ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL (CR-ESD) MALIGNANT POLYPS: RESULTS OF A PROSPECTIVE WESTERN COHORT

H Uchima; AH De Tejada; F Múgica; F Ramos; E Albeniz; P Rosón; J De La Peña; Á Teran; J Rodríguez-Sánchez; D García; AA Tenorio; A Sánchez-Yagüe; AD Pozo; C Dolz; G Fernández-Esparrach; J Santiago; Os Nogales; A Alvarez; H Cortes; JC Marín-Gabriel; Spanish Group of Endoscopic Resection (GSEED Resección Mucosa)

doi:10.1055/s-0040-1704259

Endoscopy, Inhaltsverzeichnis

Endoscopy 2020; 52(S 01): S86
DOI: 10.1055/s-0040-1704259

ESGE Days 2020 oral presentations

Friday, April 24, 2020 11:00 – 13:00 Unlock en-bloc 2 Liffey Meeting Room 2

ENDOSCOPIC SUBMUCOSAL DISSECTION FOR COLORECTAL (CR-ESD) MALIGNANT POLYPS: RESULTS OF A PROSPECTIVE WESTERN COHORT

Authors

H Uchima

¹Hospital Universitari Germans Trias I Pujol, Gastrointestinal Endoscopy, Badalona, Spain

²Teknon Medical Center, Endoscopy Unit, Barcelona, Spain
AH De Tejada

³Hospital Puerta de Hierro, Madrid, Spain
F Múgica

⁴Hospital de Donostia, San Sebastian, Spain
F Ramos

⁵Hospital Universitario HM Montepríncipe, Madrid, Spain
E Albeniz

⁶Complejo Hospitalario de Navarra, Pamplona, Spain
P Rosón

⁷Hospital Quirón Salud Malaga, Málaga, Spain
J De La Peña

⁸Hospital Marqués de Valdecilla, Santander, Spain
Á Teran

⁸Hospital Marqués de Valdecilla, Santander, Spain
J Rodríguez-Sánchez

⁹Hospital Universitario 12 de Octubre, Madrid, Spain
D García

¹⁰Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
AA Tenorio

¹⁰Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
A Sánchez-Yagüe

¹¹Hospital Costa del Sol, Marbella, Spain
AD Pozo

⁹Hospital Universitario 12 de Octubre, Madrid, Spain
C Dolz

¹²Son Llatzer, Mallorca, Spain
G Fernández-Esparrach

¹³Hospital Clínic Barcelona, Barcelona, Spain
J Santiago

³Hospital Puerta de Hierro, Madrid, Spain
Os Nogales

¹⁴Hospital Gregorio Marañón, Madrid, Spain
A Alvarez

¹⁵Hospital Universitario de Salamanca, Salamanca, Spain
H Cortes

¹⁶San Juan de Dios, Santurce, Spain
JC Marín-Gabriel

⁹Hospital Universitario 12 de Octubre, Madrid, Spain

Spanish Group of Endoscopic Resection (GSEED Resección Mucosa)

Abstract

Volltext

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.