OBJECTIVE: Endoscopic submucosal dissection (ESD) has a high curative resection rate for gastrointestinal mucosal lesions, but is not used widely in Europe because of a high complication rate and a long learning curve. This study analyzed the ESD learning curve at a single European treatment center. MATERIALS AND METHODS: ESD and hybrid-ESD (hESD) procedures were used to treat large colonic lesions that could not be resected in one piece by other endoscopic methods. Procedure duration and speed, and en-bloc, complete (R0) resection, and complication rates were analyzed. RESULTS: Fifty-three patients underwent ESD (37 pure ESD, 16 hESD), most with rectal lesions (n=34, 64.2%). The mean lesion diameter was 3.7 ± 1.1 cm2 (range 2.0-7.0 cm), the median procedure duration was 70.0 min [interquartile range (IQR) 31.0-113.0 min], and the median treatment speed was 0.086 cm2/min (IQR 0.055-0.152). En-bloc and R0 resection rates were 86.5% (32/37) and 81.1% (30/37), respectively. Procedure speed increased significantly after about 25 cases (P=0.0313). The median hESD procedure treatment speed was 0.159 cm/min (n=16, IQR 0.094-0.193), which was better than with classical ESD (P=0.04). The hESD en-bloc and R0 resection rates were comparable to those of classical ESD (P>0.05). The only complication was bleeding, 5.7% (3/53); no perforation occurred. Recurrence was detected during follow-up (median 30.0 months, IQR 12-48) in one patient (1.7%). CONCLUSION: ESD is useful and safe for resection of large colorectal polyps, and procedure speed increased considerably after 25 procedures. hESD was faster than ESD, with a high therapeutic resection rate.
OBJECTIVE: Endoscopic submucosal dissection (ESD) has a high curative resection rate for gastrointestinal mucosal lesions, but is not used widely in Europe because of a high complication rate and a long learning curve. This study analyzed the ESD learning curve at a single European treatment center. MATERIALS AND METHODS:ESD and hybrid-ESD (hESD) procedures were used to treat large colonic lesions that could not be resected in one piece by other endoscopic methods. Procedure duration and speed, and en-bloc, complete (R0) resection, and complication rates were analyzed. RESULTS: Fifty-three patients underwent ESD (37 pure ESD, 16 hESD), most with rectal lesions (n=34, 64.2%). The mean lesion diameter was 3.7 ± 1.1 cm2 (range 2.0-7.0 cm), the median procedure duration was 70.0 min [interquartile range (IQR) 31.0-113.0 min], and the median treatment speed was 0.086 cm2/min (IQR 0.055-0.152). En-bloc and R0 resection rates were 86.5% (32/37) and 81.1% (30/37), respectively. Procedure speed increased significantly after about 25 cases (P=0.0313). The median hESD procedure treatment speed was 0.159 cm/min (n=16, IQR 0.094-0.193), which was better than with classical ESD (P=0.04). The hESD en-bloc and R0 resection rates were comparable to those of classical ESD (P>0.05). The only complication was bleeding, 5.7% (3/53); no perforation occurred. Recurrence was detected during follow-up (median 30.0 months, IQR 12-48) in one patient (1.7%). CONCLUSION:ESD is useful and safe for resection of large colorectal polyps, and procedure speed increased considerably after 25 procedures. hESD was faster than ESD, with a high therapeutic resection rate.
Authors: José Carlos Marín-Gabriel; Gloria Fernández-Esparrach; José Díaz-Tasende; Alberto Herreros de Tejada Journal: World J Gastrointest Endosc Date: 2016-01-25
Authors: Sheraz R Markar; Hugh Mackenzie; Melody Ni; Jeremy R Huddy; Alan Askari; Omar Faiz; S Michael Griffin; Laurence Lovat; George B Hanna Journal: Gut Date: 2016-10-18 Impact factor: 23.059