Submucosal lesions in the colon may not always require R0 en bloc endoscopic resection

Aims Sub-mucosal lesions of the colon are much rarer than those located in the rectum [1], and their resection technique has been little studied. Based on that of rectal lesions, it most often aims for R0 en bloc resection, but without formal proof of efficacy. Consequently, the question of whether these demanding and not risk-free techniques (ESD, EFTR) should be used to treat submucosal lesions of the colon remains uncertain to date, and requires further investigation.

Methods We conducted an international retrospective study between January 2012 and May 2023, collecting all colonic submucosal lesions with histology confirmed by resection or biopsy. We assessed the proportion of lesions correctly managed by endoscopy, so that the proposed resection technique offered a level of tumor resection quality appropriate to the definitive histology of the lesion.

Results The study included 78 patients with 81 colonic submucosal lesions, from 11 European centers. Mean lesion size was 15.0 mm, and 55.6% (45/81) were located beyond the right angle. The resection techniques used included 19.8% (16/81) cold loop resections, 33.3% (27/81) conventional mucosectomies, one underwater mucosectomy, 24.7% (20/81) submucosal dissections, two hydride dissections and 13.6% (11/81) EFTR resections. Immediate complications included 2.5% (2/81) perforations, and there were no delayed complications. The study included 60.5% (49/81) R0 en bloc resections and 9.8% (8/81) biopsies. Histology revealed 92.6% (75/81) benign lesions (including one hamartoma), one GIST, two neuroendocrine neoplasia, one lymphoma and one leiomyosarcomma. The resections used were curative in 3.7% (3/81) of cases, not curative in 3.7% (3/81) and no resection was necessary in 91.4% (74/81) of cases.

Conclusions R0 en bloc resection of colonic submucosal lesions was an appropriate technique in 7.4% of cases. We propose a new therapeutic approach for colonic submucosal lesions, involving the 1st intention use of a low-risk, low-cost histological diagnostic technique (biopsy or cold loop) followed in a 2nd phase by a more advanced technique (ESD, EFTR) on the scar in the event of a negative histological result. Further studies are needed to evaluate this strategy, as well as the best technique for obtaining histological evidence between biopsy and cold loop.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• References

• 1 Rinke A, Ambrosini V, Dromain C. et al. European Neuroendocrine Tumor Society (ENETS) 2023 guidance paper for colorectal neuroendocrine tumours. J Neuroendocrinol 2023; 35: e13309

Publication History

Article published online:
15 April 2024