COLONIC ESD WITH DOUBLE-CLIP TRACTION A REVOLUTION COMING FROM EUROPE!

Aims ESD is the standard of care for removing large colorectal superficial lesions in Japan. In Europe, it is still debated due to good results of piece-meal EMR and mediocre results published so far by the Western teams. Colonic location is particularly challenging because of the thinness of the submucosa, the fold anatomy, poor maneuverability of the scope due to loops and respiratory movements. Our team has developed a counter-traction strategy using two clips and a dental rubberband (Double Clip Traction (DCT) strategy) to facilitate the procedure in a pilot study. The purpose of this study was to analyze the results of the systematic application of this strategy over 3 years of cases of consecutive colonic ESD.

Methods Prospective cohort study including all cases of colonic ESD performed consecutively using DCT in 3 French expert centers.

Results Between 03/2017 and 09/2020, 969 colorectal ESD were performed in 3 French expert centers. 621 lesions were included (exclusion of 262 rectal lesions, 51 recurrent lesions and 35 appendiceal lesions) and resected with DCT ESD. Mean lesion size was 52 x 41.4 mm. 69.2% of the lesions were

located upstream of the left angle (transverse or right colon). 14% of lesions were polypoid, 57.4% were granular LST, 28% were non-granular LST. Mean duration of procedure was 61 min for a mean speed of 38 mm 2/min.

En bloc, R0 and curative resection rates were 94.4%, 84% and 81.6%, respectively.

Perforation rate and post-procedural bleeding occurred respectively in 5% and 4.3%. Only 2 patients (0.3%) had emergency surgery for perforation.

Conclusions Colonic ESD is effective and safe in France thanks to the systematic use DCT strategy. Our results allow to consider a randomized controlled study comparing DCT ESD and piece-meal EMR for large benign colonic lesions.