Endoscopy 2025; 57(S 02): S83-S84
DOI: 10.1055/s-0045-1805258
Abstracts | ESGE Days 2025
Oral presentation
Colorectal lesions: Resect...but how? 04/04/2025, 10:00 – 11:00 Room 120+121

Should We Be More Selective with Rectal ESD? Analysis of the Prospective Multicenter Spanish CR-ESD Registry

A Lanas Gimeno
1   12 de Octubre University Hospital, Madrid, Spain
,
J C Marín-Gabriel
2   University Hospital October 12, Madrid, Spain
,
J Rodríguez Sánchez
2   University Hospital October 12, Madrid, Spain
,
A Herreros De Tejada
3   Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain
,
D de Frutos
3   Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain
,
J Santiago
3   Puerta de Hierro Majadahonda University Hospital, Majadahonda, Spain
,
H Uchima
4   Hospital Germans Trias i Pujol, Badalona, Spain
,
E Albéniz
5   Navarra Hospital Complex – Navarra Hospital, Pamplona, Spain
,
F Ramos Zabala
6   University Hospital HM Montepríncipe, Monteprincipe, Spain
,
E Rodriguez de Santiago
7   Hospital Universitario Ramón y Cajal, Madrid, Spain
,
P De Maria Pallares
8   Hospital Universitario La Paz, Madrid, Spain
,
G Fernández-Esparrach
9   Hospital Clínic, ICMDM, Gastroenterology Department, Endoscopy Unit, Barcelona, Spain
,
C Guarner Argente
10   Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
P Rosón Rodriguez
11   Xanit Hospital, Benalmádena, Spain
,
Á Terán
12   Marqués de Valdecilla University Hospital, Santander, Spain
,
M Fraile-Lopez
12   Marqués de Valdecilla University Hospital, Santander, Spain
,
A Amoros Tenorio
13   Our Lady of Candelaria University Hospital, Santa Cruz de Tenerife, Spain
,
C Dolz
14   Hospital Juaneda Miramar, Palma, Spain
,
H Cortes
15   Hospital de Urduliz, Vizcaya, Spain
,
A Sanchez-Yague
16   Hospital Costa del Sol, Marbella, Spain
,
R Duran
17   Clínica ServiDigest, Barcelona, Spain
,
D García Romero
6   University Hospital HM Montepríncipe, Monteprincipe, Spain
,
A Alvarez
18   Salamanca University Hospital, Salamanca, Spain
,
Ó Nogales Rincón
19   Gregorio Marañón General University Hospital, Madrid, Spain
,
A Del Pozo
2   University Hospital October 12, Madrid, Spain
,
J Díaz Tasende
2   University Hospital October 12, Madrid, Spain
› Institutsangaben
 

Aims To assess the potential benefits of Endoscopic Submucosal Dissection (ESD) for rectal lesions by analyzing the final histology of resected specimens within a large prospective registry

Methods Consecutive patients were enrolled in a prospective, multicenter Spanish CR-ESD registry from January 2016 to September 2024. Only rectal ESD cases were included. Based on the final histological results of the specimen, we calculated the potential Number Needed to Treat (NNT) for ESD to avoid one surgery in the registry, assuming that EMR does not cure cases with submucosal invasion, and considering a 100% complete resection rate with no complications for both ESD and EMR.

Results The Spanish ESD database included 3,073 ESD records across all locations. For this analysis, only rectal cases were selected. A total of 686 rectal neoplasms referred for ESD were recruited, all performed by members of the ESD interest group within the GSEED Endoscopic Resection Working Group. The overall en bloc resection rate was 88.1% with R0 resection achieved in 73% of cases. The conversion rate to hybrid or piecemeal EMR was 11%, while 3% of procedures were aborted due to technical difficulties. Consequently, only 64.8% of the cases initially referred for ESD were completed as such and met curative criteria. Additionally, almost 4% of lesions referred for ESD were under 20 mm and could have been resected en bloc using EMR. Out of the total cases, 102 (14.8%) exhibited submucosal invasion; of these, 38 (5.5%) had superficial invasion, while the remaining cases had deep invasion. Among those with superficial invasion, 23% presented additional risk factors for lymphatic invasion, invalidating the curative criteria. Based on the final histological results of the specimens, ESD could potentially achieve curative resection in 89.3% of cases, whereas EMR could cure 85.1% of the total cases. Thus, the potential NNT for ESD in the registry would be approximately 24 cases (95% Confidence Interval CI: 13.04–114.31). Mixed-type lesions with nodules>20 mm and non-granular laterally spreading tumors (LST) showed a notable potential benefit, with NNTs of approximately 20 (95% CI: 12.66–41.67) and 7 (95% CI: 5.38–11.63), respectively. Similarly, Kudo Vi and JNET2B patterns demonstrated NNTs of 8 (95% CI: 5.18–23.26) and 16 (95% CI: 7.58–31.25), respectively. However, the sample included more than 10% of cases corresponding to granular homogeneous LSTs, for which the NNT to avoid surgery would be approximately 91 (95% CI: 40–200) procedures in the best-case scenario [1] [2] [3].

Conclusions The overall results of this registry suggest that rectal lesions most likely to benefit from ESD should be carefully selected based on high-risk morphology, such as non-granular LSTs, mixed-type lesions with large nodules, and surface patterns like Kudo Vi and JNET2B.



Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

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