessment and management of large non-pedunculated colorectal lesions in a Western center over 10 years: lessons learned and clinical impact

“…In our cohort, we confirm that after complete ER, a recurrence may be found in almost one-quarter of patients, but is endoscopically manageable in the majority of cases. Even if our median endoscopic follow-up was relatively short (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)), data from the literature are reassuring because 96 % of recurrences occur within 6 months after index resection, and only 2 % of recurrences can be expected after 12 months [34], as also suggested by our median time-to-recurrence of 7 months (IQR 4-13). Our multivariate analysis identified independent predictors of recurrence, both known (PM vs EB resection) and poorly reported (grading of dysplasia and involvement of "risky hotspots").…”

“…Among patients with endoscopic FU (N = 204; median 16 months 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 ), recurrence was found in 42 (20.5 %) after a median interval of 7 months 4 5 6 7 8 9 10 11 12 13 from index procedure. Considering also patients experiencing > 1 recurrence (N = 19, maximum 3 per patient), endoscopic treatment of recurrence was possible in 60/64 cases (93.8 %), while 4 patients (9.5 %) were finally sent to surgery.…”

“…Endoscopic resection of these lesions often requires adoption of advanced endoscopic techniques (e. g. ESD), whose limits [4][5][6] impose a rigid selection of lesions [7,27]. Characteristics associated with a higher probability of SMI have shown suboptimal accuracy, deriving from heterogeneous series, usually including specific subtypes of lesions (e. g. only LSTs [1,28]), specific resection techniques (e. g. only ESDs [9,10] or EMRs [12,19,29]) and finally, not always including risk factors in a multivariate analysis [9,12,30]. In our series of consecutive LNPLs, potentially free of selection bias beyond referral, we confirmed the majority of known risk factors, with SMI rates according to single morphologies consistent with those summarized in a recent meta-analysis [1].…”

“…Procedures were executed by the same five endoscopists (SA, VDC, GDA, MR and EDG) over time, all of whom were experienced in endoscopic luminal resection. LNPLs were treated through: 1) endoscopic mucosal resection (EMR) when the lesion was lifted through submucosal fluid injection and finally resected through a snare; 2) ESD, when fluid submucosal injection was used to expand the submucosal space, which was then accessed through an endoscope equipped with a transparent hood for careful manual dissection through a knife; and 3) hybrid procedures, when a part of the lesion was dissected through a knife and another part resected through snaring (usually a peripheral dissection and a central snaring 19 20 ).…”

European experience of colorectal endoscopic submucosal dissection: a systematic review of clinical efficacy and safety

“…One study was not included because the R0 resection rate of colorectal ESD could not be determined [22]. Thus, after application of our inclusion and exclusion criteria, 15 European full-text studies of colorectal ESD published between 2007 and 2018 were included in this review (Table 1) [15,[23][24][25][26][27][28][29][30][31][32][33][34][35][36]. All these included studies were case series.…”