Technical Outcomes And Risk Of Stricture After Endoscopic Submucosal Dissection For Large Colorectal Lesions

Aims Endoscopic submucosal dissection(ESD)is a well-established approach for the minimally invasive treatment of colorectal(CR)neoplasia. Although technical improvements enable en-bloc removal of large circumferential and near-circumferential rectal lesions, the efficacy and safety outcomes, have only been described in few Eastern countries’ experiences. The aim of this study is to assess efficacy and safety outcomes of a cohort of patients treated with ESD for large rectal lesions in a tertiary Western center, with a particular focus on the risk of stricture.

Methods Between February2011 and June2019, a retrospective analysis of a prospectively maintained database was conducted on patients treated by ESD for large rectal lesions that required ≥75 % circumferentialresection at Humanitas Research Hospital in Milan,Italy. The primary outcome considered for this study was the risk of stricture. Secondary outcomes were en-bloc, and R0 resection rates, procedural time, and other adverse events. The curative resection rate was assessed for submucosal invasive lesions.

Results Over the study period, 213 consecutive patients underwent a rectal ESD. Eighty-eight of them(mean age:68.5±12.9years old;50-56.8 %-males)required ≥ 75 % circumferential resection(32 circumferential resections),and were included in the study analysis.The94.3 %of lesions were resected in an en-bloc fashion in a mean procedural time of110.6±63.2 min. The rate of R0 resection was80.7 %. Eighteen out of 88lesions(20.5 %)resulted in CR neoplasia with submucosal invasion. Eight of them(44.4 %)showed high-risk features of nodal involvement(non-curativeESD)and were referred for surgery. A total of 3(3.4 %) peri-procedural AEs(2 intraprocedural bleedings,1 post-procedural perforation)occurred. Post-ESD rectal strictures occurred in 4 out of 80 patients (5.0 %), being strictly associated to circumferential resections (4/32, 12.6 %). The 4 patients underwent endoscopic balloon dilation with symptoms resolution.

Conclusions Rectal ESD is a safe and effective option for managing large rectal neoplasia in a Western setting. The risk of post-procedural stricture is associated to circumferential resections, and patients should be aware of the possible need of endoscopic dilations.

Citation: Maselli R, Spadaccini M, Galtieri PA et al. OP219 TECHNICAL OUTCOMES AND RISK OF STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR LARGE COLORECTAL LESIONS. Endoscopy 2021; 53: S91.

Publication History

Article published online:
19 March 2021