Endoscopy 2025; 57(S 02): S593
DOI: 10.1055/s-0045-1806554
Abstracts | ESGE Days 2025
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Is Endoscopic Snare Resection Feasible as a Total Excision Biopsy for T1 Colorectal Cancer 20 mm or Smaller?

Authors

  • S Yamamoto

    1   NHO Osaka National Hospital, Osaka, Japan

  • W Watanabe

    1   NHO Osaka National Hospital, Osaka, Japan

  • Y Yamashita

    1   NHO Osaka National Hospital, Osaka, Japan

  • K Nakao

    1   NHO Osaka National Hospital, Osaka, Japan

  • A Kitagawa

    1   NHO Osaka National Hospital, Osaka, Japan

  • K Matsushima

    1   NHO Osaka National Hospital, Osaka, Japan

  • Y Abe

    1   NHO Osaka National Hospital, Osaka, Japan

  • S Tanaka

    1   NHO Osaka National Hospital, Osaka, Japan

  • N Fukutake

    1   NHO Osaka National Hospital, Osaka, Japan

  • H Hasegawa

    1   NHO Osaka National Hospital, Osaka, Japan

  • Y Sakakibara

    1   NHO Osaka National Hospital, Osaka, Japan

  • R Sakamori

    1   NHO Osaka National Hospital, Osaka, Japan
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Aims Endoscopic submucosal resection (ESD) is reported to be feasible as a total excision biopsy for T1 colorectal cancer (CRC). For the lesions 20 mm or smaller, endoscopic snare resection, which is technically less demanding than ESD, may be a viable alternative. This study aims to evaluate the feasibility of endoscopic snare resection as a total excision biopsy for T1 CRC lesions measuring 20 mm or smaller.

Methods We retrospectively included cases of T1 CRC measuring 20 mm or smaller and analyzed the clinicopathological factors related to resection as well as follow-up outcomes based on medical records. Cases with more than 2 lesions and pedunculated cases were excluded. We also reviewed endoscopic images to assess predictive factors for T1 deep invasion, including expansion/stiffness, erosion/ulceration, fold convergent, depression area, nonpolypoid growth, strong redness, chicken skin appearance, and Japan NBI expert team (JNET) classification 3 [1] [2].

Results Among 107 T1 CRC cases identified between January 2019 and September 2023, 68 met our inclusion criteria. 18 (26%) were T1a and 50 (74%) were T1b. Median size was 15 mm. Endoscopic snare resection was performed in 45 cases (66%; cold snare polypectomy in 1 case, hot polypectomy in 3, EMR in 37, and underwater EMR in 4), ESD in 2 cases (3%), and surgical resection in 21 cases (31%). There was no significant difference in proportion of T1b cases between the snare resection group (87%, n=41) and the surgery group (76%, n=16). En bloc resection was achieved in 87% (n=41) of snare resection cases, with R0 resection in 72% (n=34). Following Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines, additional surgery was performed for 60% (n=27) as high-risk for lymph node metastasis. No recurrence was observed in the snare resection group during a median follow-up period of 2.5 years, and no adverse events occurred, despite 22% (10/45) of patients being on antithrombotic therapy. Univariate analysis revealed expansion/stiffness (odds ratio (OR)=3.9, P=0.025), strong redness (OR=6.4, P<0.01), and JNET3 (OR=15, P<0.001) were associated with T1b. Multivariate analysis identified JNET3 as the only independent predictor of deep submucosal invasion (OR=10.2, P<0.01).

Conclusions Endoscopic snare resection appears to be a feasible option as a total excision biopsy for T1 CRC lesions measuring 20 mm or smaller, provided that the JSCCR guidelines are followed after removal.



Publication History

Article published online:
27 March 2025

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