Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center
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.
KeywordsEndoscopic 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.
- 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.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.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.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.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
- 10.(2003) The Paris endoscopic classication of supercial neoplastic lesions: esophagus, stomach, and colon. Endoscopy 58:3–43Google Scholar
- 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
- 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
- 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
- 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