Endoscopic submucosal dissection with or without snaring for colorectal neoplasms

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Colorectal endoscopic submucosal dissection (ESD) is technically challenging, limiting its widespread adoption.
• High en bloc resection rates are desirable for complete tumor removal.

Purpose of the Study:

• To compare outcomes between standard colorectal endoscopic submucosal dissection (ESD) and a simplified technique, ESD with snaring (ESD-S).
• To evaluate the safety and efficacy of both ESD and ESD-S for colorectal neoplasms.

Main Methods:

• A retrospective observational study was conducted at a single, tertiary-care center.
• 163 lesions in 162 patients underwent ESD, and 74 lesions in 71 patients underwent ESD-S.
• En bloc resection rate, procedure time, complications, and histopathologic results were analyzed.

Main Results:

• Standard ESD achieved a higher en bloc resection rate (87%) compared to ESD-S (64%).
• Histologically complete resection rates were also higher with standard ESD.
• Perforation and bleeding rates were similar between ESD and ESD-S, and comparable outcomes were observed for lesions <20 mm.

Conclusions:

• Both ESD and ESD-S are safe and effective for resecting colorectal neoplasms.
• Standard ESD is recommended for suspected superficial submucosal cancers due to its higher en bloc resection rate.
• ESD-S serves as a suitable alternative for en bloc resection of colorectal lesions smaller than 20 mm.