ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) VERSUS PIECE-MEAL ENDOSCOPIC MUCOSAL RESECTION (EMR) FOR LARGE LATERALLY SPREADING LESIONS (LSL): FRENCH RANDOMIZED CONTROLLED TRIAL (RESECT-COLON)

Aims The optimal endoscopic resection strategy for large LSL is debated between Japanese (ESD) and western (PM-EMR) attitudes. No randomized trial is available about this daily topic.

Methods Multicenter, single blinded, randomized controlled trial involving 6 centers and 11 physicians comparing ESD and PM-EMR with snare tip thermal ablation of the margin for large (>25 mm) low risk laterally spreading lesions of the colon.

The primary outcome was the recurrence rate at 6 months.

Results 359 patients were randomized between 09/15/2019 and 10/01/2021 (ESD 177, PM-EMR 182)

Location in the right colon in 60.3% of cases with a mean size of 42.9 mm (+/- 16.1).

There was a significant difference in recurrence at 6 months in favor of the ESD group: 0.6% vs 5.1% (OR 8.6 IC95% 1.5 – 49.3; p=0.019).

Secondary endpoints:

• per procedure perforation ESD 5.6% vs PM-EMR 2.2% p=0.09

• R0 resection rate ESD 93.8% vs PM-EMR 12.1% p<0.001

• mean duration of the procedure ESD 61.4 min (+/- 46.6) vs PM-EMR 20.4 min (+/- 17.1) (p<0.001)

• clinically significant delayed bleeding: ESD 7.9% vs PM-EMR 5.5%, p=0.36

• presence of deep submucosal cancer (>1000 microns) ESD 4% vs PM-EMR 3.8% p=0.8

• presence of superficial submucosal cancer (<1000 microns): ESD 3.5% vs PM-EMR 0.5% p=0.08

Conclusions ESD is superior to PM-EMR regarding 6 months recurrence rate without increasing the morbidity. R0 resection exceeds 90%, avoiding costly and unwanted follow-up colonoscopies. PM-EMR seems to be associated with a risk of loss of histological information that is detrimental to the patient.

Publication History

Article published online:
14 April 2022