Underwater Endoscopic Submucosal Dissection and Hybrid Endoscopic Submucosal Dissection as Rescue Technique in Difficult Naive Colorectal Cases

Aims Endoscopic submucosal dissection (ESD) provides a high en bloc resection rate, accurate histological evaluation, and a low rate of local recurrence as compared with EMR in colorectal lesions resection. However, colorectal ESD is still not widely used because of technical difficulty, risk of complications, time required to carry out the procedure. The favourable position in the approach to neoplasia and a clear distinction of submucosal and muscular layer are crucial points of technical difficulty. ESD with snaring, hybrid ESD (HESD), and underwater ESD (UESD) are two alternative techniques to overcome these problems. Immersion can provides good traction during dissection and magnification by the refractive index of water. We retrospectively evaluated the safety and efficacy of these techniques as alternative to standard ESD in difficult situations.

Methods Between January 2014 and July 2020, HESD was carried out on 35 and UESD on 18 colorectal neoplasms. All cases were carried out as a rescue treatment in difficult naive colorectal ESD cases. We retrospectively investigated procedure time, rates of en bloc resection, complete resection, complications, and time of procedures.

Tab. 1

	Underwater ESD (18)	Hybrid ESD (35)	p value
Adverse events (%)	5 (27.8)	8 (22.9)	ns
Perforation	1 (5.5)	4 (11.4)	ns
Bleeding	0 (0)	3 (8.6)	ns
Fever	4 (22.2)	3 (8.6)	ns
En bloc resection (%)	18 (100)	21 (60)	0.002
Average Time/Area (min/cm2)	10.2	19.0	0.002

Results In both groups lesions were located above all in the right colon (UESD 8/18 vs HESD 21/35), instead mean lesion’s area was higher in UESD group (12.7cm² vs 4.8cm²). In the UESD group, procedure time (time/resected area) was shorter compared with the ESD group (10.2 min/cm² vs 19.0 min/cm²; p 0.002), the en bloc resection rate was higher (100 % vs 60 %; p 0.002), the complete resection rate was higher (100 % vs 82.8 %; p 0.08), overall adverse events rate was similar (27.8 % vs 22.9 %; p 0.54) and always solved without surgery.

Conclusions UESD as a rescue treatment in difficult colorectal ESD cases allows higher en bloc resection rate of bigger lesions in less time. Prospective studies are necessary to validate these results.

Citation: Cecinato P, Campanale M, Lucarini M et al. eP233 UNDERWATER ENDOSCOPIC SUBMUCOSAL DISSECTION AND HYBRID ENDOSCOPIC SUBMUCOSAL DISSECTION AS RESCUE TECHNIQUE IN DIFFICULT NAIVE COLORECTAL CASES. Endoscopy 2021; 53: S174.

Publication History

Article published online:
19 March 2021