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Endoscopy 2023; 55(02): 192-197
DOI: 10.1055/a-1866-8080
Innovations and brief communications

Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion

Adrien Patenotte‡   *
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Clara Yzet‡   *
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Timothée Wallenhorst
2   Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
,
Fabien Subtil
3   Service de Biostatistique, Hospices Civils de Lyon and CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France
,
Sarah Leblanc
4   Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France
,
Marion Schaefer
5   Endoscopy and Gastroenterology Unit, Brabois Hospitals, Nancy, France
,
Thomas Walter
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Thomas Lambin
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Tanguy Fenouil
6   Institute of Pathology - East site, Groupement hospitalier Est, Hospices Civils de Lyon, Lyon, France
,
Pierre Lafeuille 
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Jean-Baptiste Chevaux
5   Endoscopy and Gastroenterology Unit, Brabois Hospitals, Nancy, France
,
Romain Legros
7   Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Florian Rostain
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Jérôme Rivory
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
,
Jérémie Jacques
7   Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France
,
Vincent Lépilliez
2   Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France
,
Mathieu Pioche
1   Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
› Author AffiliationsTrial Registration: ClinicalTrials.gov Registration number (trial ID): NCT04592003 Type of study: Retrospective
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Author commentary on Adrien Patenotte et al.Endoscopy 2023; 55(02): v4-v4
DOI: 10.1055/a-1877-0732

Abstract

Background Endoscopic submucosal dissection (ESD) is potentially a curative treatment for T1 colorectal cancer under certain conditions. The aim of this study was to evaluate the feasibility and effectiveness of ESD for lesions with a suspicion of focal deep invasion.

Methods In this retrospective multicenter study, consecutive patients with colorectal neoplasia displaying a focal (< 15 mm) deep invasive pattern (FDIP) that were treated by ESD were included. We excluded ulcerated lesions (Paris III), lesions with distant metastasis, and clearly advanced tumors (tumoral strictures).

Results 124 patients benefited from 126 diagnostic dissection attempts for FDIP lesions. Dissection was feasible in 120/126 attempts (95.2 %) and, where possible, the en bloc and R0 resection rates were 95.8 % (115/120) and 76.7 % (92/120), respectively. Thirty-three resections (26.2 %) were for very low risk tumors, so considered curative, and 38 (30.2 %) were for low risk lesions. Noncurative R0 resections were for lesions with lymphatic or vascular invasion (LVI; n = 8), or significant budding (n = 9), and LVI + budding combination (n = 4).

Conclusion ESD is feasible and safe for colorectal lesions with an FDIP ≤ 15 mm. It was curative in 26.6 % of patients and could be a valid option for a further 30.6 % of patients with low risk T1 cancers, especially for frail patients with co-morbidities.

* Joint first authors


Supplementary material



Publication History

Received: 27 January 2022

Accepted: 01 June 2022

Accepted Manuscript online:
01 June 2022

Article published online:
05 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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