Outcomes of endoscopic submucosal dissection for colorectal neoplasms: Prospective, multicenter, cohort trial

Nozomu Kobayashi, Yoji Takeuchi, Ken Ohata, Masahiro Igarashi, Masayoshi Yamada, Shinya Kodashima, Kinichi Hotta, Keita Harada, Hiroaki Ikematsu, Toshio Uraoka, Naoto Sakamoto, Hisashi Doyama, Takashi Abe, Atsushi Katagiri, Shinichiro Hori, Tomoki Michida, Takehito Yamaguchi, Masakatsu Fukuzawa, Shinsuke Kiriyama, Kazutoshi FukaseYoshitaka Murakami, Hideki Ishikawa, Yutaka Saito

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Objectives: Endoscopic mucosal resection (EMR) is the gold standard for the treatment of noninvasive large colorectal lesions, despite challenges associated with nonlifting lesions and a high rate of local recurrence. Endoscopic submucosal dissection (ESD) offers the possibility of overcoming these EMR limitations. However, a higher risk of complications and longer procedure time prevented its dissemination. As ESD now provides more stable results because of standardized techniques compared with those used earlier, this study aimed to quantify the rates of en bloc and curative resections, as well as ESD complications, in the present situation. Methods: A multicenter, large-scale, prospective cohort trial of ESD was conducted at 20 institutions in Japan. Consecutive patients scheduled for ESD were enrolled from February 2013 to January 2015. Results: ESD was performed for 1883 patients (1965 lesions). The mean procedure time was 80.6 min; en bloc and curative resections were achieved in 1759 (97.0%) and 1640 (90.4%) lesions, respectively, in epithelial lesions ≥20 mm. Intra- and postprocedural perforations occurred in 51 (2.6%) and 12 (0.6%) lesions, respectively, and emergency surgery for adverse events was performed in nine patients (0.5%). Conclusions: This trial conducted after the standardization of the ESD technique throughout Japan revealed a higher curability, shorter procedure time, and lower risk of complications than those reported previously. Considering that the target lesions of ESD are more advanced than those of EMR, ESD can be a first-line treatment for large colorectal lesions with acceptable risk and procedure time. (Clinical Trial Registration: UMIN000010136).

Original languageEnglish
JournalDigestive Endoscopy
DOIs
Publication statusAccepted/In press - 2021
Externally publishedYes

Keywords

  • colonoscopy
  • colorectal cancer
  • colorectal neoplasia
  • endoscopic mucosal resection
  • endoscopic submucosal dissection

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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