LOCAL RECURRENCE AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION: A LARGE INTERNATIONAL WESTERN MULTICENTER STUDY

Area of Science:

• Gastroenterology
• Endoscopy
• Oncology

Background:

• Limited Western data exists for surveillance post-colorectal endoscopic submucosal dissection (ESD).
• Risk stratification for local recurrence following colorectal ESD is crucial for guiding surveillance strategies.

Purpose of the Study:

• To evaluate and stratify the risk of local recurrence after colorectal ESD in a multicenter, non-Asian cohort.
• To identify factors associated with local recurrence to inform surveillance recommendations.

Main Methods:

• Retrospective analysis of 2182 colorectal ESD procedures across 13 centers.
• Categorization of recurrence risk based on resection margins and histology (LGD, HGD, non-invasive neoplasia, T1a cancer).
• Multivariable logistic regression to identify predictors of local recurrence.

Main Results:

• Overall local recurrence rate was 1.5% (22/1478) at a median of 14 months.
• Recurrence rates varied by category: 1.5% (category 1), 0.9% (category 2), 2.2% (category 3), and 1.1% (category 4).
• Very low-risk lesions (<40mm, LGD) had a recurrence rate of 0.8%. Severe fibrosis (OR:2.40) and R1/Rx resection (OR:0.30) were significant factors.

Conclusions:

• Local recurrence after colorectal ESD in a non-Asian population is low (1.5%), particularly for very low-risk lesions (0.8%).
• Severe submucosal fibrosis and incomplete resection (R1/Rx) are independent risk factors for recurrence.
• Findings support current 12-month surveillance colonoscopy recommendations and suggest potential for longer intervals in very low-risk cases.