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- Title
Endoscopic submucosal dissection for colorectal lesions: outcomes from a United States experience.
- Authors
Gupta, Nina; Rodríguez-Ruiz, Gabriela; Siddiqui, Uzma D.; Chapman, Christopher G.; Donboli, Kianoush; Hart, John; Xiao, Shu-Yuan; Waxman, Irving
- Abstract
Background and study aims: Endoscopic submucosal dissection (ESD) is commonly used in Asia for resection of large non-pedunculated colorectal polyps (LNPCPs) and early (T1) colorectal cancers. It allows for en bloc removal and is often curative. We describe outcomes of colorectal ESD from a United States (US) academic medical center and compare this to international experiences. Methods: Retrospective review was performed of colonic lesions referred to the University of Chicago Medical Center for ESD from 2012 to 2020. Clinical and procedural data were collected. Results: The study included 78 lesions with mean size of 29.7 mm (range 10–100 mm). The overall en bloc resection rate was 73.1% (n = 57). Between the first and second half of the study, it improved from 61.5 to 84.6% (p = 0.02). Histology showed adenocarcinoma in fifteen lesions (19.2%). Of all neoplastic lesions (n = 68), resection with negative margins (R0) was achieved in 54 cases (79.4%). Adverse events occurred in 9 cases (11.5%), but most (n = 6, 66.7%) were successfully treated endoscopically. Follow-up endoscopy was performed in 46 patients (59.0%) at a mean interval of 6.8 months (SD ± 5.0 months) with two case of recurrent lesion (4.3%). Conclusions: This study shows successful colorectal ESD outcomes at a US tertiary center. The en bloc resection rate was lower than other cohorts, but a learning curve was demonstrated. The R0 resection, lesion recurrence, and adverse event rates were similar to other non-Asian experiences, but not as favorable as in Asia [Fuccio et al. in Gastrointest Endosc 86:74–86.e17, 2017]. Increased ESD training in the US can help optimize utilization and outcomes.
- Subjects
UNITED States; UNIVERSITY of Chicago; COLON polyps; COLORECTAL cancer; SURGICAL margin; MEDICAL centers; ACADEMIC medical centers; RETROSPECTIVE studies
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2022, Vol 36, Issue 1, p236
- ISSN
1866-6817
- Publication type
Article
- DOI
10.1007/s00464-020-08262-4