Endoscopic submucosal dissection for colorectal lesions: outcomes from a United States experience

Abstract

Background and study aims

Endoscopic submucosal dissection (ESD) is commonly used in Asia for resection of large non-pedunculated colorectal polyps (LNPCPs) and early (T1) colorectal cancers. It allows for en bloc removal and is often curative. We describe outcomes of colorectal ESD from a United States (US) academic medical center and compare this to international experiences.

Methods

Retrospective review was performed of colonic lesions referred to the University of Chicago Medical Center for ESD from 2012 to 2020. Clinical and procedural data were collected.

Results

The study included 78 lesions with mean size of 29.7 mm (range 10–100 mm). The overall en bloc resection rate was 73.1% (n = 57). Between the first and second half of the study, it improved from 61.5 to 84.6% (p = 0.02). Histology showed adenocarcinoma in fifteen lesions (19.2%). Of all neoplastic lesions (n = 68), resection with negative margins (R0) was achieved in 54 cases (79.4%). Adverse events occurred in 9 cases (11.5%), but most (n = 6, 66.7%) were successfully treated endoscopically. Follow-up endoscopy was performed in 46 patients (59.0%) at a mean interval of 6.8 months (SD ± 5.0 months) with two case of recurrent lesion (4.3%).

Conclusions

This study shows successful colorectal ESD outcomes at a US tertiary center. The en bloc resection rate was lower than other cohorts, but a learning curve was demonstrated. The R0 resection, lesion recurrence, and adverse event rates were similar to other non-Asian experiences, but not as favorable as in Asia [Fuccio et al. in Gastrointest Endosc 86:74–86.e17, 2017]. Increased ESD training in the US can help optimize utilization and outcomes.

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References

  1. 1.

    Fuccio L, Hassan C, Ponchon T et al (2017) Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 86(1):74-86.e17

    Article  Google Scholar 

  2. 2.

    Mannath J, Subramanian V, Singh R et al (2011) Polyp recurrence after endoscopic mucosal resection of sessile and flat colonic adenomas. Dig Dis Sci 56(8):2389–2395

    CAS  Article  Google Scholar 

  3. 3.

    Heitman SJ, Bourke MJ (2017) Endoscopic submucosal dissection and EMR for large colorectal polyps: “the perfect is the enemy of good.” Gastrointest Endosc 86:87–89

    Article  Google Scholar 

  4. 4.

    Rex DK, Hassan C, Dewitt JM (2017) Colorectal endoscopic submucosal dissection in the United States: why do we hear so much about it and do so little of it? Gastrointest Endosc 85:554–558

    Article  Google Scholar 

  5. 5.

    Fujishiro M (2018) Perspective on the practical indications of endoscopic submucosal dissection of gastrointestinal neoplasms. World J Gastroenterol 21:4289–4295

    Google Scholar 

  6. 6.

    Russo P, Barbeiro S, Awadie H, Libânio D, Dinis-Ribeiro M, Bourke M (2019) Management of colorectal laterally spreading tumors: a systematic review and meta-analysis. Endosc Int Open 7(2):E239–E259

    Article  Google Scholar 

  7. 7.

    Hassan C, Repici A, Sharma P et al (2016) Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 65(5):806–820

    CAS  Article  Google Scholar 

  8. 8.

    Fujiya M, Tanaka K, Dokoshi T et al (2015) Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 81(3):583–595

    Article  Google Scholar 

  9. 9.

    De Ceglie A, Hassan C, Mangiavillano B et al (2016) Endoscopic mucosal resection and endoscopic submucosal dissection for colorectal lesions: a systematic review. Crit Rev Oncol Hematol 104:138–155

    Article  Google Scholar 

  10. 10.

    Arezzo A, Passera R, Marchese N, Galloro G, Manta R, Cirocchi R (2016) Systematic review and meta-analysis of endoscopic submucosal dissection vs endoscopic mucosal resection for colorectal lesions. United Eur Gastroenterol J 4(1):18–29

    CAS  Article  Google Scholar 

  11. 11.

    Saito Y (2015) Indication for colorectal ESD. In: Fukami N (ed) Endoscopic submucosal dissection. Springer, New York, pp 19–24

    Google Scholar 

  12. 12.

    Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T et al (2015) Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 47(9):829–854

    Article  Google Scholar 

  13. 13.

    Tanaka S, Kashida H, Saito Y et al (2015) JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 27(4):417–434

    Article  Google Scholar 

  14. 14.

    Lang GD, Konda VJ, Siddiqui UD et al (2015) A single-center experience of endoscopic submucosal dissection performed in a Western setting. Dig Dis Sci 60(2):531–536

    Article  Google Scholar 

  15. 15.

    Kikuchi R, Takano M, Takagi K et al (1995) Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 38:1286–1295

    CAS  Article  Google Scholar 

  16. 16.

    Ge PS, Jirapinyo P, Ohaya TR et al (2019) Predicting outcomes in colorectal endoscopic submucosal dissection: a United States experience. Surg Endosc 33:4016–4025

    Article  Google Scholar 

  17. 17.

    Yang D, Alhara H, Perbtani Y et al (2019) Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience. Endosc Int Open 07:E1714–E1722

    Article  Google Scholar 

  18. 18.

    Saito Y, Uraoka T, Yamaguchi Y et al (2010) A multi-center retrospective study of 1,111 colorectal endoscopic submucosal dissections (ESD). Gastrointest Endosc 72(6):1217–1225

    Article  Google Scholar 

  19. 19.

    Lee E, Lee JB, Lee SH et al (2013) Endoscopy submucosal dissection for colorectal tumors-1,000 colorectal ESD cases: one specialized institute’s experiences. Surg Endosc 27(1):31–39

    Article  Google Scholar 

  20. 20.

    Oka S, Tanka S, Saito Y et al (2015) Local recurrence after endoscopic resection for large colorectal neoplasia: a multicenter prospective study in Japan. Am J Gastroenterol 110:697–707

    Article  Google Scholar 

  21. 21.

    Emmanuel A, Gulati S, Burt M, Hayee B, Haji A (2019) Outcomes of endoscopic resection of large colorectal lesions subjected to prior failed resection or substantial manipulation. Int J Colorectal Dis 34(6):1033–1041

    Article  Google Scholar 

  22. 22.

    Pimentel-Nunes P, Pioche M, Albeniz E et al (2019) Curriculum for endoscopic submucosal dissection training in Europe: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 51:980–992

    Article  Google Scholar 

  23. 23.

    Saito Y, Fukuzawa M, Matsuda T et al (2010) Clinical outcomes of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 24:343–352

    Article  Google Scholar 

  24. 24.

    Lee EJ, Lee JB, Lee SH et al (2012) Endoscopic treatment of large colorectal tumors: comparison of endoscopic mucosal resection, endoscopic mucosal resection-precutting, and endoscopic submucosal dissection. Surg Endosc 26:2220–2230

    Article  Google Scholar 

  25. 25.

    Fuccio L, Ponchon T (2017) Colorectal endoscopic submucosal dissection (ESD). Best Pract Res Clin Gastroenterol 31(4):473–480

    Article  Google Scholar 

  26. 26.

    Probst A, Ebigbo A, Markle B et al (2017) Endoscopic submucosal dissection for early rectal neoplasia: experience from a European Center. Endoscopy 49:222–232

    PubMed  Google Scholar 

  27. 27.

    Stier MW, Chapman CG, Krietman A et al (2018) Dissection-Enabled SCaffold Assisted Resection – DeSCAR – A novel technique for resection of residual or non-lifting gastrointestinal neoplasia. Gastrointest Endosc 87:843–851

    Article  Google Scholar 

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Authors

Contributions

NG: study concept and design, acquisition of data, analysis and interpretation of data, statistical analysis, drafting of the manuscript; GRR: study concept and design, acquisition of data, drafting of the manuscript; UDS: acquisition of data, review of the manuscript; CGC: acquisition of data, review of the manuscript; KD: acquisition of data; JH: provided pathology data; SYX: provided pathology data; IW: study concept and design, acquisition of data, analysis and interpretation of data, statistical analysis, revision of the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Nina Gupta.

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Disclosures

Dr. Uzma Siddiqui is a consultant for ConMed, Boston Scientific, Medtronic and Olympus. Dr. Irving Waxman is a consultant for Boston Scientific, Medtronic, Olympus, and Cook Medical. Dr. Nina Gupta, Dr. Gabriela Rodriquez-Ruiz, Dr. Chapman, Dr. Kianoush Donboli, Dr. John Hart, and Dr. Shu-Yuan Xiao have no conflicts of interest or financial ties to disclose.

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Gupta, N., Rodríguez-Ruiz, G., Siddiqui, U.D. et al. Endoscopic submucosal dissection for colorectal lesions: outcomes from a United States experience. Surg Endosc (2021). https://doi.org/10.1007/s00464-020-08262-4

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Keywords

  • Endoscopic submucosal dissection
  • Colorectal polyp
  • Colorectal cancer
  • Therapeutic endoscopy