Endoscopy 2023; 55(11): 1002-1009
DOI: 10.1055/a-2116-9930
Original article

Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study

Clara Yzet
 1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Yann Le Baleur
 2   Endoscopy and Gastroenterology Unit, Hospital Saint Joseph, Paris, France
,
Jérémie Albouys
 3   Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Jérémie Jacques
 3   Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
 3   Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Maximilien Barret
 4   Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
,
Einas Abou Ali
 4   Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France
,
 5   Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France
,
Jean-Baptiste Chevaux
 5   Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France
,
Sarah Leblanc
 6   Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
,
Vincent Lepillez
 6   Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
,
Jocelyn Privat
 7   Endoscopy and Gastroenterology Unit, Vichy Hospital, Vichy, France
,
Thibault Degand
 8   Endoscopy and Gastroenterology Unit, Dijon University Hospital, Dijon, France
,
Timothée Wallenhorst
 9   Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
,
Jérôme Rivory
 1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Ulriikka Chaput
10   Endoscopy and Gastroenterology Unit, Saint-Antoine University Hospital, Paris, France
,
Arthur Berger
11   Endoscopy and Gastroenterology Unit, Bordeaux University Hospital, Bordeaux, France
,
Karim Aziz
12   Endoscopy and Gastroenterology Unit, Saint Brieuc Hospital, Saint Brieuc, France
,
Gabriel Rahmi
13   Endoscopy and Gastroenterology Unit, Georges Pompidou European Hospital, Paris, France
,
Emmanuel Coron
14   Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland.
15   Digestive Diseases Institute, University Hospital Nantes, Nantes, France
,
Eric Kull
16   Endoscopy and Gastroenterology Unit, Metz Hospital, Metz, France
,
Ludovic Caillo
17   Endoscopy and Gastroenterology Unit, Nîmes University Hospital, Nîmes, France
,
18   Endoscopy and Gastroenterology Unit, Nice University Hospital, Nice, France
,
Stéphane Koch
19   Endoscopy and Gastroenterology Unit, Besançon University Hospital, Besançon, France
,
Fabien Subtil
20   Biostatistics Unit, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, and Laboratoire de Biométrie et Biologie Évolutive, Lyon, France
,
Mathieu Pioche
 1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
› Author Affiliations
Trial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04592003 Type of study: Multicenter


Abstract

Introduction Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions.

Methods All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins.

Results 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20–30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30–40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations.

Conclusion ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.

Tables 1 s–5 s, Fig. 1 s



Publication History

Received: 02 September 2022

Accepted after revision: 06 June 2023

Article published online:
27 July 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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