SCAR-ENGAGED COLORECTAL LESIONS: ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) VERSUS A HYBRID RESECTION TECHNIQUE (ENDOSCOPIC UNSCARRING MUCOSAL RESECTION – EUMR)

Aims:

Scar-engaged colorectal lesions are characterized by absent or inadequate submucosal lifting, posing a serious challenge for curative resection with need for surgery. We propose a hybrid resection technique that we called Endoscopic Unscarring Mucosal Resection consisting in marking, incision, partial dissection, creation of mucosal flaps and snaring until complete removal of the lesion (en bloc or piecemeal depending on size).

Methods:

We conducted a retrospective analysis on 74 scar-engaged lesions treated at “Santa Maria Nuova”, Reggio Emilia or “San Raffaele”, Milan, Italy by a single experienced endoscopist. Depending on morphology, size and location of the lesions EUMR (n = 47) or ESD (n = 27) was prefered.

Results:

EUMR was performed on 27 colonic and 20 rectal lesions with a median size of 3 (1 – 8)cm; ESD on 4 colonic and 23 rectal lesions, median size 3 (1 – 7)cm. Mean procedural time was 80 (20 – 204)min and 80 (27 – 250)min, respectively. We experienced 1 case (2.1%) of delayed bleeding and 1 (2.1%) post-resection stricture in the EUMR group. No case of bleeding, 2 (7.4%) intraprocedural and 1 delayed perforation (3.7%) in the ESD group. A complete resection was obtained in all cases in both groups with 23 en-bloc ESD (85.2%). The most prevalent histological diagnosis was high-grade dysplasia in both (53 vs. 44%) with 4 cases (14.9%) of adenocarcinoma in the ESD group and no cases in the EUMR. Available up to 60 months follow-up data for 44 lesions in the EUMR and 23 in the ESD group revealed 4 cases (9%) vs. no evidence for recurrence respectively. 2 of 4 recurrence cases were successfully retreated with EUMR without further recurrence.

Conclusions:

When compared to ESD, EUMR is an effective technique for the treatment of scar-engaged colorectal lesions with similar results but a better safety profile.