Endoscopic submucosal dissection (ESD) has a high curative resection rate for gastrointestinal mucosal lesions, but is not used widely in Europe because of a high complication rate and a long learning curve.
Dr Andrzej Białek and colleagues analyzed the ESD learning curve at a single European treatment center.
ESD and hybrid-ESD (hESD) procedures were used to treat large colonic lesions that could not be resected in one piece by other endoscopic methods.
Procedure duration and speed, and en-bloc, complete (R0) resection, and complication rates were analyzed.
The team reported that 53 patients underwent ESD, most with rectal lesions.
The mean lesion diameter was 4 cm, the median procedure duration was 70 min, and the median treatment speed was 0.086 cm2/min.
|En-bloc resection rates were 87%|
|European Journal of Gastroenterology & Hepatology|
En-bloc and R0 resection rates were 87%, and 81%, respectively.
Procedure speed increased significantly after about 25 cases.
The research team found that the median hESD procedure treatment speed was 0.159 cm2/min, which was better than with classical ESD.
The team noted that the hESD en-bloc and R0 resection rates were comparable to those of classical ESD.
The researchers observed that the only complication was bleeding, and no perforation occurred.
Recurrence was detected during follow-up in 1 patient.
Dr Białek and colleagues conclude, "ESD is useful and safe for resection of large colorectal polyps, and procedure speed increased considerably after 25 procedures."
"hESD was faster than ESD, with a high therapeutic resection rate."