Endoscopic Submucosal Dissection for Colorectal Lesions in a Community-based European Hospital: Experience and...

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Oncology

Background:

• Endoscopic submucosal dissection (ESD) is established for large/complex colorectal lesions.
• Conventional ESD (C-ESD) can be technically demanding; hybrid ESD (H-ESD) offers faster removal for non-malignant lesions.
• This study evaluates ESD experience and learning curve in a Swiss regional hospital.

Purpose of the Study:

• To assess the feasibility and outcomes of colorectal ESD in a non-tertiary hospital setting.
• To analyze the learning curve associated with ESD procedures.
• To compare the efficacy of conventional ESD versus hybrid ESD.

Main Methods:

• Retrospective evaluation of 90 colorectal ESD procedures (2018-2024).
• Primary outcome: recurrence rate at first follow-up endoscopy.
• Secondary outcomes: en-bloc resection rates, procedural time, and complication rates, stratified by learning curve periods.

Main Results:

• No significant difference in recurrence rates between C-ESD (8.1%) and H-ESD (9.7%).
• C-ESD achieved significantly higher en-bloc (98% vs 18%) and R0 resection rates (86% vs 18%) compared to H-ESD.
• Procedural times were similar (C-ESD: 86 min, H-ESD: 88 min); all parameters improved with experience. Two complications (2.2%) required surgery.

Conclusions:

• Colorectal ESD is feasible and learnable in non-tertiary hospitals, yielding comparable outcomes to specialized centers with careful case selection.
• Conventional ESD demonstrates superior en-bloc and R0 resection rates.
• Hybrid ESD serves as a valuable rescue option in specific cases.