Aims To describe the feasibility, technical success, en-bloc resection and complications of CR-ESD for malignant polyps in a western cohort.
Methods We evaluated all the cases of CR-ESD in malignant polyps (histology showing invasion of submucosa) included between January 2016 and January 2019 in a prospective multicenter spanish database.
Comparative data according to location was analyzed. Categorical data was compared using Pearson´s-chi-squared-test, and cuantitative data with T student test.
Results From 851 colorectal ESDs, 58 (6.8 %) cases with submucosal invasion were evaluated.
Mean age was 68 years-old, being male 72%.
The locations were rectum n=21 (36%), sigmoid n=10 (17%), descending colon n=8 (13.7%), splenic flexure=2 (3.4%), transverse colon n=4 (7%), hepatic flexure n=3 (5%), ascending colon n=7 (12%), and cecum n=3 (5%).
Complete CR-ESD of the lesion was achieved in 48 cases (82.76%), En-bloc resection in 41 (70.69%). There were 10 (17%) aborted procedures due to technical reasons (2/10), perforation (2/10) or muscle-retracting-sign (6/10).
The specimen mean size was 38.3mm x 30.67mm (CI 95% 33.93-42.68 for major axis, and 26.15-35.19 for minor axis).
Submucosal fibrosis was absent (F0) in 18 cases, and severe (F2) in 23 cases (39.66%).
There were 3 (5%) delayed bleeding, 10 (17%) intraprocedural perforations and 2 (3.4%) delayed perforations.
There were a total of 30 (51.7%) surgeries: 19 (63%) due to histology, 10 for aborted ESD and 1 for delayed perforation.
When comparing the results of CR-ESD for malignant polyps according to location, the en bloc resection was higher in the rectosigmoid compared to the rest of the colon (83,87% vs 55,55% respectively, p=0.018).
Need for surgery, was lower after ESD in the rectum than in the colon, with 8 surgeries (38%) vs 22 surgeries (59%), Pr=0.029.
Conclusions CR-ESD for malignant polyps in the distal colon (sigmoid and rectum) shows better results compared to more proximal locations.
