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Hybrid endoscopic submucosal dissection as a salvage option for difficult colorectal conventional endoscopic submucosal dissection

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Abstract

Background

When total submucosal dissection is difficult to achieve during conventional colorectal endoscopic submucosal dissection (C-ESD), the lesion can be resected by final snaring through salvage hybrid ESD (SH-ESD). This study aimed to examine the outcomes of SH-ESD and identify its indications that could achieve en bloc resection.

Methods

We recruited 1039 consecutive patients with colorectal lesions that underwent ESD at Hiroshima University Hospital between January 2015 and December 2020. C-ESD was attempted thoroughly in 924 lesions (C-ESD group, including 9 lesions in which ESD was discontinued), and SH-ESD was performed owing to some difficulties in 115 lesions (SH-ESD group). Risk factors for incomplete resection by SH-ESD and ESD discontinuation were evaluated using multivariate analysis. The outcomes were compared between cases with remaining undissected submucosa of < 20 mm in diameter in the SH-ESD and C-ESD groups, using propensity score matching.

Results

Multivariate analysis revealed that a procedure time > 80 min and remaining undissected submucosa ≥ 20 mm in diameter were significant risk factors for incomplete resection after SH-ESD and ESD discontinuation. By propensity score matching analysis, procedure time was significantly shorter in the SH-ESD group with remaining undissected submucosa < 20 mm in diameter than in the C-ESD group (71 min vs. 90 min, p = 0.0053), although no significant difference was found in the en bloc resection rate (94% vs. 87%, p = 0.0914).

Conclusion

SH-ESD can be an alternative surgical method when conventional ESD is difficult to continue in cases in which the remaining undissected submucosa is < 20 mm in diameter.

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Authors and Affiliations

  1. Department of Gastroenterology, Hiroshima University Hospital, 1-2-3, Kasumi, Minamiku, Hiroshima, 734-8551, Japan

    Shin Morimoto, Hidenori Tanaka, Yudai Takehara, Noriko Yamamoto, Fumiaki Tanino, Yuki Kamigaichi, Ken Yamashita, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe & Shiro Oka

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  1. Shin Morimoto
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  2. Hidenori Tanaka
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Contributions

All authors contributed to the conception and design of this study. SM, YT, NY, FT, YK, and KY collected and analyzed the data. SM wrote the initial draft of the manuscript, HTan assisted in revising the manuscript, and all authors commented on the previous versions of the manuscript. SO critically reviewed and approved the final version of the manuscript. All authors have approved the manuscript and agreed to its submission for publication.

Corresponding author

Correspondence to Hidenori Tanaka.

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Shin Morimoto, Hidenori Tanaka, Yudai Takehara, Noriko Yamamoto, Fumiaki Tanino, Yuki Kamigaichi, Ken Yamashita, Hidehiko Takigawa, Ryo Yuge, Yuji Urabe, and Shiro Oka have no conflicts of interest or financial ties to declare.

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Morimoto, S., Tanaka, H., Takehara, Y. et al. Hybrid endoscopic submucosal dissection as a salvage option for difficult colorectal conventional endoscopic submucosal dissection. Surg Endosc 38, 222–228 (2024). https://doi.org/10.1007/s00464-023-10544-6

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