Endoscopy 2019; 51(04): S182
DOI: 10.1055/s-0039-1681709
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 13:30 – 14:00: Colon ESD 2 ePoster Podium 1
Georg Thieme Verlag KG Stuttgart · New York

ENDOSCOPIC SUBMUCOSAL DISSECTION IN LARGE RECTAL ADENOMAS AND EARLY CANCER: INITIAL RESULTS IN A BICENTRIC SERIES

D de Frutos
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
B Conde
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
B Agudo
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
M Hernández
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
M López
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
CE González
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
J Santiago
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
I González Partida
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
M González-Haba
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
A Garrido
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
P Matallanos
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
E Blazquez
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
M Bote
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
M Sol Delgado
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
P García
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
,
JL Calleja
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
2   MD Anderson Cancer Centre Madrid, Gastroenterology and Hepatology, Madrid, Spain
,
A Herreros de Tejada
1   Puerta de Hierro – Majadahonda University Hospital, Gastroenterology and Hepatology, Majadahonda, Spain
2   MD Anderson Cancer Centre Madrid, Gastroenterology and Hepatology, Madrid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

To evaluate ESD for the treatment of large rectal adenomas and early cancer (LRAEC) in two Spanish centers.

Methods:

Prospective registry of consecutive LRAEC cases with ESD carried out in 2 Spanish centers. All procedures were performed by the same endoscopist (AH). All rectal ESD of LRAEC from the first case in November 2012 to March 2018 were analysed. Recurrence analysis excluded 10 cases due to several reasons: surgery due to non-curative ESD (4), less than 12 months of surveillance (3) or missing data (3). To estimate the influence of the learning curve in rectal ESD we compare the dissection speed between de first 10 procedures (group 1) and the last 10 procedures (group 2).

Results:

A total of 32 ESD of LRAEC were registered, male proportion 53%, mean age 65.9 y/o (SD 12). The mean size of LRAEC was 55.8 mm, with 31% prevalence of submucosal fibrosis (F1 or F2). Technical results and complications are summarized in Table 1. Most complications observed were mild and were successfully controlled endoscopically or with medical treatment.

Tab. 1:

Main Results

Mean diameter, mm (Range)

55.8 (10 – 120)

R0 (%)

28 (88)

Groups 3 and 4 of the Vienna Classification (%)

28 (87)

Complications (%): bleeding (%), perforation (%)

7 (22): 2 (6), 4 (13)

Group 5 of the Vienna Classification (%)

4 (13)

Surgery due to complications (%)

0 (0)

En-bloc (%)

31 (97)

Recurrence (12 months) (%)

0 (0)

In group 1 the dissection speed was 6.3 (SD 2.7)min/cm2 whereas in group 2 was 5.2 (SD 3.7)min/cm2 not reaching statistical significance (p = 0.288). There were no case of severe complication requiring surgery.

Conclusions:

Results of our series of ESD in LRAEC are similar to those reported in Asian series, highlighting the excellent en-bloc resection rate for LRAEC over 5 cm on average, with no local recurrence after 1-year follow-up. Higher dissection speed might reflect a progression in the learning curve, although no significant differences could be reached.