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CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(02): E258-E262
DOI: 10.1055/a-1321-1271
Original article

Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

Christian Suchy
1   Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn,
Academic Teaching Hospital, University of Bonn, Bonn, Germany
,
Moritz Berger
2   Institute of Medical Biometry, Informatics and Epidemiology (IMBIE),
Faculty of Medicine, University of Bonn, Bonn, Germany
,
Ingo Steinbrück
3   Department of Medicine/Gastroenterology, Evangelisches Diakoniekrankenhaus Freiburg, Freiburg, Germany
,
Tsuneo Oyama
4   Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan
,
Naohisa Yahagi
5   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
,
Franz Ludwig Dumoulin
1   Department of Medicine and Gastroenterology, Gemeinschaftskrankenhaus Bonn,
Academic Teaching Hospital, University of Bonn, Bonn, Germany
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Abstract

Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1).

Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians.

Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically.

Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.



Publication History

Received: 04 August 2020

Accepted: 20 October 2020

Article published online:
03 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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