Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence

Roberta Maselli; Marco Spadaccini; Paul J. Belletrutti; Piera Alessia Galtieri; Simona Attardo; Silvia Carrara; Andrea Anderloni; Alessandro Fugazza; Elisa Chiara Ferrara; Gaia Pellegatta; Andrea Iannone; Cesare Hassan; Alessandro Repici

doi:10.1055/a-1551-3058

Endoscopy International Open, Table of Contents

CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(01): E127-E134
DOI: 10.1055/a-1551-3058

Review

Endoscopic submucosal dissection for colorectal neoplasia: outcomes and predictors of recurrence

Roberta Maselli‡

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

²Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy

,

Marco Spadaccini‡

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

²Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy

,

Paul J. Belletrutti

²Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy

,

Piera Alessia Galtieri

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

,

Simona Attardo

³Gastroenterology Unit, Ospedale Maggiore della Carità, Novara, Italy

,

Silvia Carrara

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

,

Andrea Anderloni

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

,

Alessandro Fugazza

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

,

Elisa Chiara Ferrara

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

,

Gaia Pellegatta

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

,

Andrea Iannone

⁴Section of Gastroenterology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy

,

Cesare Hassan

⁵Digestive Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy

,

Alessandro Repici

¹Humanitas University, Department of Biomedical Science, Pieve Emanuele (Milan), Italy

²Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Humanitas University, Rozzano (Milan), Italy

› Author Affiliations

Abstract

Background and study aims The role of endoscopic submucosal dissection (ESD) for colorectal lesions in Western communities is unclear and its adoption is still limited. The aim of this study is to assess the long-term outcomes of a large cohort of patients treated with colorectal ESD in a tertiary Western center.

Patients and methods A retrospective analysis was conducted on patients treated by ESD for superficial colorectal lesions between February 2011 and November 2019. The primary outcome was the recurrence rate. Secondary outcomes were en-bloc and R0 resection rates, procedural time, adverse events (AEs), and need for surgery. The curative resection rate was assessed for submucosal invasive lesions.

Results A total of 327 consecutive patients, median age 69 years (IQR 60–76); 201 men (61.5 %) were included in the analysis. Of the lesions, 90.8 % were resected in an en-bloc fashion. The rate of R0 resection was 83.1 % (217/261) and 44.0 % (29/66) for standard and hybrid ESD techniques, respectively. Submucosal invasion and piecemeal resection independently predicted R1 resections. A total of 18(5.5 %) intra-procedural AEs (perforation:11, bleeding:7) and 12(3.7 %) post-procedural AEs occurred (perforation:2, bleeding: 10). Eighteen adenoma recurrences per 1,000 person-years (15cases, 5.6 %) were detected after a median follow-up time of 36 months. All recurrences were detected within 12 months. No carcinoma recurrences were observed. R1 resection status and intra-procedural AEs independently predicted recurrences with seven vs 150 recurrences per 1,000 person-years in the R0 vs R1 group, respectively.

Conclusions Colorectal ESD is a safe and effective option for managing superficial colorectal neoplasia in a Western setting, with short and long-terms outcomes comparable to Eastern studies. En-bloc R0 resection and absence of intra-procedural AEs are associated with reduced risk of recurrence.

Full Text

References

References
1 Ferlay J, Autier P, Boniol M. et al. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 2007; 18: 581-592
2 Zauber AG, Winawer SJ, O'Brien MJ. et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med 2012; 366: 687-696
3 Moss A, Bourke MJ, Williams SJ. et al. Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 2011; 140: 1909-1918
4 Fujiya M, Tanaka K, Dokoshi T. et al. Efficacy and adverse events of EMR and endoscopic submucosal dissection for the treatment of colon neoplasms: a meta-analysis of studies comparing EMR and endoscopic submucosal dissection. Gastrointest Endosc 2015; 81: 583-595
5 Fuccio L, Hassan C, Ponchon T. et al. Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis. Gastrointest Endosc 2017; 86: 74-86.e17
6 Yamada M, Saito Y, Takamaru H. et al. Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms in 423 cases: a retrospective study. Endoscopy 2017; 49: 233-242
7 Gupta N, Rodríguez-Ruiz G, Siddiqui UD. et al. Endoscopic submucosal dissection for colorectal lesions: outcomes from a United States experience. Surg Endosc 2021;
8 Ge PS, Jirapinyo P, Ohya TR. et al. Predicting outcomes in colorectal endoscopic submucosal dissection: a United States experience. Surg Endosc 2019; 33: 4016-4025
9 Draganov PV, Aihara H, Karasik MS. et al. Endoscopic submucosal dissection in North America: A large prospective multicenter study. Gastroenterology 2021;
10 Bordillon P, Pioche M, Wallenhorst T. et al. Double-clip traction for colonic endoscopic submucosal dissection: a multicenter study of 599 consecutive cases (with video). Gastrointest Endosc 2021;
11 Roland D, Rahmi G, Pérez-Cuadrado-Robles E. et al. Endoscopic submucosal dissection in rectal tumors extending or not to the dentate line: A comparative analysis. Dig Liver Dis 2020; 52: 296-300
12 Taşkın OC, Aslan F, Kulaç I. et al. Pathologic evaluation of large colorectal endoscopic submucosal dissections: an analysis of 279 cases with emphasis on the importance of multidisciplinary work and establishing examination protocols. Int J Surg Pathol 2020; 28: 600-608
13 Vandenbroucke JP, von Elm E, Altman DG. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4: e297
14 Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T. et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2015; 47: 829-854
15 The Paris endoscopic classification of superficial neoplastic lesions. esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58: S3-S43
16 Kudo S, Tamura S, Nakajima T. et al. Diagnosis of colorectal tumorous lesions by magnifying endoscopy. Gastrointest Endosc 1996; 44: 8-14
17 Ferlitsch M, Moss A, Hassan C. et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017; 49: 270-297
18 Schlemper RJ, Riddell RH, Kato Y. et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47: 251-255
19 Kikuchi R, Takano M, Takagi K. et al. Management of early invasive colorectal cancer. Risk of recurrence and clinical guidelines. Dis Colon Rectum 1995; 38: 1286-1295
20 Tanaka S, Kashida H, Saito Y. et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc 2015; 27: 417-434
21 Saito Y, Uraoka T, Yamaguchi Y. et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
22 Shigita K, Oka S, Tanaka S. et al. Long-term outcomes after endoscopic submucosal dissection for superficial colorectal tumors. Gastrointest Endosc 2017; 85: 546-553
23 Hassan C, Repici A, Sharma P. et al. Efficacy and safety of endoscopic resection of large colorectal polyps: a systematic review and meta-analysis. Gut 2016; 65: 806-820
24 Andrisani G, Fukuchi T, Hassan C. et al. Rectal neoplasia extending to the dentate line: clinical outcomes of endoscopic submucosal dissection. Scand J Gastroenterol 2020; 55: 1363-1368
25 McCarty TR, Bazarbashi AN, Thompson CC. et al. Hybrid endoscopic submucosal dissection (ESD) compared with conventional ESD for colorectal lesions: a systematic review and meta-analysis. Endoscopy 2020;
26 Cong ZJ, Hu LH, Ji JT. et al. A long-term follow-up study on the prognosis of endoscopic submucosal dissection for colorectal laterally spreading tumors. Gastrointest Endosc 2016; 83: 800-807
27 Niimi K, Fujishiro M, Kodashima S. et al. Long-term outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy 2010; 42: 723-729
28 Moss A, Williams SJ, Hourigan LF. et al. Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut 2015; 64: 57-65
29 de Neree Tot Babberich MPM, Bronzwaer MES, Andriessen JO. et al. Outcomes of surgical resections for benign colon polyps: a systematic review. Endoscopy 2019; 51: 961-972
30 van Hattem WA, Shahidi N, Vosko S. et al. Piecemeal cold snare polypectomy versus conventional endoscopic mucosal resection for large sessile serrated lesions: a retrospective comparison across two successive periods. Gut 2021; 70: 1691-1697
31 D'Amico F, Amato A, Iannone A. et al. Risk of covert submucosal cancer in patients with granular mixed laterally spreading tumors. Clin Gastroenterol Hepatol 2021; 19: 1395-1401

Supplementary Material

Supplementary material