Multimodal Use of Advanced Endoscopic Resection Techniques for Local Recurrent Colorectal Adenomas: A Single Center Prospective Study

Aims Local recurrence occurs in up to 20 % of piecemeal endoscopic mucosal resection (EMR) and re-treatment can be technically challenging. Advanced endoscopic techniques, such as endoscopic submucosal dissection (ESD) and endoscopic full thickness resection (EFTR), alone or combined, allow deep en bloc large lesion removal, thus potentially achieving oncological radicality. Our study aims to assess efficacy and safety of ESD, EFTR and hybrid techniques (ESD+EFTR; ESD+EMR) for the treatment of recurrent polyps.

Methods Fourteen patients with 14 lesions who received endoscopic treatment for local recurrence after endoscopic resection for colorectal epithelial neoplasms between April 2017 and April 2019 were enrolled. Patients with colon cancer predisposition syndromes, colorectal carcinoma, lesion with deep submucosal invasion (>1000 μm), inflammatory bowel disease, coagulopathy and confirmed pregnancy state were excluded. Treatment methods, treatment outcomes, and recurrence rate were evaluated for each recurrent lesion.

Results One patient was excluded from the analysis, because recurrence was not confirmed at pathology,and 13 patients were considered for efficacy analysis (M/F 6/7, median age 75yrs [IQR 69-81]). Recurrent adenomas had a mean size of 19.2mm [range 10-40], being mostly located in the rectum (85 %). On histological examination ten lesions presented tubulovillous architecture, three of which with high grade dysplasia, and three were tubular adenomas with low grade dysplasia.R0 resection rate for ESD, EFTR and hybrid techniques was respectively 100 %,100 % and 67 %. No major early/late complications were observed. In a mean follow-up of 9.2 months [IQR 6-12], recurrence was observed in only one case three months after hybrid ESD+EMR; FTR re-treatment was performed with negative endoscopic follow-up at 12 months.

Tab. 1

	ESD(n = 4)	EFTR(n = 6)	Hybrid techniques (EMR+ESD; EFTR+ESD)(n= 3)	Total procedures (n= 13)
En-bloc resection rate (%)	4 (100)	6 (100)	1 (33)	11 (85)
R0 resection rate (%)	4 (100)	6 (100)	2 (67)	12 (92)
Recurrence rate (%)	0	0	1 (33)	1 (8)
Major adverse event, n (%)	0	0	0	0

Conclusions In our experience multimodal use of advanced endoscopic techniques, single or combined, represent safe and effective treatment options for locally recurrent adenomas.

Citation: Ghersi S, Gazzola A, Apolito P et al. eP224 MULTIMODAL USE OF ADVANCED ENDOSCOPIC RESECTION TECHNIQUES FOR LOCAL RECURRENT COLORECTAL ADENOMAS: A SINGLE CENTER PROSPECTIVE STUDY. Endoscopy 2021; 53: S172.

Publication History

Article published online:
19 March 2021