Published online Jun 16, 2023. doi: 10.4253/wjge.v15.i6.458
Peer-review started: February 20, 2023
First decision: April 13, 2023
Revised: May 12, 2023
Accepted: May 31, 2023
Article in press: May 31, 2023
Published online: June 16, 2023
Processing time: 114 Days and 7.9 Hours
While colon endoscopic mucosal resection (EMR) is an effective technique, removal of larger polyps often requires piecemeal resection, which can increase recurrence rates. Endoscopic submucosal dissection (ESD) in the colon offers the ability for en bloc resection and is well-described in Asia, but there are limited studies comparing ESD vs EMR in the West.
To evaluate different techniques in endoscopic resection of large polyps in the colon and to identify factors for recurrence.
The study is a retrospective comparison of ESD, EMR and knife-assisted endo
A total of 376 patients and 428 polyps were included. Mean polyp size was greatest in the ESD group (35.8 mm), followed by knife-assisted endoscopic resection (33.3 mm) and EMR (30.5 mm) (P < 0.001). ESD achieved highest en bloc resection (90.4%) followed by knife-assisted endoscopic resection (31.1%) and EMR (20.2%) (P < 0.001). A total of 287 polyps had follow-up (67.1%). On follow-up analysis, recurrence rate was lowest in knife-assisted endoscopic resection (0.0%) and ESD (1.3%) and highest in EMR (12.9%) (P = 0.0017). En bloc polyp resection had significantly lower rate of recurrence (1.9%) compared to non-en bloc (12.0%, P = 0.003). On multivariate analysis, ESD (in comparison to EMR) adjusted for polyp size was found to significantly reduce risk of recurrence [adjusted hazard ratio 0.06 (95%CI: 0.01-0.57, P = 0.014)].
In our study, EMR had significantly higher recurrence compared to ESD and knife-assisted endoscopic resection. We found factors including resection by ESD, en bloc removal, and use of circumferential incision were associated with significantly decreased recurrence. While further studies are needed, we have demonstrated the efficacy of ESD in a Western population.
Core Tip: Endoscopic submucosal dissection is an effective and safe technique. Compared to endoscopic mucosal resection, we find that endoscopic submucosal dissection as well as knife-assisted endoscopic resection to achieve higher en bloc resection, circumferential incision, R0 resection as well as lower recurrence rate. While further studies are needed, we have demonstrated the efficacy of endoscopic submucosal dissection in a Western population.