Clinical Outcomes of Endoscopic Submucosal Dissection for Residual Neoplasia After Incomplete Resection of Large Non-Pedunculated Colorectal Polyps: A Large Multicenter Propensity Match Study
Recommended Citation
Robalino Gonzaga E, Zhang Y, Mohammed AS, Bani Fawwaz BA, Farooq A, Khan NI, King WW, Jawaid SA, Othman MO, Khalaf MA, Friedland S, Joseph A, Hwang JH, Aadam AA, Solinski MA, Bechara R, Marhaba J, D'Souza LS, Saeed A, Andrawes SA, Tomizawa Y, Khan A, Sharma N, Dang F, Samarasena JB, Nagao S, Nishimura M, Cyrus P, Tobias Z, Chandan S, Abbasi A, Pathak S, Cosgrove N, Deepanshu J, Mustafa AM, Kadkhodayan K, Hayat M, Hasan MK, Aihara H, Draganov PV, and Yang D. Clinical Outcomes of Endoscopic Submucosal Dissection for Residual Neoplasia After Incomplete Resection of Large Non-Pedunculated Colorectal Polyps: A Large Multicenter Propensity Match Study. Gastrointest Endosc 2025.
Document Type
Article
Publication Date
7-22-2025
Publication Title
Gastrointestinal endoscopy
Abstract
BACKGROUND AND AIMS: Data on endoscopic submucosal dissection (ESD) for residual neoplasia after incomplete resection (ER) of large non-pedunculated colorectal polyps (LNPCPs) remains scarce. We aimed to evaluate and compare outcomes of ESD in treatment naïve (control) lesions vs. those with prior failed ER.
METHODS: Multicenter propensity-score (PS) match study of ESDs performed for LNPCPs between January 2021 to September 2024. The following covariates were used for PS calculation: age, sex, and lesion characteristics (size, location, morphology, histology). Endpoints included: rates of en-bloc and R0 resection, adverse events and neoplasia recurrence on surveillance.
RESULTS: A total of 1447 consecutive patients underwent ESD during the study period. PS match resulted in the selection of 361 (control) and 184 (prior failed ER) strictly matched 2:1 pairs. En-bloc and R0 resection rates were similar between the control and prior failed ER arms: 91.7% vs 89.7%; p=.44 and 80.9% vs. 81.0%; p=.98, respectively. There was no difference in the rate of perforation between the control and prior failed ER arms (4.7% vs. 4.4%; p=1.00), whereas there was non-statistically significant trend towards higher delayed bleeding in the prior failed ER group (1.63% vs. 0.83%, relative risk: 1.96; p=0.40). Neoplasia recurrence on surveillance was 3.6% in the control and 5.8% in the prior failed ER group (p=0.32).
CONCLUSIONS: ESD can be performed safely and effectively as a salvage therapy after failed attempt at ER of LNPCPs. ESD may be selectively considered as part of our endoscopic armamentarium for the management of these difficult-to-treat lesions. support current guideline endorsed indications for ESD for the treatment of residual neoplasia after incomplete ER.
PubMed ID
40706906
ePublication
ePub ahead of print
