A Surveillance Endoscopy Strategy Based on Local Recurrence Rates after Colorectal Endoscopic Submucosal Dissection.

Jin Hwa Park,Dong-Hoon Yang,Sang Hyoung Park,Seung-Jae Myung,Ji Young Yoon,Suk-Kyun Yang,Byong Duk Ye,Sung Wook Hwang,Jeong-Sik Byeon

doi:10.3390/jcm10194591

Abstract

Backgrounds: It is not clear when and how frequently surveillance endoscopy should be performed after colorectal endoscopic submucosal dissection (ESD). We aimed to suggest a surveillance endoscopy strategy by investigating the cumulative local recurrence rates and identifying risk factors for local recurrence after colorectal ESD. Methods: We reviewed the medical records of 770 patients who underwent colorectal ESD for 778 lesions at our institution from 2005 to 2016. We investigated the cumulative local recurrence rates and risk factors for local recurrence. Results: Local recurrence developed in 12 (1.5%) of 778 lesions during the follow-up period of 37.4 ± 31.7 months. The one-, three-, and five-year cumulative local recurrence rates were 0.4%, 1.7%, and 2.2%, respectively. The risk factors for local recurrence were piecemeal resection (odds ratio (OR) 3.948, 95% confidence interval (CI) 1.164–13.385; p = 0.028) and histological incomplete resection (OR 8.713, 95% CI 2.588–29.334; p < 0.001). Local recurrence tended to develop frequently after ESD of early cancers. Conclusions: Short-term surveillance endoscopy should be recommended after piecemeal ESD, histological incomplete resection, and ESD of early colorectal cancers. Surveillance endoscopy with longer intervals can be suggested after en bloc ESD with the histological complete resection of benign colorectal tumors.

Highlights

Colorectal cancer is one of the most common cancers worldwide and the third cause of cancer-related deaths [1]
On the basis of these findings, we suggest more frequent surveillance endoscopies after colorectal Endoscopic submucosal dissection (ESD) in cases of piecemeal resection, histological incomplete resection, and early cancer, whereas a surveillance endoscopy strategy similar to that after conventional colonoscopic polypectomy could be recommended after colorectal ESD without these risk factors
We suggest that piecemeal resection, histological incomplete resection, and early cancer may be risk factors for local recurrence after colorectal ESD

Summary

Introduction

Colorectal cancer is one of the most common cancers worldwide and the third cause of cancer-related deaths [1]. Endoscopic submucosal dissection (ESD) is one of the several endoscopic resection techniques for colorectal neoplasms. Despite a relatively high rate of adverse events including perforation, ESD is considered a good treatment option in large laterally spreading tumors (LSTs) and early colorectal cancers, including mucosal and superficial submucosal cancer, because of its high en bloc resection rate, even in large lesions [5,6,7,8]. After endoscopic resection of colorectal neoplasms, surveillance endoscopy should be performed regularly to manage local recurrence and metachronous neoplasms. Several international guidelines recommend strategic endoscopy surveillance intervals according to the risk of local recurrence and metachronous neoplasms [9,10]. These intervals are based on previous studies that investigated mainly conventional endoscopic resection

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