Efficacy and safety of endoscopic resection techniques of large colorectal lesions: experience of a referral center in Italy

Abstract

Background Endoscopic mucosal resection and submucosal dissection (ESD) are treatments of choice for superficial neoplastic colorectal lesions. Only a few studies have compared these techniques. Aim To compare the efficacy and safety of endoscopic piecemeal mucosal resection (EPMR), ESD and hybrid-endoscopic submucosal dissection (H-ESD) of large colorectal lesions in a Western endoscopic center. Methods This is a retrospective analysis on a prospective medical database of consecutive colorectal superficial lesions larger than 20 mm, resected by EPMR, ESD or H-ESD collected from 2015 to 2019. Results Two hundred twenty-nine colorectal lesions were included. All lesions were completely endoscopically resected, 65.9% by EPMR, 19.7% by ESD and 14.4% by H-ESD. Endoscopic control after the index procedure was available for 86.5% patients. Among these patients, 80% had a second follow-up colonoscopy. The overall recurrence rate was 13.2, 0 and 6.1% for EPMR, ESD and H-ESD respectively, with a significant difference between EPMR and ESD. All recurrences were endoscopically treated during follow-up procedures. Risk of complications was not significantly different between the three groups.Conclusions EPMR, ESD and H-ESD are effective and safe procedures. Recurrence rate in EPMR was higher but can be managed endoscopically with high success rates. EPMR is faster and technically simpler so should be considered a potential first-line therapy for colorectal superficial neoplastic lesions.

Risk Prediction of Post-Endoscopic Submucosal Dissection Coagulation Syndrome

“…We found, furthermore, that PECS developed less frequently when the ESD with snaring procedure was used. Previous studies have shown no significant differences between ESD with snaring and ESD throughout respect to perforation and bleeding [13][14][15]. However, the incidence of PECS as a complication of ESD has not been investigated.…”

Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases

“…Previous reports on the clinical outcomes of hybrid ESD and C-ESD for colorectal lesions are summarized in Table 4. 11,17,[19][20][21][22][23][24][25][26] Although several studies have shown that the en bloc resection rate is significantly lower with the use of hybrid ESD techniques (56.8%-94.1%) than with the use of C-ESD techniques (81.5%-100%), most did not classify hybrid ESD into preplanned SH-ESD and unplanned RH-ESD. [18][19][20]22 In general, planned SH-ESD is used for relatively small tumors that can be easily snared, whereas unplanned RH-ESD is used for lesions that are difficult to resect.…”

“…Previous studies found no significant difference in the incidence of complications, including bleeding and perforation, between C-ESD and hybrid ESD. 17,26 The wall of the large intestine is thinner than that elsewhere in the gastrointestinal tract and is more susceptible to perforation than the stomach, making ESD more difficult. However, RH-ESD may be an option when resection is difficult, such as when the lesion is in the cecum or when severe fibrosis is present.…”

Comparison of two pathological processing methods for large endoscopic submucosal dissection (ESD) specimens

“…With the development of surgery, ESD can be used throughout the gastrointestinal tract to treat increasingly larger tumours 16 17. According to the conventional method, after serially sliced, the sectioned specimens with a length greater than 4 cm should be cut into two segments to fit the size of the dehydration cassettes.…”