title: Treatment of large colorectal neoplasms by endoscopic submucosal dissection: a European single-center study.
abstract: OBJECTIVE
  Endoscopic submucosal dissection (ESD) has a high curative resection rate for gastrointestinal mucosal lesions, but is not used widely in Europe because of a high complication rate and a long learning curve. This study analyzed the ESD learning curve at a single European treatment center.
  
  
  METHODS
  ESD and hybrid-ESD (hESD) procedures were used to treat large colonic lesions that could not be resected in one piece by other endoscopic methods. Procedure duration and speed, and en-bloc, complete (R0) resection, and complication rates were analyzed.
  
  
  RESULTS
  Fifty-three patients underwent ESD (37 pure ESD, 16 hESD), most with rectal lesions (n=34, 64.2%). The mean lesion diameter was 3.7 ± 1.1 cm2 (range 2.0-7.0 cm), the median procedure duration was 70.0 min [interquartile range (IQR) 31.0-113.0 min], and the median treatment speed was 0.086 cm2/min (IQR 0.055-0.152). En-bloc and R0 resection rates were 86.5% (32/37) and 81.1% (30/37), respectively. Procedure speed increased significantly after about 25 cases (P=0.0313). The median hESD procedure treatment speed was 0.159 cm/min (n=16, IQR 0.094-0.193), which was better than with classical ESD (P=0.04). The hESD en-bloc and R0 resection rates were comparable to those of classical ESD (P>0.05). The only complication was bleeding, 5.7% (3/53); no perforation occurred. Recurrence was detected during follow-up (median 30.0 months, IQR 12-48) in one patient (1.7%).
  
  
  CONCLUSIONS
  ESD is useful and safe for resection of large colorectal polyps, and procedure speed increased considerably after 25 procedures. hESD was faster than ESD, with a high therapeutic resection rate.
authors.affiliation: Departments of aGastroenterology bCell Pathology, Pomeranian Medical University, Szczecin cEndotherapy Ltd, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Białek
authors.forename: Jan
authors.initials: J
authors.lastname: Pertkiewicz
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Karpińska
authors.forename: Wojciech
authors.initials: W
authors.lastname: Marlicz
authors.forename: Dariusz
authors.initials: D
authors.lastname: Bielicki
authors.forename: Teresa
authors.initials: T
authors.lastname: Starzyńska
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy / Q000009:adverse effects / Q000193:education / Q000379:methods*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects / Q000193:education / Q000379:methods; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome