COLORECTAL (CR) ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD) IN WESTERN COUNTRIES WHEN HISTOLOGY SHOWS LOW GRADE DYSPLASIA: IS THE RISK ACCEPTABLE?

Aims The ESGE has recently published a curriculum for ESD training in Europe. However, there are no recommendations concerning the maximum acceptable percentage of lesions with histology showing Vienna category ≤ 3. This quality measure seems relevant because colonic perforation after EMR of LSLs occurs in 1-2% cases and related surgery is seldom needed (0.1%).

Methods Consecutive patients were enrolled in a prospective multicentre Spanish CR-ESD registry since January 2016 to August 2019.

Results We recruited 896 CR neoplasms submitted for ESD and performed by members of the ESD interest group of the GSEED Endoscopic Resection Working Group. At least 1 CR-ESD was performed in 25 hospitals. Seven centres met the proposed standard of the ESGE of performing > 25 ESD/year. The histology showed a Vienna category (VC) ≤ 3 in 505 cases (56.3%). These specimens were significantly smaller than those with VC ≥ 4 (median: 35 mm vs. 40 mm; p< 0.0001). Severe fibrosis was less common in VC ≤ 3 (20.2% vs. 26%; p= 0.04). In lesions VC ≤ 3, the percentages of LSLs-G homogeneous type (14.3% vs 9%; p= 0.01) and NG FE type were higher (38.6% vs 16.4%; p< 0.0001). The intraprocedural perforation rate (15.4 vs 14.1%; p=0.5) and the delayed perforation rates were similar between both groups (2.2% vs. 2.6%; p= 0.7). There were no differences in the need for surgery because of perforation in both groups (2% vs. 2%; p= 0.94). When perforation rates and need for surgery in hospitals with high case load (>25 ESD/year) were compared with the remaining, the differences were not statistically significant.

Conclusions In our multicentre CR-ESD series, >50% of the cases showed VC ≤ 3 and the intraprocedural perforation rate was at least 7 times higher than those of EMR. Additionally, the need for surgery was 20-fold.