914 Dissection-Enabled Scaffold-Assisted Resection (DeSCAR): A Novel Technique for Resection of Residual or Non-Lifting GI Neoplasia of the Colon, Expanded Experience and Follow-Up

Abstract

INTRODUCTION: Colonic lesions referred for endoscopic mucosal resection (EMR) may not be amenable to conventional snare resection due to previous manipulation or submucosal invasion or because of flat lesions unable to be snared. In 2018, we initially described Dissection-enabled Scaffold Assisted Resection (DeSCAR)—a combination of circumferential endoscopic submucosal dissection (ESD) with EMR—to be safe for the endoscopic resection for removal of non-lifting or residual colonic lesions with suspected submucosal involvement or fibrosis. We describe our expanded experience and follow up of patients undergoing DeSCAR and assess the efficacy, safety, and feasibility of DeSCAR for endoscopic resection of non-lifting or residual colonic lesions. METHODS: Lesions referred for EMR were retrospectively reviewed. Our initial cohort of 29 patients from 2015-2017 combined with 28 additional patients from 2018-2019 were identified where the DeSCAR technique was performed for colonic lesions with incomplete lifting and/or snaring. Cases were reviewed for location, prior manipulation, rates of successful hybrid resection, adverse events, and endoscopic follow up to assess for residual lesions. RESULTS: 57 lesions underwent DeSCAR for non-lifting or residual colonic lesions. Patients were 51% female and 49% male with an average age 69 (SD +/- 9.6 yrs). Lesions were located in the cecum (n = 16), right colon (n = 22), transverse colon (n = 5), left colon (n = 7), rectum (n = 4), or in other locations defined by distance from the anus (n = 4). Average lesion size was 27.7 mm (SD +/- 16.6 mm). Previous manipulation occurred in 54 of 57 cases (68% biopsy, 47% resection attempt, 18% intralesional tattoo). The technical success rate for resection of non-lifting lesions was 100%. There were two delayed bleeding episodes (one required endoscopic intervention) and one small perforation (managed by successful endoscopic hemoclip closure at the time of perforation). No other adverse events were observed. Endoscopic follow up was available in 27 patients (47%) with no residual adenoma noted in 25 patients (93% of those with surveillance). CONCLUSION: Our expanded experience with DeSCAR continues to demonstrate a high safety, feasibility, and effectiveness profile for the endoscopic management of non-lifting or residual colonic lesions, providing en-bloc resection of tissue for histologic review. Further studies are needed to demonstrate long-term eradication and direct comparison with other currently available endoscopic techniques.