Efficacy of hybrid endoscopic submucosal dissection (ESD) as a rescue treatment in difficult colorectal ESD cases

Abstract

Background and Aim: Endoscopic submucosal dissection (ESD), which provides a higher en bloc resection rate than conventional endoscopic mucosal resection (EMR), is considered to be a useful treatment option for large colorectal tumors. However, colorectal ESD is not widely used because of its technical difficulty, risk of complications and time required. To overcome these drawbacks, a simpler modified technique, ESD with snaring (hybrid ESD), has been developed. The aim of the present study was to retrospectively compare the safety and efficacy of hybrid ESD and conventional ESD for colorectal tumors.Methods: Between September 2008 and June 2016, ESD was carried out on 137 lesions and hybrid ESD on 27 lesions. All hybrid ESD cases were carried out as a rescue treatment in difficult ESD cases. We retrospectively investigated procedure time, and the rates of en bloc resection, perforation, bleeding, and local recurrence.Results: In the hybrid ESD group, procedure time was shorter compared with the ESD group (108 AE 59.5 min vs 122 AE 72.2 min), but the en bloc resection rate was lower (66.7% vs 94.2%). However, there were no significant differences in procedure time, or in rates of en bloc resection, perforation and bleeding between the two groups. Local recurrence did not develop in any of our cases.Conclusions: Hybrid ESD as a rescue treatment in difficult ESD cases may be less effective for en bloc resection of large colorectal tumors. Indication for hybrid ESD may be limited to scheduled treatment from the outset and emergency cases with patients who present unstable vital signs during ESD.

Randomized controlled trial comparing submucosal endoscopy with mucosal resection and endoscopic submucosal dissection in the esophagus and stomach: Animal study

“…Recently, other easier mucosal resection methods such as hybrid ESD or precutting EMR were reported. 15,16 We conducted and carried out present study in 2012 which preceded these reports. However, these techniques are appealing in lieu of ESD in some situations.…”

Endoscopic Mucosal Resection with Circumferential Incision in Difficult Colorectal Lesions

“…EMR has been widely used in colorectal polyps [1, 2] being usually piecemeal for lesions >20 mm. Contrariwise, ESD has a higher en-bloc resection, complete resection, and lower local recurrence rates [2, 3].…”

“…Contrariwise, ESD has a higher en-bloc resection, complete resection, and lower local recurrence rates [2, 3]. However, several drawbacks, including a technically demanding and time-consuming procedure, long learning curve, and significant risk of complications, limit its colorectal use [1, 3, 4]. Currently, ESD has been proposed for hard-to-resect lesions, such as LST-NG or nonlifting lesions, that otherwise require surgical resection [1, 2, 4, 5].…”

“…Techniques combining ESD and EMR have been developed to minimize ESD limitations, including EMR with circumferential incision (EMR-CI) and ESD-hybrid (ESD-H) [1, 3-5]. EMR-CI consists in an EMR following circumferential mucosal incision without partial submucosal dissection, avoiding snare slippage [1, 3, 5].…”

“…EMR-CI consists in an EMR following circumferential mucosal incision without partial submucosal dissection, avoiding snare slippage [1, 3, 5]. For large colorectal lesions (>20 mm), ESD revealed superior to EMR-CI or ESD-H due to the higher complete resection rate [2, 4, 5].…”