Comparison of precutting endoscopic mucosal resection and endoscopic submucosal dissection for large (20-30mm) flat colorectal lesions.

Abstract

The complete and safe removal of large (≥20mm) colorectal lesions is an area of concern. Endoscopic submucosal dissection (ESD) effectively removes these lesions compared with endoscopic mucosal resection (EMR). However, ESD requires advanced techniques, longer procedure time, and high cost. Precutting EMR (EMR-P) is a modified EMR method that overcomes the limitations of EMR. This study aimed to compare the efficacy and safety of EMR-P and ESD in large (20-30mm) flat colorectal lesions. This was a retrospective analysis of cases in which 20- to 30-mm flat colorectal lesions were resected at Seoul St. Mary's Hospital from January 2014 to December 2019. Propensity score matching was performed to control for possible confounders. Two hundred and ninety-nine patients were included in this study. After matching, 90 patients were assigned to each group. There were no significant difference in complete resection rates (92.2% vs 92.2%, P=1.000), en bloc resection rates (95.6% vs 97.8%, P=0.682), and mean size of lesions (22.9±3.1mm vs 23.0±3.1mm, P=0.867) between EMR-P and ESD. Procedure time was significantly shorter with EMR-P (11.0±6.5min vs 37.0±19.3min, P<0.001). The adverse events rate was not significantly different between both groups. No local recurrence occurred in both groups. Precutting EMR was not significantly different to ESD in terms of complete resection rate and en bloc resection rate for 20- to 30-mm flat colorectal lesions without fibrosis. Furthermore, EMR-P has shorter procedure time than ESD. EMR-P could be considered one of standard treatments for large flat colorectal lesions.