Endoscopy 2025; 57(S 02): S621-S622
DOI: 10.1055/s-0045-1806625
Abstracts | ESGE Days 2025
ePosters

UNDERWATER ENDOSCOPIC SUBMUCOSAL DISSECTION (UESD) VERSU STANDARD ENDOSCOPIC SUBMUCOSAL DISSECTION (GESD) FOR SUPERFICIAL COLORECTAL NEOPLASMS: a propensity score matched analysis. Short running head: UESD vs GESD

Authors

  • G Andrisani

    1   Campus Bio Medico University of Rome, Selcetta, Italy

  • G Antonelli

    2   Gastroenterology and Digestive Endoscopy Unit, Castelli Hospital, Roma, Italy

  • T Fukuchi

    3   Fujisawa City Hospital, Fujisawa, Japan

  • L Frazzoni

    4   Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, Forlì-Cesena, Italy

  • J Hamanaka

    5   Yokohama Minami Kyosai Hospital, Yokohama City, Japan

  • C Hassan

    6   Humanitas University, Rozzano, Italy

  • G Parente

    7   University of Salerno, Fisciano, Italy
    8   Campus biomedico via alvaro del portillo 200, Roma, Italy

  • F M Di Matteo

    9   Bio-Medico Campus University Hospital, Rome, Italy

  • K Hirasawa

    10   Yokohama City University Medical Center, 横浜市, Japan
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Aims Endoscopic submucosal dissection (ESD) for superficial colorectal lesions is technically challenging and requires a long learning curve. Underwater ESD (UESD) has recently emerged as a less complex technical alternative, but only small retrospective data from Eastern cohorts are currently available. Our aim was to evaluate the effectiveness and safety of UESD in a Western setting, as compared to the current standard of care (standard ESD in an Eastern setting).

Methods We performed a 1-to-4 nearest-neighbor retrospective propensity score-matched analysis between all UESD cases and all standard ESD (SESD) cases performed and collected prospectively in a Western and an Eastern interventional endoscopy referral center, respectively. The following confounders were accounted for: lesion site, size, morphology and depth of histological invasion. The primary outcomes were En bloc and R0 resection rates. The secondary outcomes were procedure speed (mm²/min), calculated by dividing the area of the resected specimen (mm²) by the procedure time (minutes), and procedure time, calculated from submucosal injection to the complete dissection of the lesion [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] [23] [24].

Results Overall, 100 patients for UESD and 400 patients for SESD were included, matched for all baseline parameters. The morphology of lesions in the SESD group was: 452 (25.4%) LST-G, 1,082 (60.7%) LST-NG, and 249 (13.9%) sessile (0-Is). The mean size of lesions was 40.9+14.7 mm as major axis, and 33.6+13.5 mm as minor axis. In the UESD group, most of lesions was LST-G (55-55%), followed by 18 (18%) LST-NG, and 27 (27%) sessile (0-Is). The mean size of lesions was 57.4+27.9 mm as major axis, and 40.3+18.9 mm as minor axis.

UESD yielded higher rate of en-bloc resection (100% vs. 86.5%, p<0.001) and lower rate of perforation (1% vs. 9.5%, p=0.009). No significant difference between the two techniques was observed in terms of vertical R0 resection rate, speed and time of dissection, and delayed bleeding rate.

Conclusions Our findings suggest that UESD allows to achieve resection speed and procedure times comparable to those of expert Japanese endoscopists, with a significant reduction in the risk of perforation



Publication History

Article published online:
27 March 2025

© 2025. European Society of Gastrointestinal Endoscopy. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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