Histology of colonic submucosal lesions reveals a high proportion of benign lesions that do not require R0 en bloc endoscopic resection

Abstract

Background and study aims

Submucosal lesions in the colon are much rarer than those in the rectum. Their nature is poorly understood, as is the best technique for their excision. Based on that of rectal lesions, it most often aims for R0 en bloc resection, but without formal proof of efficacy. The aim of this study was to evaluate histology of these lesions and determine whether submucosal lesions of the colon always require R0 en bloc endoscopic resection.

Patients and methods

We conducted a retrospective international study of all colonic submucosal lesions with confirmed histology by resection or biopsy. We assessed the proportion of lesions correctly managed by endoscopy, so that the proposed resection technique offered a level of tumor resection quality appropriate to the definitive histology of the lesion.

Results

One hundred patients with 105 colonic submucosal lesions from 13 European centers were included. Histology revealed 91.4% (96/105) non-malignant lesions and 8.6% (9/105) malignant lesions. Endoscopic techniques used were curative in 41.7% (5/12) of cases requiring resection, non-curative in 58.3% (7/12), and endoscopic resection was not necessary in 88.7% (93/105). There was no delayed surgery for adverse events.

Conclusions

Most colonic submucosal lesions are non-malignant and do not warrant advanced endoscopic resection. A new therapeutic approach could be first-line use of a low-risk, low-cost histological diagnostic technique followed in a second phase by a more advanced technique in the event of a malignant histological result. Further studies are needed to evaluate this step-up strategy.

Keywords

Endoscopy Lower GI Tract - Polyps / adenomas / ... - Tissue diagnosis - Endoscopic resection (polypectomy, ESD, EMRc, ...)

• References

• 1 Faulx AL, Kothari S. Standards of Practice Committee. et al. The role of endoscopy in subepithelial lesions of the GI tract. Gastrointest Endosc 2017; 85: 1117-1132
• 2 Veyre F, Lambin T, Fine C. et al. Endoscopic characterization of rectal neuroendocrine tumors with virtual chromoendoscopy: differences between benign and malignant lesions. Endoscopy 2021; 53: E215-E216
• 3 Rinke A, Ambrosini V, Dromain C. et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol 2023; 35: e13309
• 4 Ramage JK, De Herder WW, Delle Fave G. et al. ENETS Consensus Guidelines Update for Colorectal Neuroendocrine Neoplasms. Neuroendocrinology 2016; 103: 139-143
• 5 Bronswijk M, Vandenbroucke A-M, Bossuyt P. Endoscopic treatment of large symptomatic colon lipomas: A systematic review of efficacy and safety. United European Gastroenterol J 2020; 8: 1147-1154
• 6 Fahmawi Y, Hanjar A, Ahmed Y. et al. Efficacy and safety of full-thickness resection device (FTRD) for colorectal lesions endoscopic full-thickness resection: A systematic review and meta-analysis. J Clin Gastroenterol 2021; 55: e27-e36
• 7 Zhang H-P, Wu W, Yang S. et al. Endoscopic treatments for rectal neuroendocrine tumors smaller than 16 mm: a meta-analysis. Scand J Gastroenterol 2016; 51: 1345-1353
• 8 Schmidt A, Beyna T, Schumacher B. et al. Colonoscopic full-thickness resection using an over-the-scope device: a prospective multicentre study in various indications. Gut 2018; 67: 1280-1289