936 Endoscopic Submucosal Dissection as a Salvage Therapy After Failed Endoscopic Mucosal Resection for Colorectal Lesions: A Single Center Experience

Abstract

INTRODUCTION: There is limited data in efficacy of Endoscopic Submucosal Dissection (ESD) as a salvage therapy after failed Endoscopic Mucosal Resection (EMR) attempt leading to scar tissue formation. We present a single center experience of ESD in evaluating safety and efficacy of ESD in treatment of colorectal lesions with failed prior attempt of EMR. METHODS: All patients who had ESD for colorectal lesions after prior unsuccessful attempt of removal by EMR, from 1/2013 to 12/2018 were included. Patient and procedure related data points were collected. Technical success was defined as successful completion of ESD to remove colonic lesions and clinical success was defined as complete removal of colonic lesions with negative margins. RESULTS: A total of 19 patients were included. The average age was 68.3 ± 7.5 years, 53% (10/19) patients were female. 10 patients had right sided, 2 patients had left sided and 7 patients had rectal lesions. The average size of the lesion was 3.9 ± 2.5 cm. 10 patients (53%) had en bloc resection and 9 patients (47%) had piecemeal resection despite ESD due to scar tissue formation from prior EMR attempt. Technical success of ESD was 100%. The average duration of the procedure was 103.5 ± 48 minutes. Complications occurred in 2 cases (10.5%), both had En bloc resection. One patient developed bleeding requiring endoscopic treatment and another patient developed microperforation managed conservatively. Of resected lesions, there were 9 tubular adenomas, 5 sessile serrated adenoma, 1 Tubulovillous adenoma, 1 neuroendocrine tumor and 3 samples with histology showing tubular adenoma but with positive margins for adenocarcinoma. ESD specimen added the diagnosis of carcinoma. All of the patients with en bloc resection had negative peripheral margins while of 9 patients who had piecemeal resection, 3 patients had positive margins for carcinoma. Thus clinical success of ESD was 84%. 2 of these patients required surgery while 1 was lost to follow up. Out of 16 patients with initial successful ESD, 13 patients had follow up for average 24 months without any recurrence (3 patients were lost to follow up). A trainee was involved in 60% of the procedures. CONCLUSION: ESD is a safe and effective method of diagnosis and treatment for colorectal lesions as a salvage therapy after failed EMR with overall low complication rates and low recurrence rates. ESD should be considered in centers of expertise prior to referring patients for surgical approach.