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

Endoscopic submucosal dissection (ESD) has become an established technique for en-bloc resection of large or complex colorectal lesions. However, conventional ESD (C-ESD) can be technically challenging and time-consuming. For non-malignant lesions, ESD with snaring [hybrid ESD (H-ESD)] can facilitate lesion removal and to save time. We report the experience and learning curve in a regional hospital setting in Switzerland.

We retrospectively evaluated the outcomes of all ESD procedures performed between 2018 and 2024 in our hospital. Primary outcome was the recurrence rate at the first follow-up endoscopy. Secondary outcomes included en-bloc resections, procedural time and complication rates stratified by periods in the learning curve.

Ninety patients (42 women; mean age 67 ± 12 years) were included in the study of which 51 underwent C-ESD and 39 H-ESD. The recurrence rate at first follow-up endoscopy was 8.8% (6/68) with no difference (p>0.05) between C-ESD (8.1%; 3/37) and H-ESD (9.7%; 3/31). The overall en-bloc resection rate was 63%, significantly higher (p<0.001) in the C-ESD group (98%) vs H-ESD (18%). Similarly, R0 resection rates were significantly (p<0.001) higher in C-ESD (86%) vs H-ESD (18%) groups. Procedural times were similar in the C-ESD (86 ± 44 min) and H-ESD (88 ± 45 min) groups. All parameters improved as the learning curve advanced. Complications requiring surgical intervention occurred in two cases (2.2%) one in the C-ESD and one in the H-ESD group.

Colorectal ESD is a feasible and can be self-taught in non-tertiary hospitals, achieving outcomes comparable to those reported in specialized centers, under appropriate case selection. Although conventional ESD achieves higher en-bloc and R0-resections than hybrid ESD, the latter may serve as a rescue option in selected cases.