Use of endoscopic submucosal dissection or full-thickness resection device to treat residual colorectal neoplasia after endoscopic resection: a multicenter historical cohort study

Author:

Yzet Clara1,Le Baleur Yann2,Albouys Jérémie3,Jacques Jérémie3,Doumbe-Mandengue Paul3ORCID,Barret Maximilien4,Abou Ali Einas4,Schaefer Marion5ORCID,Chevaux Jean-Baptiste5,Leblanc Sarah6,Lepillez Vincent6,Privat Jocelyn7,Degand Thibault8,Wallenhorst Timothée9,Rivory Jérôme1,Chaput Ulriikka10,Berger Arthur11,Aziz Karim12,Rahmi Gabriel13,Coron Emmanuel1415,Kull Eric16,Caillo Ludovic17,Vanbiervliet Geoffroy18ORCID,Koch Stéphane19,Subtil Fabien20,Pioche Mathieu1

Affiliation:

1. Endoscopy and Gastroenterology Unit, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France

2. Endoscopy and Gastroenterology Unit, Hospital Saint Joseph, Paris, France

3. Department of Endoscopy and Gastroenterology, Dupuytren University Hospital, Limoges, France

4. Endoscopy and Gastroenterology Unit, Cochin University Hospital, Paris, France

5. Endoscopy and Gastroenterology Unit, Nancy University Hospital, Nancy, France

6. Department of Endoscopy and Gastroenterology, Hôpital Privé Jean Mermoz, Lyon, France

7. Endoscopy and Gastroenterology Unit, Vichy Hospital, Vichy, France

8. Endoscopy and Gastroenterology Unit, Dijon University Hospital, Dijon, France

9. Endoscopy and Gastroenterology Unit, Pontchaillou University Hospital, Rennes, France

10. Endoscopy and Gastroenterology Unit, Saint-Antoine University Hospital, Paris, France

11. Endoscopy and Gastroenterology Unit, Bordeaux University Hospital, Bordeaux, France

12. Endoscopy and Gastroenterology Unit, Saint Brieuc Hospital, Saint Brieuc, France

13. Endoscopy and Gastroenterology Unit, Georges Pompidou European Hospital, Paris, France

14. Department of Gastroenterology and Hepatology, University Hospital of Geneva (HUG), Geneva, Switzerland.

15. Digestive Diseases Institute, University Hospital Nantes, Nantes, France

16. Endoscopy and Gastroenterology Unit, Metz Hospital, Metz, France

17. Endoscopy and Gastroenterology Unit, Nîmes University Hospital, Nîmes, France

18. Endoscopy and Gastroenterology Unit, Nice University Hospital, Nice, France

19. Endoscopy and Gastroenterology Unit, Besançon University Hospital, Besançon, France

20. Biostatistics Unit, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, CNRS, and Laboratoire de Biométrie et Biologie Évolutive, Lyon, France

Abstract

Introduction Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions. Methods All consecutive patients with RCN treated either using the FTRD or by ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate, defined as an en bloc resection with histologically tumor-free lateral and deep margins. Results 275 patients (median age 70 years; 160 men) who underwent 177 ESD and 98 FTRD procedures for RCN were included. R0 resection was achieved in 83.3 % and 77.6 % for ESD and FTRD, respectively (P = 0.25). Lesions treated by ESD were however larger than those treated by FTRD (P < 0.001). The R0 rates for lesions of 20–30 mm were 83.9 % and 57.1 % in the ESD and FTRD groups, respectively, and for lesions of 30–40 mm were 93.6 % and 33.3 %, respectively. On multivariable analysis, ESD procedures were associated with statistically higher en bloc and R0 resection rates after adjustment for lesion size (P = 0.02 and P < 0.001, respectively). The adverse event rate was higher in the ESD group (16.3 % vs. 5.1 %), mostly owing to intraoperative perforations. Conclusion ESD is effective in achieving R0 resection for RCN whatever the size and location of the lesions. When residual lesions are smaller than 20 mm, the FTRD is an effective alternative.

Publisher

Georg Thieme Verlag KG

Subject

Gastroenterology

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