Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile

Santos-Antunes, João; Marques, Margarida; Morais, Rui; Carneiro, Fátima; Macedo, Guilherme

doi:10.1159/000514797

Cited by 6 publications

(9 citation statements)

References 25 publications

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“…Moreover, according to our previous studies, a minimum of 30 procedures must be carried out to significantly increase en bloc resection, and 90 procedures are needed to achieve a R0 resection rate >75%, with concomitant speed improvement. Indeed, we suggest that, ideally, only experienced endoscopists (preferably with >90 previous procedures) should carry out giant resections [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center

Mendes¹,

Barreiro²,

Mascarenhas³

et al. 2023

GE Port J Gastroenterol

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Background: Endoscopic submucosal dissection (ESD) is a minimally invasive technique for en bloc resection of superficial neoplastic lesions, independent of their size. However, for giant gastrointestinal superficial neoplasia, the risk of invasive cancer is higher, and ESD is typically challenging. Despite the increasing literature on giant resections, data on their efficacy and safety are still lacking. Objective: The aim of this study was to describe ESD outcomes from a Portuguese center, compare them with other international studies, and analyze the possible risk factors influencing outcomes. Methods: We conducted a retrospective single-center review using a prospectively collected database, including patients with rectal ESD resections larger than 10 cm, between January 2016 and December 2021. Clinical, procedural, and pathological data were collected and analyzed. Revision of the literature for comparison with international results was done through PubMed. Data were analyzed and statistical analysis performed, using Microsoft Excel and SPSS, to identify significant risk factors. Results: The study included 15 rectal resections, with a mean diameter of 140.9 mm (range 105–270), corresponding to lesions of 125.9 mm (87–238). The overall en bloc resection rate was 100% (n = 15). According to ESGE criteria, procedure was considered curative in 53.3% (n = 8), non-curative with high risk in 13.3% (n = 2), and local-risk recurrence in 33.3% (n = 5). Adverse events occurred in 26.7% (n = 4): 1 minor perforation and 3 stenosis, most endoscopically managed. For non-curative resections with local-risk recurrence, surveillance without adjuvant therapy was performed in all cases. For high-risk non-curative resections, surgery was performed in 1 patient and adjuvant chemoradiation therapy in another. Follow-up (mean 16 months) demonstrated a recurrence rate of 0%. Statistical analysis revealed resection size ≥20 cm as a risk factor for perforation (p value 0.067), and involvement of ≥90% of the circumference and procedural time ≥4 h as risk factors for stenosis (p value 0.029 and 0.009, respectively). Conclusions: Although challenging, ESD for giant lesions seems effective and safe, with a still relevant rate of complications, which were mostly endoscopically treated. Rigorous characterization of lesions is crucial to predict and avoid complications or the need for therapy escalation.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center

Mendes¹,

Barreiro²,

Mascarenhas³

et al. 2023

GE Port J Gastroenterol

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“…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.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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Background and study aims: Endoscopic submucosal dissection (ESD) in colorectal lesions is technically demanding, and a significant rate of non-curative procedures is expected. We aimed to assess the rate of residual lesion after a non-curative ESD for colorectal cancer (CRC), and to establish predictive scores to be applied in the clinical setting. Patients and Methods: Retrospective multicenter analysis of consecutive colorectal ESDs. Patients with non-curative ESDs performed for the treatment of CRC lesions submitted to complementary surgery or with at least one follow-up endoscopy were included. Results: From 2255 colorectal ESDs, 381 (17%) were non-curative, and 135 of them were performed in CRC lesions. Residual lesion was observed in 24 (18%) patients. Surgery was performed in 96 patients, and 76 (79%) had no residual lesion in the colorectal wall or in the lymph nodes. Residual lesion rate for SM1 cancers was 0%, and for >SM1 cancers was also 0% if no other risk factors were present. Independent risk factors for lymph node metastasis were poor differentiation and lymphatic permeation (NC-Lymph score). Risk factors for the presence of residual lesion in the wall was piecemeal resection, poor differentiation and positive or indeterminate vertical margin (NC-Wall score). Conclusions: Lymphatic permeation or poor differentiation warrants surgery due to the high risk of lymph node metastasis, mainly in >SM1 cancers. In the remaining cases, en-bloc and R0 resections determine low risk of residual lesion in the wall. Our scores can be a useful tool for the management of patients submitted to non-curative colorectal ESDs.

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“…Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are well-established resection techniques for colorectal superficial tumors, depending on their size, morphology, and localization [ 1 , 2 , 3 , 4 ]. For larger lesions (>40 mm diameter) and whenever superficial submucosal cancer is suspected or cannot be firmly excluded, ESD is the recommended approach, as it allows en bloc resection regardless of the lesion's size, leading to a minimized recurrence risk [ 5 , 6 ].…”

Section: Introduction and Objectivesmentioning

confidence: 99%

Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers

Ferreira

Marques

Morais

et al. 2023

GE Port J Gastroenterol

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Introduction: Endoscopic submucosal dissection (ESD) is a well-established resection technique for colorectal superficial tumors, but its role in the treatment of anorectal junction (ARJ) lesions still remains to be determined. With this study, we aimed to evaluate the feasibility, safety, and efficacy of ESD for the resection of ARJ lesions, in comparison to more proximal rectal lesions. Methods: We performed a retrospective analysis of prospectively collected data concerning all consecutive rectal ESD procedures performed in two European centers, from 2015 to 2021. Results: A total of two hundred and fifty-two rectal lesions were included. Sixty (24%) were ARJ lesions, and the remaining 192 (76%) were located proximally. Technical success was achieved in 248 procedures (98%), and its rate was similar in both locations (p = 0.246). Most of the lesions presented high-grade dysplasia/Tis adenocarcinoma (54%); 36 (15%) had submucosal adenocarcinoma, including 20 superficial (sm1) and 16 deeply invasive (>SM1) T1 cancers. We found no differences between ARJ and rectal lesions in regard to en bloc resection rate (100% vs. 96%, p = 0.204), R0 resection rate (76% vs. 75%, p = 0.531), curative resection rate (70% vs. 70%, p = 0.920), procedures’ median duration (120 min vs. 90 min, p = 0.072), ESD velocity (14 vs. 12 mm2/min, p = 0.415), histopathology result (p = 0.053), and the need for surgery due to a non-curative ESD (5% vs. 3%, p = 0.739). Also, there was no statistically significant difference that concerns delayed bleeding (7% vs. 8%, p = 0.709), perforation (0% vs. 5%, p = 0.075), or the need for readmission (2% vs. 2%, p = 0.939). Nevertheless, anorectal stenosis (5% vs. 0%, p = 0.003) and anorectal pain (9% vs. 1%, p = 0.002) were significantly more frequent in ARJ lesions. Conclusion: ESD is a safe and efficient resection technique for the treatment of rectal lesions located in the ARJ.

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Colorectal Endoscopic Submucosal Dissection in a Western Center: Analysis of Outcomes and Safety Profile

Cited by 6 publications

References 25 publications

Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center

Endoscopic Submucosal Dissection for Resections Larger than 10 cm: Outcomes from a Portuguese Center

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

Endoscopic Submucosal Dissection Is Safe and Effective for Lesions Located at the Anorectal Junction: Analysis from Two Referral European Centers

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