Clinical outcomes of colon endoscopic submucosal dissection for colonic neoplasms: A single center experience in South Taiwan

Abstract The endoscopic submucosal dissection (ESD) is an advanced procedure for removal of colorectal lesions with highly suspicion of limited submucosal invasion or cannot be optimally removed by snare-based techniques. To analyze the clinical outcomes of colonic ESD, we retrospectively enrolled 230 patients with 244 colonic neoplasms, who received ESD procedure from April 2012 to October 2020 at Kaohsiung Chang Gung memorial hospital. The average age was 64 years old with mean follow-up times 22.59 months. 34 lesions were loss of follow-up. Most lesions were lateral spreading tumor with non-granular type. The average ESD time was 51.9 minutes. 9 cases had procedure-related complications, including 2 intra-procedure perforations and 7 delayed bleeding without procedure-related mortality. 241 lesions (98.8%) achieved En-bloc resection while 207 lesions (84.8%) achieved R0 resection. Most lesion was tubulo-(villous) adenoma. Malignancy included 35 adenocarcinoma and 5 NET. No local recurrence was developed during follow-up. Multivariate analysis for long ESD time revealed significance in size ≥ 10 cm2 and endoscopist experience < 3 years. Pre-ESD EUS revealed good prediction in discrimination of mucosal (Sensitivity: 0.90) and submucosal lesion (Specificity: 0.67).