Endoscopic Submucosal Dissection in Naive Colorectal Neoplasm Performed With a Water Jet System-Assisted Knife: Higher EN Bloc Resection Rate Than Conventional Technique

Aims Endoscopic submucosal dissection (ESD) is a minimally invasive approach that facilitates en bloc resection of colorectal lesions. This technique provides a high en bloc resection rate, accurate histological evaluation, and a low rate of local recurrence as compared with conventional EMR. However, colorectal ESD is still not widely used because of technical difficulty, risk of complications, and time required to carry out the procedure. To overcome the last limitation several techniques have been proposed. One of these is the use of a water jet system-assisted knife that allows to inject and cut with the same device. In this study, we retrospectively evaluated the safety and efficacy of this technique and compared it with conventional ESD technique (CESD).

Methods Between January 2014 and July 2020, ESD was carried out on 162 naive colorectal neoplasms, in 120 cases a water jet system-assisted knife (WESD) was used. We retrospectively investigated the rates of en bloc resection, complete resection, perforation, bleeding, and time of procedures.

Results In both groups a high amount of lesions was located in the colon (WESD 57/120 vs CESD 29/42), instead mean neoplasm area was higher in WESD (9.0cm² vs 4.8cm²). Procedure time (time/area of lesion) was similar in both groups (WESD 15.5 min/cm² vs CESD 15.5 min/cm²), the en bloc resection was higher in WESD (94.2 % vs 83.3 %; p 0.03), the complete resection rate was similar (90.8 % vs 90.5 %; p 0.94), overall adverse events rate tended to be lower in WESD (12.5 % vs 21.4 %; p 0.16).

Tab. 1

	Water jet system-assisted knife ESD (120)	Conventional ESD (42)	p value
En bloc resection (%)	113 (94.2)	38 (90.5)	0.03
Adverse events (%)	15 (12.5)	9 (21.4)	0.16
Perforation	7 (5.8)	6 (14.3)	0.08
Bleeding	2 (1.7)	2 (4.8)	0.27
Fever	11 (9.2)	1 (2.4)	0.15

Conclusions WESD in colorectal neoplasms allows higher en bloc resection rate in the same time than CESD with low rate of adverse events.

Citation: Cecinato P, Campanale M, Lucarini M et al. eP234 ENDOSCOPIC SUBMUCOSAL DISSECTION IN NAIVE COLORECTAL NEOPLASM PERFORMED WITH A WATER JET SYSTEM-ASSISTED KNIFE: HIGHER EN BLOC RESECTION RATE THAN CONVENTIONAL TECHNIQUE. Endoscopy 2021; 53: S175.

Publication History

Article published online:
19 March 2021