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Hybrid-ESD has a high therapeutic resection rate of colorectal polyps

The latest European Journal of Gastroenterology evaluates the treatment of large colorectal neoplasms by endoscopic submucosal dissection.

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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."

Eur J Gastroenterol Hepatol 2014: 26(6): 607-615
13 May 2014

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