Advanced bipolar and microwave energy- a safer alternative compared to monopolar electrosurgical devices in Western colorectal endoscopic submucosal dissection (ESD) practice?

Aims ESD is recommended by the European Society of Gastrointestinal Endoscopy for en-bloc resection of colorectal lesions>20mm, given lower recurrence rates and potential for organ preservation in the context of early submucosal invasive cancer. However, ESD is technically challenging and published Western data demonstrates inferior outcomes and safety profile when compared to Eastern counterparts. This has been attributed to factors including difference in endoscopy training and volume of suitable lesions. Additionally, most published data involves ESD using monopolar electrosurgical devices. We share our experience of performing colorectal ESD without in-house mentoring at a tertiary centre in the UK, with a novel electrosurgical device combining bipolar radiofrequency for dissection and microwave energy for coagulation.

Methods This was an observational study of patients undergoing ESD at our hospital between September 2019, when the service was introduced, to October 2024. Referrals from internal and external sites within the UK were reviewed at a dedicated complex polyp multi-disciplinary meeting, before proceeding to ESD. Data including patient demographics, procedural outcomes and complications were collected from electronic health records and retrospective analysis was performed.

Results A total of 163 procedures were performed, with 43 cases from 2019-2021 and 120 cases between 2022-2024. The cohort composed of 98 male and 65 female patients, with the majority (88%) of patients aged>50 years. From 2019-2021, 70% of cases were rectal lesions. With increasing experience, more non-rectal cases were performed. Between 2022-2024, rectal lesions accounted for only 34% of cases. The mean size of lesions resected was 5cm. Within the first hundred cases, resection speed doubled from 4 cm²/hour in the initial 25 cases, to 8 cm²/hour in the final 25 cases. This resection speed was maintained despite taking on more lesions proximal to the rectum with increasing experience. Complications were rare, there were no cases of immediate bleeding and only five cases (3%) of delayed bleeding. Three patients (2%) suffered delayed perforation. Of these, only one required surgery whilst the other two were managed conservatively. One patient (0.6%) was readmitted to hospital due to post-polypectomy syndrome. Additionally, we were able to achieve high rates of technical success (en-bloc resection). The overall success rate was 85%, accounting for the lower success rates when the service was initially introduced in 2019. For comparison, the success rate was 88% and 93% in 2023 and 2024 respectively. Recurrence was seen in only two patients (1%).

Conclusions Our findings demonstrate that ESD performed with a novel electrosurgical device combining advanced bipolar radiofrequency for dissection and microwave energy for coagulation, has an excellent safety and efficacy profile compared to published European data.

Publication History

Article published online:
27 March 2025