Local recurrence after colorectal endoscopic submucosal dissection: a large international Western multicenter study

Western data to help guide surveillance recommendations after colorectal endoscopic submucosal dissection (ESD) remain scarce. In this multicenter study, we evaluate and stratify the risk of local recurrence after colorectal ESD.

A retrospective analysis of colorectal ESD at 13 centers was conducted between January 2015 and September 2025. Local recurrence was defined as neoplasia at the ESD site detected during surveillance colonoscopy (SC). Recurrence risk was calculated for the following groups: category 1 (R0 resection of low-grade dysplasia [LGD]), category 2 (R0 resection of high-grade dysplasia), category 3 (R1/Rx resection of noninvasive neoplasia), and category 4 (curative resection of T1a cancer). Multivariable logistic regression was performed to identify factors associated with recurrence.

In total, 2182 patients underwent colorectal ESD (median lesion size of 34 mm). En bloc and R0 resection rates were 93.6% and 81.1%, respectively. SC data were available in 1478 of the 2182 patients. Local recurrence occurred in 1.5% (22/1478) of patients at a median of 14 months: 1.5% (12/775) in category 1, 0.9% (3/330) in category 2, 2.2% (6/279) in category 3, and 1.1% (1/94) in category 4. Recurrence in very-low-risk lesions (defined as <40 mm in size with only LGD on histology) was 0.8% (4/478). Severe fibrosis was a risk factor for local recurrence (OR, 2.40; 95% CI, 1.12-4.89; P = .019), whereas R0 resection was associated with a lower likelihood (OR, 0.30; 95% CI, 0.15-0.58; P < .001).

In this multicenter non-Asian study, local recurrence after colorectal ESD was 1.5% and 0.8% for very-low-risk lesions. Severe submucosal fibrosis and R1/Rx resection were independently associated with local recurrence. Our data support current recommendations for SC at 12 months after ESD and raise the possibility of a longer interval for very-low-risk lesions.