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Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study

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Abstract

Background and Aims

Hybrid endoscopic submucosal dissection (ESD) is a colorectal lesion resection procedure that includes both planned and salvage procedures. Previous colorectal hybrid ESD studies have involved single institutions or few operators over a short timeframe, and the size for indication has not been established. In this multicentre study, we investigated the clinical outcomes of hybrid ESD for colorectal tumors that met the 30 mm lesion size criterion.

Methods

From January 2008 to December 2018, colorectal hybrid ESD was performed for 172 lesions (diameter range, ≥ 20– < 30 mm) at Hiroshima GI Endoscopy Research Group. We compared clinicopathological characteristics and outcomes between 56 and 116 lesions in planned and salvage groups, respectively. We also compared data between 2008 and 2013 (the first period) and 2014 and 2018 (the second period) to assess operator experience.

Results

No significant difference was found in the complete en bloc resection rate between the planned and salvage groups (92.9% vs. 83.6%, respectively). Procedure time was shorter in the planned group (44.5 min) than in the salvage group (72.0 min, p < 0.01). The perforation rate was higher in the salvage group (21.6%) than in the planned group (0%, p < 0.01); however, the perforation rate during snaring in the salvage group was 1.8%. During the second period relative to the first period, we recorded a significantly higher complete en bloc resection rate (95.7% vs. 75.6%, respectively, p < 0.01) and experienced operator rate (75.5% vs. 53.9%, respectively, p < 0.01). Furthermore, no significant difference was found in the complete en bloc resection rate between the planned and salvage groups during the second period (100% vs. 94.4%, respectively).

Conclusion

Colorectal hybrid ESD, especially salvage hybrid ESD performed by experienced operators, is adoptable and safe for lesions with diameters ranging from ≥ 20 to < 30 mm.

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Acknowledgments

We wish to thank Dr. Reiji Higashi at the Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Dr. Akira Furudoi at the Department of Gastroenterology, JA Hiroshima General Hospital, Hiroshima, Japan; Dr. Koichi Nakadoi at the Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan; Dr. Motomi Terasaki at the Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan; Dr. Hiroyuki Kanao at the Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan; Dr. Tomohiro Miwata at the Department of Gastroenterology, Chugoku Rosai Hospital, Hiroshima, Japan; Dr. Makoto Higashiyama, Dr. Yoshikazu Yoshihuku at the Department of Gastroenterology, Shobara Red Cross Hospital, Hiroshima, Japan; Dr. Maho Kusunoki at the Department of Gastroenterology, Prefectural Akitsu Hospital, Hiroshima, Japan; and Dr. Shiro Okamoto at the Department of Gastroenterology, Kure Kyosai Hospital, Hiroshima, Japan, for their data collection.

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Authors and Affiliations

  1. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan

    Yuki Okamoto, Shiro Oka & Kazuaki Chayama

  2. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan

    Shinji Tanaka

  3. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan

    Shinji Nagata

  4. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan

    Masaki Kunihiro

  5. Department of Gastroenterology, National Hospital Organization Kure Medical Center, Chugoku Cancer Center, Hiroshima, Japan

    Toshio Kuwai

  6. Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Yuko Hiraga

  7. Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan

    Seiji Onogawa

  8. Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan

    Takeshi Mizumoto

  9. Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan

    Hideharu Okanobu

  10. Department of Gastroenterology, Prefectural Akitsu Hospital, Hiroshima, Japan

    Morihisa Akagi

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  1. Yuki Okamoto
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  2. Shiro Oka
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Correspondence to Shiro Oka.

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Yuki Okamoto, Shiro Oka, Shinji Tanaka, Shinji Nagata, Masaki Kunihiro, Toshio Kuwai, Yuko Hiraga, Seiji Onogawa, Takeshi Mizumoto, Hideharu Okanobu, Morihisa Akagi and Kazuaki Chayama have no conflicts of interest or financial ties to disclose.

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Okamoto, Y., Oka, S., Tanaka, S. et al. Indications and outcomes of colorectal hybrid endoscopic submucosal dissection: a large multicenter 10-year study. Surg Endosc 36, 1894–1902 (2022). https://doi.org/10.1007/s00464-021-08471-5

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