COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION: DO WE MEET THE RECOMMENDATIONS OF THE ESGE? A SPANISH MULTICENTRE PROSPECTIVE STUDY

Aims The ESGE has recently proposed some quality metrics concerning CR-ESD: En bloc resection rates >90%, perforation rate < 3% and the need for surgery because of complications < 1%.

Methods Consecutive patients were enrolled in a prospective multicentre Spanish CR-ESD registry since January 2016 to August 2019. Since the ESGE recommends a minimum case load of 25 ESD procedures per year, the quality metrics were analysed in centres that met this proposed standard.

Results We recruited 896 CR neoplasms submitted for an ESD and performed by members of the ESD interest group of the GSEED Endoscopic Resection Working Group. Seven centres met the standard of performing > 25 CR-ESD/year. The mean CR-ESD/year values were 76 (hospital A), 66 (B), 56 (C), 34 (D), 32 (E), 32 (F), and 26 (G). The case load of CR-ESD for this period was: 244 (A), 192 (B), 121 (C), 63 (D), 57 (E), 71 (F) and 59 (G), respectively. Finally, 807 CR-ESD were analysed. The en bloc resection rate was: 96%, 89, 81, 96.8, 64.9, 87.3 and 76.3, respectively. The intraprocedural perforation rate was: 29.1%, 1, 14, 3.2, 14, 14.1 and 8.5%, respectively. The delayed perforation rate was: 2.1, 1, 5.2, 0, 5.4, 3.1 and 3.5%, respectively. The need for surgery because of perforation was: 2.9%, 1, 1.7, 0, 3.5, 2.8 and 3.4%, respectively. Additionally, the need for surgery because of bleeding was: 0.4%, 0.5, 0, 0, 1.8, 1.4 and 1.7%, respectively.

Conclusions Recommendations according the ESGE position statement were met in 2 centres concerning the en bloc resection rate (A and D). The statement regarding the overall perforation rate was met in 1 case (B), and the recommendation concerning the need for surgery was met in 1 hospital (D). None of them fulfilled all the quality criteria although 2 of them were close to meet them.