Endoscopy 2018; 50(04): S68
DOI: 10.1055/s-0038-1637229
ESGE Days 2018 oral presentations
20.04.2018 – Colon: endoscopic resection session 1
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC SUBMUCOSAL DISSECTION OF 328 LARGE COLORECTAL NEOPLASIAS: OUTCOME AND LEARNING CURVE FROM A SPECIALIZED CENTER IN EUROPE

CF Frimand Rönnow
1   Lund University, Surgery, Malmö, Sweden
,
N Uedo
2   Osaka International Cancer Institute, Gastroenetrology, Osaka, Japan
,
E Toth
3   Lund University, Gastroenterology, Malmö, Sweden
,
H Thorlacius
1   Lund University, Surgery, Malmö, Sweden
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

Endoscopic submucosal dissection (ESD) allows en bloc resection of large colorectal lesions but ESD experience is limited outside Asia. The aim of this study was to evaluate the outcome and learning curve of ESD in the treatment of colorectal neoplasias in a European center.

Methods:

328 colorectal ESDs were performed and after excluding 33 cases of submucosal invasive CRC resected with ESD and two cases of carcinoid tumors, we retrospectively included and reviewed 293 lesions in 290 patients.

Results:

169 lesions (58%) were located in the rectum and 124 (42%) were located in the colon. Median size was 4 cm (range 1 – 12.5) and lesion type was: Is 142, IIa 135 and IIa/Is 16. En bloc resection was achieved in 233 cases amounting to an en bloc resection rate of 79%. R0 resection was accomplished in 203 cases (69%) and RX and R1 were attained in 82 (28%) and 6 (2%) cases respectively. Median time was 98 minutes (range 10 – 588) and median proficiency was 0.12 cm2/min. Complications occurred in 23 patients (8%) divided into 12 direct perforations, 5 delayed perforations, 1 direct bleeding and 5 delayed bleeding. Six patients (2%) had emergency surgery. 185 patients were followed up endoscopically and median follow up time was 12 months (range 3 – 53) revealing 7 recurrences (4%). En bloc rate significantly improved from 61% during the first period and gradually increased to 97% during the last period. ESD proficiency significantly improved between the first study period (0.06 cm2/min) and the last study period (0.18 cm2/min).

Conclusions:

This study represents the largest material on colorectal ESD in western countries as of today and shows that colorectal ESD can be implemented in western countries after appropriate training and achieve a high rate of en bloc and R0 resections with a concomitant low incidence of complications.