Endoscopic Submucosal Dissection (ESD) for the management of Fibrotic Non-lifting Colorectal Lesions (NLCs): results from a large multicenter retrospective study
Rattachement africain : it. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Aims Non-lifting colorectal lesions (NLCLs), often resulting from previous unsuccessful treatments or biopsies, are challenging to treat due to submucosal fibrosis. Various endoscopic techniques have been proposed for their management; however no standard approach has been established. This study aimed to assess the feasibility, effectiveness, and safety of endoscopic submucosal dissection (ESD) for these lesions, including cases requiring conversion to hybrid-ESD (H-ESD), when performed by experienced endoscopists in tertiary referral centers. Methods We performed a retrospective analysis of prospective collected data of all consecutive patients diagnosed with NLCLs with submucosal fibrosis at two italian tertiary referral centers from January 2009 to September 2022. The fibrosis degree of lesions was classified during the index procedure as F1 or mild and F2 or severe [ 1 ]. All procedures were performed by expert operators, defined as those having completed at least 100 colorectal ESDs and regularly receiving referrals from other hospitals. The primary endpoint was the recurrence rate, while secondary endpoints included adverse events (AEs) rate, technical success (TS) rate (en bloc resection regardless of technique), complete resection (CR) and curative resection (cR) rates, surgical intervention rate, and features associated with outcomes. Results 178 patients with NLCLs were included (52 previously biopsied, 126 recurrent after previous resection). ESD was used in 111 (62.4%) and H-ESD in 67 (37.6%) cases. During a median follow-up of 373 days (IQR 540), the overall recurrence rate was 3.6%, all treated by endoscopy. The overall AE rate was 13.4%, and perforation was the most frequent (8.4%), without significant differences between ESD and H-ESD (p=0.53). All AEs were successfully managed endoscopically, while 6.1% of patients were referred for surgery, only due to malignant histology The TS rate was 71.9%, significantly higher in previously biopsied lesions compared to recurrent ones (78.8% vs. 55.6%, p=0.04). On multivariate analysis rectal location (p<0.001), F1 fibrosis (p=0.026), and previously biopsied lesions (p=0.006) predicted ESD TS without the need for conversion to H-ESD. Conclusions ESD/H-ESD approach is feasible and safe for NLCLs when performed by experienced operators. Previously biopsied lesions, rectal localization, and lower fibrosis grades were associated with higher TS rates. Publication History Article published online: 27 March 2025 © 2025. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Endoscopic Submucosal Dissection (ESD) for the management of Fibrotic Non-lifting Colorectal Lesions (NLCs): results from a large multicenter retrospective study
- Date Crossref
- 01/03/2025
- Éditeur
- Georg Thieme Verlag KG
- Type
- proceedings-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
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Vita-Salute San Raffaele University pays non établi dans la noticeUniversité ou école supérieure
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IRCCS Policlinico San Donato Gastroenterology and Gastrointestinal Endoscopy pays non établi dans la noticeÉtablissement de santé
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Istituti di Ricovero e Cura a Carattere Scientifico pays non établi dans la noticeÉtablissement de santé
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Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele pays non établi dans la noticeÉtablissement de santé
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Azienda Sanitaria Unità Locale di Reggio Emilia pays non établi dans la noticeÉtablissement de santé
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Azienda USL di Bologna pays non établi dans la noticeÉtablissement de santé
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IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola pays non établi dans la noticeÉtablissement de santé
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University of Foggia Department of Medical and Surgical Sciences pays non établi dans la noticeUniversité ou école supérieure
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IRCCS San Raffaele Scientific Institute Gastroenterology and Gastrointestinal Endoscopy pays non établi dans la noticeStructure de recherche
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Gastroenterology Unit pays non établi dans la noticeInstitution
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Unit of Gastroenterology and Digestive Endoscopy pays non établi dans la noticeInstitution
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Vita-Salute San Raffaele University, Gastroenterology and Gastrointestinal Endoscopy — IRCCS Policlinico San Donato et Istituti di Ricovero e Cura a Carattere Scientifico, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.