Is colorectal endoscopic submucosal dissection safe and effective for 15–19-mm tumors?

Abstract

The outcomes of colorectal endoscopic submucosal dissection (ESD) in 15-19 mm tumors are unclear. This study compared the effectiveness and safety of colorectal ESD for 15-19 mm tumors and tumors exceeding that size. MethodsFrom August 2018 to December 2020, 213 cases of colorectal tumors removed by colorectal ESD at a tertiary hospital were enrolled in this study. The cases were divided into two groups according to the pathologically measured size of the resected lesion: an intermediate group (15-19 mm, n = 62) and a large group (≥ 20 mm, n = 151). The en bloc resection rate, complete resection rate, and complications were investigated retrospectively. ResultsThe en bloc resection rate was signi cantly higher in the intermediate than large group (100% vs. 94%, p = 0.049), and the mean total procedure time was shorter in the intermediate than large group (29.2 ± 12.6 vs. 48.4 ±28.8 min, p < 0.001). However, the mean procedure speed was signi cantly lower in the intermediate than large group (0.25 ± 0.10 vs. 0.28 ± 0.11 cm 2 /min; p = 0.031). The complete resection rate, post-procedural bleeding, and perforation rate were not signi cantly different between the two groups. In multivariate analyses, the total procedure time and mean procedure speed were signi cantly associated with lesion size. ConclusionColorectal ESD of 15-19 mm lesions is effective, and has a shorter procedure time and higher en bloc resection rate than the same procedure for larger lesions.

Approaches and considerations in the endoscopic treatment of T1 colorectal cancer

“…Therefore, EMR does not consistently ensure en bloc resection or complete resection as the lesion size approaches 20 mm for lesions < 20 mm. Accordingly, for CRCs slightly smaller than 20 mm or with suspected comorbid submucosal fibrosis, or any other case where EMR may not readily achieve en bloc resection, modified EMR or endoscopic submucosal dissection (ESD) can be considered for more reliable en bloc and complete resection [ 40 , 41 ].…”