Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience

Dennis Yang; Hiroyuki Aihara; Yaseen B. Perbtani; Andrew Y. Wang; Abdul Aziz Aadam; Yutaka Tomizawa; Joo Ha Hwang; Baiming Zou; Nikola S. Natov; Amanda Siegel; Milad Pourmousavi Khoshknab; Mouen A. Khashab; Saowanee Ngamruengphong; Harshit S. Khara; David L. Diehl; Thibaut Maniere; Sherif Andrawes; Petros Benias; Nikhil A. Kumta; Fariha Ramay; Raymond E. Kim; Jason Samarasena; Kenneth Chang; Rintaro Hashimoto; Benjamin Tharian; Sumant Inamdar; Gloria Lan; Amrita Sethi; Michael J. Nosler; Abdalaziz Tabash; Mohamed O. Othman; Peter V. Draganov

doi:10.1055/a-1010-5663

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(12): E1714-E1722
DOI: 10.1055/a-1010-5663

Original article

Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience

Dennis Yang

¹Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA

,

Hiroyuki Aihara

²Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Boston, MA, USA

,

Yaseen B. Perbtani

¹Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA

,

Andrew Y. Wang

³Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA

,

Abdul Aziz Aadam

⁴Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA

,

Yutaka Tomizawa

⁵Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA

,

Joo Ha Hwang

⁵Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA

,

Baiming Zou

⁶Department of Biostatistics, University of Florida, Gainesville, FL, USA

,

Nikola S. Natov

³Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA

,

Amanda Siegel

⁴Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA

,

Milad Pourmousavi Khoshknab

⁷Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA

,

Mouen A. Khashab

⁷Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA

,

Saowanee Ngamruengphong

⁷Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA

,

Harshit S. Khara

⁸Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA

,

David L. Diehl

⁸Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA

,

Thibaut Maniere

⁹Division of Gastroenterology and Hepatology, Universite de Sherbrooke, Sherbrook, QC, Canada

,

Sherif Andrawes

¹⁰Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA

,

Petros Benias

¹⁰Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA

,

Nikhil A. Kumta

¹¹Division of Gastroenterology, Mount Sinai Hospital, New York, NY, USA

,

Fariha Ramay

¹²Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA

,

Raymond E. Kim

¹²Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA

,

Jason Samarasena

¹³Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA

,

Kenneth Chang

¹³Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA

,

Rintaro Hashimoto

¹³Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA

,

Benjamin Tharian

¹⁴Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA

,

Sumant Inamdar

¹⁴Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA

,

Gloria Lan

¹⁵Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA

,

Amrita Sethi

¹⁵Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA

,

Michael J. Nosler

¹⁶UC Health Medical Group, Fort Collins, CO, USA

,

Abdalaziz Tabash

¹⁷Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA

,

Mohamed O. Othman

¹⁷Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA

,

Peter V. Draganov

¹Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA

› Author Affiliations

Abstract

Background and aims Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America.

Methods This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection.

Results In total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8–88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4–81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19–76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection.

Conclusion Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease.

Full Text

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