Low Grade Neoplasia And Colorectal (CR) Endoscopic Submucosal Dissection (ESD): Are The Adverse Events Acceptable? Results Of A Prospective Multicentre Registry

Aims The European Society of Gastrointestinal Endoscopy (ESGE) has recently published a position statement for optical diagnosis suggesting that, for Vienna category (VC)≤ 3 colorectal lesions (CRL), performing EMR would be sufficient therapy. Our aims were: 1.) to assess the ESD complication rates when comparing VC≤ 3 vs. VC≥ 4 CRL and 2.) to compare the overall ESD risk of complications with a previously published Spanish EMR series.

Methods Consecutive patients were enrolled in a prospective multicentre CR-ESD registry since January 2016 to October 2020.

Results We recruited 1,314 CRL submitted for ESD and performed by members of the Spanish GSEED Endoscopic Resection Working Group. The procedure was aborted in 62 cases and histological assessment was yet to be finalized in 37, thus 1,215 CR-ESD were analysed. The histology showed VC≤ 3 in 627 cases (51.6 %). These specimens were significantly smaller than those with VC ≥ 4 (median: 45 mm vs. 38 mm; p< 0.0001). Severe fibrosis was less common in VC≤ 3 (20.4 % vs. 25.1 %; p= 0.04). The intraprocedural perforation (IPP) rate (17.5 % vs 14.5 %; p=0.1) and the delayed perforation (DP) rates were similar between both groups (2.3 % vs. 2.7 %; p= 0.7). There were no differences in the need for surgery because of perforation (NFSP) according to histology: 2.1 % vs. 2.2 %; p= 0.9. When IPP and NFSP for ESD were compared with a previously published Spanish EMR series those figures were significantly increased regardless of the histology: Proportion difference of IPP was +0.15 for ESD (CI 95 %: 0.17 - 0.12; p<0.00001) and NFSP +0.02 (CI 95 %: 0.01 – 0.03; p< 0.00001).

Conclusions In our CR-ESD series, >50 % of the cases showed VC≤3 and the IPP and DP rates were similar to those VC≥4 CRL. When compared with previously published EMR series, the overall IPP rates and the NFSP were significantly increased for ESD.

Citation: Marín-Gabriel JC, Herreros-de-Tejada A, Ramos-Zabala F et al. OP217 LOW GRADE NEOPLASIA AND COLORECTAL (CR) ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD): ARE THE ADVERSE EVENTS ACCEPTABLE? RESULTS OF A PROSPECTIVE MULTICENTRE REGISTRY. Endoscopy 2021; 53: S90.

Publication History

Article published online:
19 March 2021