Treatment of large colorectal neoplasms by endoscopic submucosal dissection: a European single-center study

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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.


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 cm (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 cm2/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%).


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.

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