Journal article
Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience
Endoscopy International Open, Vol.7(12), pp.E1714-E1722
12/01/2019
DOI: 10.1055/a-1010-5663
PMCID: PMC6887644
PMID: 31803823
Abstract
Background and aims
Rectal lesions traditionally represent the first lesions approached during endoscopic submucosal dissection (ESD) training in the West. We evaluated the safety and efficacy of rectal ESD in North America.
Methods
This is a multicenter retrospective analysis of rectal ESD between January 2010 and September 2018 in 15 centers. End points included: rates of en bloc resection, R0 resection, adverse events, comparison of pre- and post-ESD histology, and factors associated with failed resection.
Results
In total, 171 patients (median age 63 years; 56 % men) underwent rectal ESD (median size 43 mm). En bloc resection was achieved in 141 cases (82.5 %; 95 %CI 76.8–88.2), including 24 of 27 (88.9 %) with prior failed endoscopic mucosal resection (EMR). R0 resection rate was 74.9 % (95 %CI 68.4–81.4). Post-ESD bleeding and perforation occurred in 4 (2.3 %) and 7 (4.1 %), respectively. Covert submucosal invasive cancer (SMIC) was identified in 8.6 % of post-ESD specimens. There was one case (1/120; 0.8 %) of recurrence at a median follow-up of 31 weeks; IQR: 19–76 weeks). Older age and higher body mass index (BMI) were predictors of failed R0 resection, whereas submucosal fibrosis was associated with a higher likelihood of both failed en bloc and R0 resection.
Conclusion
Rectal ESD in North America is safe and is associated with high en bloc and R0 resection rates. The presence of submucosal fibrosis was the main predictor of failed en bloc and R0 resection. ESD can be considered for select rectal lesions, and serves not only to establish a definitive tissue diagnosis but also to provide curative resection for lesions with covert advanced disease.
Details
- Title: Subtitle
- Safety and efficacy of endoscopic submucosal dissection for rectal neoplasia: a multicenter North American experience
- Creators
- Dennis Yang - University of FloridaHiroyuki Aihara - Brigham and Women's HospitalYaseen B. Perbtani - University of FloridaAndrew Y. Wang - University of VirginiaAbdul Aziz Aadam - Northwestern UniversityYutaka Tomizawa - University of WashingtonJoo Ha Hwang - University of WashingtonBaiming Zou - University of FloridaNikola S. Natov - University of VirginiaAmanda Siegel - Northwestern UniversityMilad Pourmousavi Khoshknab - Johns Hopkins MedicineMouen A. Khashab - Johns Hopkins HospitalSaowanee Ngamruengphong - Johns Hopkins HospitalHarshit S. Khara - Geisinger Health SystemDavid L. Diehl - Geisinger Health SystemThibaut Maniere - Université de SherbrookeSherif Andrawes - Northwell HealthPetros Benias - Northwell HealthNikhil A. Kumta - Mount Sinai HospitalFariha Ramay - University of Maryland, BaltimoreRaymond E. Kim - University of Maryland, BaltimoreJason Samarasena - University of California, IrvineKenneth Chang - University of California, IrvineRintaro Hashimoto - University of California, IrvineBenjamin Tharian - Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USASumant Inamdar - Division of Gastroenterology and Hepatology, University of Arkansas Medical Sciences, Little Rock, AR, USAGloria Lan - NewYork–Presbyterian HospitalAmrita Sethi - NewYork–Presbyterian HospitalMichael J. Nosler - University of Colorado HealthAbdalaziz Tabash - Baylor University Medical CenterMohamed O. Othman - Baylor University Medical CenterPeter V. Draganov - University of Florida
- Resource Type
- Journal article
- Publication Details
- Endoscopy International Open, Vol.7(12), pp.E1714-E1722
- Publisher
- Georg Thieme Verlag KG
- DOI
- 10.1055/a-1010-5663
- PMID
- 31803823
- PMCID
- PMC6887644
- ISSN
- 2364-3722
- eISSN
- 2196-9736
- Language
- English
- Date published
- 12/01/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984696771502771
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