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Published on: March 24, 2023
Endoscopic Submucosal Dissection for Previously Attempted Colorectal Lesions: An International Multicenter
Suchapa Arayakarnkul1, Hiroyuki Aihara2, Alessandro Repici3
1Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Salvage endoscopic submucosal dissection (ESD) effectively treats previously attempted colorectal lesions (PACLs), achieving high en bloc and R0 resection rates. Adverse events were infrequent and manageable, demonstrating the safety of this expert-performed procedure.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Colorectal Oncology
Background:
- Salvage endoscopic submucosal dissection (ESD) is a potential treatment for previously attempted colorectal lesions (PACLs).
- Submucosal fibrosis in PACLs presents challenges for procedural difficulty and resection outcomes.
- Evaluating the efficacy and safety of salvage ESD for PACLs is crucial.
Purpose of the Study:
- To assess the efficacy of salvage endoscopic submucosal dissection (ESD) in treating previously attempted colorectal lesions (PACLs).
- To evaluate the safety profile of salvage ESD for PACLs, including adverse events and need for surgical intervention.
Main Methods:
- An international, multicenter study involving consecutive patients undergoing ESD for PACLs.
- Assessment of en bloc resection, R0 resection, and local recurrence rates for efficacy.
- Monitoring of adverse events (AEs), procedure-related mortality, and surgical management requirements for safety.
Main Results:
- High rates were achieved: 83.4% en bloc, 76.2% R0 resection, and 73.5% curative resection.
- Adverse events (AEs) occurred in 11.8% of patients, with intraprocedural perforation (4.6%) being most common. Most AEs were managed endoscopically.
- Local recurrence was 6.9% in patients with follow-up data; no procedure-related mortality was observed.
Conclusions:
- Salvage endoscopic submucosal dissection (ESD) demonstrates high efficacy in treating previously attempted colorectal lesions (PACLs).
- Adverse events associated with salvage ESD are uncommon when performed by experts and are typically managed endoscopically.
