ENDOSCOPIC SUBMUCOSAL DISSECTION OR PIECEMEAL ENDOSCOPIC MUCOSAL RESECTION FOR LARGE SUPERFICIAL COLORECTAL LESIONS: COST-EFFECTIVENESS IN THE ERA OF SYSTEMATIC COUNTERTRACTION

Aims Endoscopic management is preferred to surgical management for large superficial colorectal lesions. However, the optimal endoscopic resection strategy for large superficial colorectal lesions (piecemeal endoscopic mucosal resection [pEMR] or endoscopic submucosal dissection [ESD]) is debated in particular from an economical point of view.

Methods A model was created to compare the cost-effectiveness of ESD and pEMR according to optical diagnosis (Japan NBI Expert Team [JNET], laterally spreading tumour [LST], CONECCT). We distinguished three groups from the same multicentre ESD cohort and compared the medical and economic outcomes: real-life ESD data (U-ESD) compared to modelled selective ESD (S-ESD JNET; S-ESD LST; S-ESD CONECCT) and exclusive pEMR strategies (U-EMR).

Results The en-bloc, R0, and curative resection rates were 97.5%, 86.5%, and 82.6%, respectively in the real life ESD cohort of 833 colorectal lesions. U-ESD was the least-expensive strategy, with a total cost of management of 2,858,048.17 €, i.e. 3,431.03 €/patient and was also the most effective strategy because it avoided 774 surgeries, which was more than any other strategy. It outperformed S-ESD CONNECT (total cost of management=2,951,411.44 €, and 3,543.11 €/patient, 765 surgeries avoided), S-ESD LST (total cost of management=3,055,951.53 €, and 3,668.61 €/patient, 749 surgeries avoided), and S-ESD JNET (total cost of management=3,547,426.97 € and 4,258.62 €/patient, 704 surgeries avoided) and U-EMR (total cost of management=4,060,547.62 € and 4,874.61 €/patient, 620 surgeries avoided).

Conclusions In the era of clip-and-rubber-band countertraction, ESD for all large LSTs is more cost-effective than pEMR and S-ESD.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2022