Comparison of Endoscopic Submucosal Dissection for Primary and Recurrent Colorectal Lesions: A Single-Center European Study

J Laparoendosc Adv Surg Tech A. 2019 Mar;29(3):366-373. doi: 10.1089/lap.2018.0429. Epub 2018 Oct 25.


Introduction: Endoscopic submucosal dissection (ESD) is an acknowledged endoscopic technique for the management of early gastrointestinal neoplasia. The clinical experience and the research from the Eastern ESD centers show that experienced endoscopists can successfully treat even the most demanding recurrent colorectal lesions.

Aim: The aim of this study was to analyze the clinical outcomes of the management of recurrent colorectal lesions in comparison with those of primary lesions in the setting of high-volume European center.

Methods: A retrospective analysis of 298 cases (228 primary lesions and 70 recurrent lesions) performed by a single endoscopist was carried out. Evaluating learning curves for both primary and recurrent lesions, cumulative sum analysis was performed.

Results: Primary lesions had ∼9% higher R0 resection rate (86.84% versus 78.51%). Yet, this difference did not reach statistical significance (P = .091). The presence of recurrent lesion and lengthy procedure (≥150 min) are risks factors of R1 resection, whereas rectal localization of the lesion was associated with lower risk of R1 resection. The cumulative R0 of 80% was achieved at 36th procedure in the primary lesions group, whereas for the recurrent lesions it was reached at 50th procedure (overall 229 procedures).

Conclusions: Our study underlines the importance of proper experience in ESD before the management of recurrent lesions. Even after the completion of high volume of primary lesions, first recurrent lesions can pose a challenge. Nevertheless, the final outcomes are promising, as the complications do not pose a serious risk to the patients and high R0 resection rate can be achieved in a reasonable timeframe.

Keywords: ESD learning curve; colorectal endoscopic submucosal dissection; endoscopic management of colorectal lesions; recurrent colorectal lesions.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Colon / pathology
  • Colon / surgery
  • Colorectal Neoplasms / surgery*
  • Endoscopic Mucosal Resection / adverse effects
  • Endoscopic Mucosal Resection / education
  • Endoscopic Mucosal Resection / methods*
  • Europe
  • Female
  • Follow-Up Studies
  • Hospitalization / statistics & numerical data
  • Humans
  • Learning Curve
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / surgery
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Rectum / pathology
  • Rectum / surgery
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome