Feasibility, safety, and outcomes of LGI endoscopic submucosal dissection from UK ESD Registry: The largest multicentre prospective study on Western population

Aims The outcome of ESD in early gastrointestinal neoplasia in Japan is well established whereas in the west, it is variable depending on the volume and experience. Therefore, a multicentre national registry was set up in the UK to prospectively evaluate the practice and outcomes of ESD.

Methods This is a prospective observational study for patients undergoing ESD for early GI neoplasia. All technical and outcoms data was prospectively collected onto REDCap.

Results There were 568 colorectal ESDs from August 2016 to August 2023 recruited from 6 large tertiary referral centres in the UK. Mean age of the patients was 67.3 years (range 37 – 90 years) with male preponderance (341 males vs. 227 females). Majority were in the rectum: 300, 52.8% while 126 (22.2%) in the left colon and 142 (25%) were in the proximal colon. Polyp size ranges from 10 to 210 mm (mean 47 mm). 318 (56%) were flat polyp.

Of 568 ESDs, 128 (22.6%) were hybrid ESDs where more than 80% of submucosal dissection was completed by using a knife before using a snare for completion. Technical success was achieved in 97.7% (555 cases) with en-bloc rate of 83.1%.

Overall, there were 22 (4%) intraprocedural perforation (7 proximal and 15 distal colon) and 7 (1.3%) intraprocedural bleeding (3 proximal and 4 distal colon) which were all managed endoscopically. There were 3 (0.5%) delayed perforation (2 in caecum and 1 in rectum) and out of which, 1 required surgery and 2 were managed conservatively. There were 15 (2.7%) delayed bleeding (6 proximal and 9 distal colon) and 4 of them required blood transfusion while others were managed conservatively/endoscopically. 5 were readmitted with post polypectomy syndrome.

Post resection histology showed 508 adenomatous neoplasia, 18 sessile serrated lesions (SSLs) with dysplasia, 4 SSLs without dysplasia, 3 hyperplastic polyps, 6 neuroendocrine tumours and 1 squamous cell cancer and 1 melanoma.

Post resection ESD of 508 adenomatous lesions showed majority (298, 58.6%) was low grade dysplasia with R0 rate of 65%. 142 (28%) were high grade dysplasia with R0 rate of 85.5%. There were 66 (13%) submucosally invasive cancers with deep margin R0 rate of 75.1% and lateral margin R0 rate of 79.7%.

Conclusions Our multicentre data demonstrates that ESD in rectum and colon is feasible, safe, and effective in Western setting. We did not observe any difference in adverse outcomes between ESDs in the left and right colon. Overall, R0 rate are suboptimal which could be related to hybrids ESD or resecting too close the margin of the lesion and needs improvement.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
15. April 2024