Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Significance of rescue hybrid endoscopic submucosal dissection in difficult colorectal cases

  • Hayato Yamaguchi (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Masakatsu Fukuzawa (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Takashi Kawai (Endoscopy Center, Tokyo Medical University Hospital) ;
  • Takahiro Muramatsu (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Taisuke Matsumoto (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Kumiko Uchida (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Yohei Koyama (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Akir Madarame (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Takashi Morise (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Shin Kono (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Sakik Naito (Department of Gastroenterology and Hepatology, Tokyo Medical University) ;
  • Naoyoshi Nagata (Endoscopy Center, Tokyo Medical University Hospital) ;
  • Mitsushige Sugimoto (Endoscopy Center, Tokyo Medical University Hospital) ;
  • Takao Itoi (Department of Gastroenterology and Hepatology, Tokyo Medical University)
  • Received : 2022.09.29
  • Accepted : 2023.03.13
  • Published : 2023.11.30
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Abstract

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90-197] minutes) >C-ESD (90 [60-140] minutes) >SH-ESD (52 [29-80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%-30%]) than in the en bloc resection group (40% [20%-60%]). Conclusions: RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.

Keywords

Acknowledgement

The authors thank ThinkSCIENCE Inc. (Tokyo, Japan) for their English language assistance.

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