Rates of Cancer, Non-curative Resection, Adverse Event and Surgery After Colonic Endoscopic Submucosal Dissection...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Endoscopic Procedures

Background:

• Endoscopic submucosal dissection (ESD) is favored over endoscopic mucosal resection (EMR) for colon cancer with suspected superficial invasion.
• Data on ESD utilization, including cancer and non-curative resection (NCR) rates, are limited.
• Accurate patient selection is vital for optimizing ESD outcomes.

Purpose of the Study:

• To evaluate the utilization and outcomes of ESD in a large Western cohort.
• To determine rates of cancer, NCR, and subsequent surgery after colonic ESD.
• To identify predictors of NCR in colonic ESD procedures.

Main Methods:

• Retrospective analysis of 547 consecutive colonic lesions treated with ESD across multiple centers.
• Assessment of histopathological findings, including cancer and high-grade dysplasia.
• Evaluation of NCR rates, surgical intervention rates, and adverse events.

Main Results:

• Histopathology confirmed cancer in 12% of lesions; 24.6% showed high-grade dysplasia.
• The overall NCR rate was 59.1% for patients and 39% for lesions.
• Surgery was required in 7.6% of NCR cases, with an 8.8% adverse event rate.

Conclusions:

• Most colonic ESDs in this cohort treated benign pathology, with a high NCR rate for cancerous lesions.
• Despite high NCR, the overall surgery rate remained low, indicating ESD's safety.
• Refining lesion selection criteria and optimizing ESD techniques are necessary to enhance efficiency and safety, potentially matching EMR's performance.