Surgical Endoscopy

, Volume 32, Issue 5, pp 2328–2339 | Cite as

Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center

  • Reza V. Milano
  • Edi Viale
  • Michael J. Bartel
  • Chiara Notaristefano
  • Pier Alberto Testoni



Endoscopic submucosal dissection (ESD) and hybrid-ESD techniques are treatment modalities for colorectal neoplasia, although mostly used in the Eastern hemisphere. Only few data on ESD for colorectal neoplasia have been published in the West. We report the outcomes of colorectal ESD and hybrid ESD in a single Italian center.


We retrospectively evaluated the outcomes of all ESD and hybrid-ESD procedures for colorectal neoplasia performed over the first 2-year experience from a prospectively recorded database. Neuroendocrine tumors and adenocarcinoma with submucosal infiltration through the submucosal (SM) 2 layer or deeper were excluded. The primary outcome was the recurrence rate at the 6- to 12-month follow-up.


Fifty-two patients were included in the study, of which 23 underwent ESD and 29 hybrid ESD. The mean lesion sizes for ESD and hybrid ESD were similar (25.8 vs. 25.4 mm, p = 0.940), while median procedure length was significantly longer for ESD (120 vs. 60 min, p < 0.001). ESD and hybrid ESD yielded similar en-bloc resection rate (82.6 vs. 82.8%) and R0 resection rate (34.8 vs. 31%). ESD had a lower neoplasia recurrence rate than hybrid ESD (11.7 vs. 20%) and a lower bleeding rate (0 vs. 8.7%). One perforation occurred in the hybrid-ESD cohort and two perforations in the ESD cohort, of which one required surgical intervention. Non-recurrence at follow-up was associated with R0 status, en-bloc resection, and lesion size ≤ 20 mm.


Our outcomes are comparable with other studies in Western series. Studies addressing the cost effectiveness of ESD and comparing its long-term outcome with endoscopic mucosal resection in the West are needed.


Endoscopic submucosal dissection ESD Hybrid ESD Colorectal Italian center Western center 


Compliance with ethical standards


Drs. Reza V Milano, Edi Viale, Michael J. Bartel, Chiara Notaristefano, and Pier Alberto Testoni have no conflicts of interest or financial ties to disclose.


  1. 1.
    Yamamoto H, Osawa H (2011) Endoscopic submucosal dissection using small-caliber-tip transparent hood and sodium hyaluronate. Tech Gastrointest Endosc 13:79–83. doi: 10.1016/j.tgie.2011.02.005 CrossRefGoogle Scholar
  2. 2.
    Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu K-I, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352. doi: 10.1007/s00464-009-0562-8 CrossRefPubMedGoogle Scholar
  3. 3.
    Saito Y, Uraoka T, Yamaguchi Y, Hotta K, Sakamoto N, Ikematsu H, Fukuzawa M, Kobayashi N, Nasu J, Michida T, Yoshida S, Ikehara H, Otake Y, Nakajima T, Matsuda T, Saito D (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225. doi: 10.1016/j.gie.2010.08.004 CrossRefPubMedGoogle Scholar
  4. 4.
    Nakajima T, Saito Y, Tanaka S, Iishi H, Kudo SE, Ikematsu H, Igarashi M, Saitoh Y, Inoue Y, Kobayashi K, Hisasbe T, Matsuda T, Ishikawa H, Sugihara KI (2013) Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc Other Interv Tech 27:3262–3270. doi: 10.1007/s00464-013-2903-x CrossRefGoogle Scholar
  5. 5.
    Fujishiro M, Yahagi N, Nakamura M, Kakushima N, Kodashima S, Ono S, Kobayashi K, Hashimoto T, Yamamichi N, Tateishi A, Shimizu Y, Oka M, Ogura K, Kawabe T, Ichinose M, Omata M (2006) Endoscopic submucosal dissection for rectal epithelial neoplasia. Endoscopy 38:493–497. doi: 10.1055/s-2006-925398 CrossRefPubMedGoogle Scholar
  6. 6.
    Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, De Ceglie A, Amato A, Berr F, Bhandari P, Bialek A, Conio M, Haringsma J, Langner C, Meisner S, Messmann H, Morino M, Neuhaus H, Piessevaux H, Rugge M, Saunders BP, Robaszkiewicz M, Seewald S, Kashin S, Dumonceau JM, Hassan C, Deprez PH (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 47:829–854. doi: 10.1055/s-0034-1392882 CrossRefPubMedGoogle Scholar
  7. 7.
    Toyonaga T, Man-I M, Morita Y, Sanuki T, Yoshida M, Kutsumi H, Inokuchi H, Azuma T (2009) The new resources of treatment for early stage colorectal tumors: Emr with small incision and simplified endoscopic submucosal dissection. Dig Endosc. doi: 10.1111/j.1443-1661.2009.00872.x Google Scholar
  8. 8.
    Bae JH, Yang D-H, Lee S, Soh JS, Lee S, Lee H-S, Lee HJ, Park SH, Kim K-J, Ye BD, Myung S-J, Yang S-K, Byeon J-S (2015) Optimized hybrid endoscopic submucosal dissection for colorectal tumors: A randomized controlled trial. Gastrointest Endosc. doi: 10.1016/j.gie.2015.06.057 Google Scholar
  9. 9.
    Bartel MJ, Brahmbhatt BS, Wallace MB (2016) Management of colorectal T1 carcinoma treated by endoscopic resection from the Western perspective. Dig Endosc 28:330–341. doi: 10.1111/den.12598 CrossRefPubMedGoogle Scholar
  10. 10.
    (2003) The Paris endoscopic classication of supercial neoplastic lesions: esophagus, stomach, and colon. Endoscopy 58:3–43Google Scholar
  11. 11.
    Kudo S, Hirota S, Nakajima T, Hosobe S, Kusaka H, Kobayashi T, Himori M, Yagyuu a (1994) Colorectal tumours and pit pattern. J Clin Pathol 47:880–885. doi: 10.1136/jcp.47.10.880 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Veitch AM, Vanbiervliet G, Gershlick AH, Boustiere C, Baglin TP, Smith LA, Radaelli F, Knight E, Gralnek IM, Hassan C, Dumonceau JM (2016) Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines. Endoscopy. doi: 10.1055/s-0042-102652 Google Scholar
  13. 13.
    Ft B, Rh FC, Nd H T (2014) WHO classification of tumours of the digestive system. J Clin Ultrasound 00:1–6. doi: 10.1002/jcu.22189 Google Scholar
  14. 14.
    Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, Dixon MF, Fenoglio-Preiser CM, Fléjou JF, Geboes K, Hattori T, Hirota T, Itabashi M, Iwafuchi M, Iwashita a, Kim YI, Kirchner T, Klimpfinger M, Koike M, Lauwers GY, Lewin KJ, Oberhuber G, Offner F, Price AB, Rubio CA, Shimizu M, Shimoda T, Sipponen P, Solcia E, Stolte M, Watanabe H, Yamabe H (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47:251–255. doi: 10.1136/gut.47.2.251 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bhurwal A, Bartel MJ, Heckman MG, Diehl NN, Raimondo M, Wallace MB, Woodward TA (2016) Endoscopic mucosal resection: Learning curve for large nonpolypoid colorectal neoplasia. Gastrointest Endosc. doi: 10.1016/j.gie.2016.04.020 PubMedGoogle Scholar
  16. 16.
    Patel N, Patel K, Ashrafian H, Athanasiou T, Darzi A, Teare J (2016) Colorectal endoscopic submucosal dissection: Systematic review of mid-term clinical outcomes. Dig Endosc. doi: 10.1111/den.12597 PubMedGoogle Scholar
  17. 17.
    De Lisi S, Fiori G RD et al (2012) Endoscopic submucosal dissection (ESD) for residual or recurrent colorectal adenomas: a single center experience. Dig. Liver Dis 44S:S170CrossRefGoogle Scholar
  18. 18.
    Golger D, Probst A, Pommer B, Anthuber M, AH HM (2010) Endoscopic submucosal dissection (ESD) of colorectal lesions–the European experience. Gastro Intest Endosc 71:S1410CrossRefGoogle Scholar
  19. 19.
    Suzuki N, Toyonaga T, Man R TG (2008) Endoscopic submucosal dissection (ESD) for large, sessile colorectal polyps: Early experience at a UK centre. CME J Gastroenterol Hepatol Nutr 9:121–126Google Scholar
  20. 20.
    Repici A, Hassan C, Pagano N, Rando G, Romeo F, Spaggiari P, Roncalli M, Ferrara E, Malesci A (2013) High efficacy of endoscopic submucosal dissection for rectal laterally spreading tumors larger than 3 cm. Gastrointest Endosc 77:96–101. doi: 10.1016/j.gie.2012.08.036 CrossRefPubMedGoogle Scholar
  21. 21.
    Kruse E, Wilhelms G HC et al (2012) 83 widespread endoscopic submucosal dissections (ESDs) in 81 patients with large laterally spreading tumours up to 19 cm in the rectosigmoid: experience from a European center. Endoscopy 44:441CrossRefGoogle Scholar
  22. 22.
    Saito Y, Fukuzawa M, Matsuda T, Fukunaga S, Sakamoto T, Uraoka T, Nakajima T, Ikehara H, Fu KI, Itoi T, Fujii T (2010) Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352. doi: 10.1007/s00464-009-0562-8 CrossRefPubMedGoogle Scholar
  23. 23.
    Toyonaga T, Man-I M, Morita Y, Azuma T (2014) Endoscopic submucosal dissection (ESD) versus simplified/hybrid ESD. Gastrointest Endosc Clin N Am 24:191–199. doi: 10.1016/j.giec.2013.11.004 CrossRefPubMedGoogle Scholar
  24. 24.
    Probst A, Golger D, Anthuber M, Märkl B, Messmann H (2012) Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center. Endoscopy 44:660–667. doi: 10.1055/s-0032-1309403 CrossRefPubMedGoogle Scholar
  25. 25.
    Hotta K, Oyama T, Shinohara T, Miyata Y, Takahashi A, Kitamura Y, Tomori A (2010) Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc 22:302–306. doi: 10.1111/j.1443-1661.2010.01005.x CrossRefPubMedGoogle Scholar
  26. 26.
    Choi IJ, Kim CG, Chang HJ, Kim SG, Kook MC, Bae JM (2005) The learning curve for EMR with circumferential mucosal incision in treating intramucosal gastric neoplasm. Gastrointest Endosc 62:860–865. doi: 10.1016/j.gie.2005.04.033 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Reza V. Milano
    • 1
  • Edi Viale
    • 1
  • Michael J. Bartel
    • 2
  • Chiara Notaristefano
    • 1
  • Pier Alberto Testoni
    • 1
  1. 1.Division of Gastroenterology and Gastrointestinal EndoscopyVita Salute San Raffaele University, Scientific Institute San RaffaeleMilanItaly
  2. 2.Section of Gastroenterology, Fox Chase Cancer CenterTemple University Health SystemPhiladelphiaUSA

Personalised recommendations