CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(12): E1714-E1722
DOI: 10.1055/a-1010-5663
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience

Dennis Yang
 1  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Hiroyuki Aihara
 2  Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Boston, MA, USA
,
Yaseen B. Perbtani
 1  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
,
Andrew Y. Wang
 3  Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
,
Abdul Aziz Aadam
 4  Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA
,
Yutaka Tomizawa
 5  Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
,
Joo Ha Hwang
 5  Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA
,
Baiming Zou
 6  Department of Biostatistics, University of Florida, Gainesville, FL, USA
,
Nikola S. Natov
 3  Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, USA
,
Amanda Siegel
 4  Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, IL, USA
,
Milad Pourmousavi Khoshknab
 7  Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
,
Mouen A. Khashab
 7  Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
,
Saowanee Ngamruengphong
 7  Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, USA
,
Harshit S. Khara
 8  Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA
,
David L. Diehl
 8  Division of Gastroenterology and Hepatology, Geisinger Health System, Danville, PA, USA
,
Thibaut Maniere
 9  Division of Gastroenterology and Hepatology, Universite de Sherbrooke, Sherbrook, QC, Canada
,
Sherif Andrawes
10  Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA
,
Petros Benias
10  Division of Gastroenterology and Hepatology, Northwell Health, Staten Island, NY, USA
,
Nikhil A. Kumta
11  Division of Gastroenterology, Mount Sinai Hospital, New York, NY, USA
,
Fariha Ramay
12  Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
,
Raymond E. Kim
12  Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
,
Jason Samarasena
13  Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
,
Kenneth Chang
13  Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
,
Rintaro Hashimoto
13  Division of Gastroenterology and Hepatology, University of California Irvine, Irvine, CA, USA
,
Benjamin Tharian
14  Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA
,
Sumant Inamdar
14  Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USA
,
Gloria Lan
15  Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA
,
Amrita Sethi
15  Division of Gastroenterology and Hepatology, New York Presbyterian Hospital, New York, NY, USA
,
Michael J. Nosler
16  UC Health Medical Group, Fort Collins, CO, USA
,
Abdalaziz Tabash
17  Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA
,
Mohamed O. Othman
17  Division of Gastroenterology and Hepatology, Baylor University Medical Center, Houston, TX, USA
,
Peter V. Draganov
 1  Division of Gastroenterology and Hepatology, University of Florida, Gainesville, FL, USA
› Author Affiliations
Further Information

Publication History

submitted 09 June 2019

accepted after revision 16 August 2019

Publication Date:
02 December 2019 (online)

  

Abstract

Background and aims Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America.

Methods This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection.

Results In total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8–88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4–81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19–76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection.

Conclusion Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease.