Impact of ESD Case Volume per Year on Rectal Lesions: Analysis of the Prospective Multicenter Spanish CR-ESD Registry

Aims The European Society of Gastrointestinal Endoscopy (ESGE) recommends performing more than 25 Endoscopic Submucosal Dissection (ESD) procedures per year to maintain expertise. This study aims to evaluate the impact of annual ESD case volume per center on rectal ESD outcomes across Spanish institutions.

Methods Consecutive patients were enrolled in a prospective, multicenter Spanish ESD registry from January 2016 to September 2024. Hospitals were categorized into three groups based on annual case volume: more than 25 ESDs per year, 15–25 ESDs per year, and fewer than 15 ESDs per year. We analyzed outcomes across these groups. Additionally, a multivariate analysis was conducted to identify predictors of non-curative resections [1] [2].

Results The Spanish ESD database of the GSEED Endoscopic Resection Working Group includes 3,073 ESD records across all anatomical locations. For this analysis, only rectal cases were selected. A total of 686 rectal neoplasms referred for ESD were included, all performed by members of the ESD interest group of the GSEED group. Three centers performed more than 25 ESDs per year; five centers performed between 15 and 25 cases per year; and 27 centers performed fewer than 15 ESDs per year. The overall ¨en bloc¨ resection rate was 88.1%, with R0 resection achieved in 73% of cases, and 68.1% of cases met curative criteria. The conversion rate to hybrid or piecemeal EMR was 11%. Procedures were aborted due to technical difficulties in 3% of cases. Among the cases analyzed, delayed bleeding occurred in 9.1% of patients and intraprocedural perforation occurred in 7.1% of cases. An analysis of outcomes based on case volume per year (> 25 cases/year, 15–25 cases/year, and<15 cases/year) revealed the following: ¨en bloc¨ 'resection rates were 93.9%, 88.5%, and 82%, respectively (p<0.001); R0 resection rates were 79%, 68.5%, and 69.6%, respectively (p=0.034); curative resection rates were 74.4%, 63.6%, and 65.2%, respectively (p=0.028); and conversion rates to hybrid or piecemeal EMR were 5.3%, 10.6%, and 16.7%, respectively (p=0.02). In the multivariate analysis, the presence of Kudo V (OR 3.42; 95% CI 1.94–5.4; p<0.01) and the presence of fibrosis (OR 1.9; 95% CI 1.51–2.39; p<0.001) were significant positive predictors of non-curative resections. Performing>25 ESDs per year failed to prove to be a protective factor against non-curative resections (OR 0.76; 95% CI 0.5–1.16; p=0.21).

Conclusions In this registry, the predictors for non-curative resections appear to be more closely related to lesion characteristics, such as the presence of fibrosis or a Kudo V pattern, rather than the case volume of centers performing>25 cases per year.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

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