Resection outcomes and recurrence rates of endoscopic submucosal dissection (ESD) and hybrid ESD for colorectal tumors in a single Italian center

Reza V. Milano, Edi Viale, Michael J. Bartel, Chiara Notaristefano, Pier Alberto Testoni

Endoscopic submucosal dissection (ESD) and hybrid-ESD techniques are treatment modalities for colorectal neoplasia, although mostly used in the Eastern hemisphere. Only few data on ESD for colorectal neoplasia have been published in the West. We report the outcomes of colorectal ESD and hybrid ESD in a single Italian center. We retrospectively evaluated the outcomes of all ESD and hybrid-ESD procedures for colorectal neoplasia performed over the first 2-year experience from a prospectively recorded database. Neuroendocrine tumors and adenocarcinoma with submucosal infiltration through the submucosal (SM) 2 layer or deeper were excluded. The primary outcome was the recurrence rate at the 6- to 12-month follow-up. Fifty-two patients were included in the study, of which 23 underwent ESD and 29 hybrid ESD. The mean lesion sizes for ESD and hybrid ESD were similar (25.8 vs. 25.4 mm, p = 0.940), while median procedure length was significantly longer for ESD (120 vs. 60 min, p < 0.001). ESD and hybrid ESD yielded similar en-bloc resection rate (82.6 vs. 82.8%) and R0 resection rate (34.8 vs. 31%). ESD had a lower neoplasia recurrence rate than hybrid ESD (11.7 vs. 20%) and a lower bleeding rate (0 vs. 8.7%). One perforation occurred in the hybrid-ESD cohort and two perforations in the ESD cohort, of which one required surgical intervention. Non-recurrence at follow-up was associated with R0 status, en-bloc resection, and lesion size ≤ 20 mm. Our outcomes are comparable with other studies in Western series. Studies addressing the cost effectiveness of ESD and comparing its long-term outcome with endoscopic mucosal resection in the West are needed.