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Endoscopic submucosal dissection versus endoscopic mucosal resection for laterally spreading rectal tumours
Hadrien Alric1,2, Maximilien Barret2,3, Alix Becar1
1Service d'Hépato-gastroentérologie et Endoscopies Digestives, Hôpital Européen Georges-Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.
Summary
Endoscopic submucosal dissection (ESD) shows lower local recurrence rates for superficial rectal tumors compared to endoscopic mucosal resection (EMR). ESD also achieved higher en bloc and complete resection rates, improving treatment outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Endoscopy
Background:
- Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are primary endoscopic techniques for superficial rectal tumors.
- Comparing the efficacy and safety of these two methods is crucial for optimizing treatment strategies.
Purpose of the Study:
- To compare the outcomes of ESD and EMR in treating superficial rectal tumors.
- To evaluate local recurrence rates, curative resection rates, and complication profiles of both techniques.
Main Methods:
- A retrospective observational study included 254 patients from two French centers.
- Patients underwent either ESD (159) or EMR (95) for superficial rectal tumors.
- Primary outcome was local recurrence at first follow-up; secondary outcomes included resection rates, procedure time, hospital stay, and complications.
Main Results:
- ESD group had significantly lower local recurrence rates (4.3% vs. 16.9%; p=0.005).
- ESD demonstrated higher en bloc (88.1% vs. 42.7%) and complete resection rates (85.5% vs. 38.9%; p<0.001).
- Curative resection rates were comparable (92.5% for ESD vs. 90.6% for EMR; p=0.59), with similar rates of additional surgery (6.0% overall).
Conclusions:
- ESD offers superior rates of en bloc and R0 resection compared to EMR for superficial rectal tumors.
- These findings translate to significantly lower local recurrence rates following ESD, establishing it as a more effective endoscopic resection technique.
