Endoscopy 2018; 50(04): S80
DOI: 10.1055/s-0038-1637264
ESGE Days 2018 oral presentations
21.04.2018 – Colon: endoscopic resection session 2
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC MANAGEMENT OF EARLY COLORECTAL CANCER: COMPARISON BETWEEN PIECEMEAL MUCOSECTOMY AND HYBRID SUBMUCOSAL DISSECTION IN A SINGLE TERTIARY MEDICAL CENTRE IN NORTHERN ITALY

E Viale
1   Division of Gastroenterology and Gastrointestinal Endoscopy, Scientific Institute San Raffaele, Milan, Italy
,
GF Bonura
2   Division of Gastroenterology and Gastrointestinal Endoscopy Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
,
A Podda
2   Division of Gastroenterology and Gastrointestinal Endoscopy Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
,
C Notaristefano
1   Division of Gastroenterology and Gastrointestinal Endoscopy, Scientific Institute San Raffaele, Milan, Italy
,
PA Testoni
2   Division of Gastroenterology and Gastrointestinal Endoscopy Vita-Salute San Raffaele University, Scientific Institute San Raffaele, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

 

Aims:

Gastrointestinal early neoplasm exceeding 20 mm in diameter are often be removed with piecemeal endoscopic mucosal resection (PEMR), but it seems to increase the risk of recurrence. Endoscopic submucosal dissection (ESD) is an alternative procedure to enable en-bloc resection with a lower local recurrence but, its technical difficulties, its longer procedure time and increased risk of perforation limit its widespread. To overcome these issues it has been developed a new hybrid technique: hybrid ESD (ESD-H), a simplified ESD (used also as a rescue procedure in difficult colorectal ESD cases). The main aim of our study was to analyze recurrence rate lesions after removing early stage of colorectal lesions ≥30 mm removal in a single, tertiary-care, centre employing ESD-H or PEMR. Safety, duration of procedures were analyzed too.

Methods:

We retrospectively evaluated 105 patients (106 lesions) undergone endoscopic resection of non-pedunculated colorectal neoplasia ≥30 mm. Glycerol, epinephrine and indigo carmine were injected into the submucosal layer at the beginning of both procedures. After injection, in the ESD-H, it was performed a needle knife circumferential incision with and the neoplasm was en-bloc resected by snare while in PEMR the lesion was piece meal removed by snare too.

Results:

27 lesions were resected with ESD-H, 79 lesions with PEMR. ESD-H had a higher rate of perforations (overall 37%: ESD-H as rescue treatment 90%; ESD-H naïve 10%) compared to PEMR (0%) (p < 0.0001), and a longer duration (84.44 ± 29.56 minutes for ESD-H, 47,72 ± 25.52 minutes for PEMR, p < 0.0001). Follow up after both procedures (at 3 – 6, 12 – 18, 24, 36 months) showed a recurrence rate of 22% for ESD-H and 24.6% for PEMR (ns).

Conclusions:

In our experience, PEMR and ESD-H do not differ by the rate of recurrence. The latter has an higher complication rate, most cases owing to rescue treatment