Short- and Long-Term Outcomes of Western-Based Endoscopic Submucosal Dissection for Colorectal Lesions

 

Aims The role of ESD for CR lesions in Western communities is unclear and its adoption is still limited. This may be attributed to the disappointing technical outcomes in preliminary studies, along with the lack of long-term data coming from Western centers. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center.

Methods Between February 2011 and November 2019, a retrospective analysis of a prospectively maintained database was conducted on patients treated by colorectalESD.The primary outcome was the recurrence rate. Secondary outcomes were en-bloc, and R0 resection rates, and adverse events. The curative resection rate was assessed for submucosal invasive lesions. Statistical analysis included descriptive statistics, Chi square and Kaplan-Meier tests.

Results Over the study period, 327 consecutive patients (median age:69(IQR:60-76)years old; 201-61.5 %-males)were included in the analysis. The90.8 %of lesions were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 %(29/66) for standard and hybrid techniques, respectively. Submucosal invasion and piece-meal resection independently predicted R0 resections. A total of 18(5.5 %) intra-procedural AEs (11perforations and 7bleedings) and 12(3.7 %) post-procedural AEs (2 perforations and 10 bleedings) occurred. The two patients readmitted for a post procedural perforation were referred for surgery and were excluded from the follow-up analysis.Seventy-five out of 327lesions (23.0 %) resulted in CR neoplasia with submucosal invasion. Fifty-seven of them showed high-risk features of nodal involvement (non-curativeESD) and were excluded from the follow-up analysis, which finally involved 268patients. Eighteen adenoma recurrences per 1,000 person-years (15 cases,5.6 %) were detected in a median follow-up time of 36months.No carcinoma recurrences were observed. R1 resection and intra-procedural adverse events independently predicted recurrences.

Conclusions Colorectal-ESD, especially with standard approach, is a safe and effective option for colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to published Eastern series. Achieving en-bloc, R0resections, avoiding intra-procedural adverse events might minimize the risk of adenoma recurrence.

Citation: Maselli R, Spadaccini M, Belletrutti PJ et al. eP239 SHORT- AND LONG-TERM OUTCOMES OF WESTERN-BASED ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL LESIONS. Endoscopy 2021; 53: S176.

Publication History

Article published online:
19 March 2021

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