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.
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.
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%).
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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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.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Guarantor of the article: Irving Waxman, MD.
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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
- Endoscopic submucosal dissection
- Colorectal polyp
- Colorectal cancer
- Therapeutic endoscopy