Endoscopy 2019; 51(04): S190
DOI: 10.1055/s-0039-1681733
ESGE Days 2019 ePoster podium presentations
Saturday, April 6, 2019 14:00 – 14:30: Colon ESD 3 ePoster Podium 1
Georg Thieme Verlag KG Stuttgart · New York

LONG-TERM OUTCOMES OF COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION: EXPERIENCE IN A WESTERN CENTRE

J Arribas Anta
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
Á Cañete Ruiz
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
T Álvarez-Nava Torrego
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
C Piedracoba Cadahía
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
DR De la Cruz Esteban
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
M Rodriguez Carrasco
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
E Romero Romero
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
A Del Pozo García
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
JB Díaz Tasende
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
,
JC Marín Gabriel
1   Gastroenterology, University Hospital Doce de Octubre, Madrid, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

To analyze long-term follow-up after endoscopic submucosal dissection (ESD) and to compare recurrence rates according to different variables.

Methods:

Prospective data from ESD performed were collected on an "intention to treat" basis, from September 2008 to December 2015. When ESD was not possible to achieve, KAR was performed, either "en bloc" or piecemeal (pKAR). Kapplan-Meier survival curves were used to assess the 5 years recurrence rate and results were compared according to different factors (type of resection, en bloc vs. piecemeal resections, R0 vs. R1resections, lateral margins (LM) involvement, histology and location) using log-rank test.

Results:

89 patients were initially included. 20 were excluded: 11 for having less than 6months follow-up and 9 because of the need of surgery (3 for delayed perforations, 2 for technical difficulties and 4 because the histology showed deep submucosal invasion).

Finally, 69 patients were included. ESD was performed in 31 of these patients, KAR in 11 and pKAR in 27. Median follow-up was 27 months (range 6 – 60). "En bloc" rate was 60,9% and R0 rate 31,0%. Histology according to Vienna classification was: 33, 3% Vienna 3, 65,2% Vienna 4 and 1,5% Vienna 5 (sm1).

Recurrence rate at 5year was 19%. The average number of endoscopies needed to eliminate recurrence was 2 (range 2 – 7) and no patient needed surgery for this reason.

Recurrence rate was significantly higher in piecemeal resections vs. en bloc resections (27,2% vs. 15,7%, p = 0,036) and R1 resections vs. R0 resections (26,3% vs. 0% p = 0,034). The presence of affected or unknown lateral margins in "en bloc" resections without other poor prognosis factors had higher recurrence rates without statistical significant differences (28% vs. 0% p = 0,09).

Conclusions:

In our study the 5 year disease free survival rate was 81% and no patient needed surgery during follow-up. Piecemeal and R1 resections had significantly higher recurrence rates and LM involvement showed higher recurrence rates without statistical significance.