MANAGEMENT OF SUPERFICIAL RECTAL TUMORS BY SUBMUCOSAL DISSECTION: A CANADIAN EXPERIENCE

Aims Our objective is to evaluate ESD efficacy in a Canadian practice.

Methods Retrospective analysis of consecutive patients that underwent ESD procedure between 07/2017 and 10/2019.

Results 20 patients (mean age 67 yo (50–79), sex ratio = 12 H/8 F) were included. 13 tumors had a mixed granular morphology while 7 tumors had a non granular morphology. Paris classification were 0-Is (n = 8), 0-IIa (n = 3), 0-IIa + Is (n = 6), 0-IIa + c (n = 3), and had Kudo pattern III (n = 4), IV (n = 13) or V (n = 3). Average procedure time was 157 minutes (73–473). 15 (75%) of ESD resection were en bloc, 4 (20%) by fragmented endoscopic mucosal resection (EMR) and 1 (5%) by surgery. The pathology revealed 2 LGD adenoma, 9 HGD adenoma and 7 adenocarcinoma (4 intra-mucosal, 2 sm1 and 1 sm3) The average pathology tumor length was 60 mm (13–110; n = 15). An adverse event happened in 9 cases (45%): 4 perforations were treated endoscopically, 4 urinary retentions and 1 hemorrhoidal thrombosis were treated medically. Average length of hospital stay was 2,1 days (1–5). The resection was R0 and curative in 9/20 (45%). The resections weren’t curative because of a positive lateral marge (5), a positive deep marge (1), ESD failure (1) or P-EMR (4). 10 patients had an endoscopic follow up (average = 37 weeks post-ESD). 1 patient had an adenoma recurrence.

Conclusions ESD is a difficult endoscopic technique, but it allows a good treatment of advanced rectal lesions with a low recurrence rate.