Complications and curative endoscopic submucosal dissection in colorectal lesions. Is there any difference between current ESD approaches?

Aims Different methods in colorectal ESD (endoscopic submucosal dissection) are known: conventional (CM), tunnelled (TD), flap (FM), pocket (PCM), traction (TRM), dilumen device (DESD) and others. Primary endpoint: to evaluate the complication rates among these approaches. Secondary endpoint: to evaluate the curative ESD rate (ESGE criteria). Methods A national colorectal ESD (c-ESD) database was retrospectively analysed (Jan/16-Jul/22). Descriptive comparisons, propensity score matching (1:1) and multivariable regression were performed. The variables matched were: age, sex, location, morphology, optical diagnosis, size, nonlifting sign and anticoagulation or antiaggregation (AAG). p: < 0.05. Results 704 cases were reviewed. 63% males. Median age 68 (62.00-75.00). The most frequent location was the rectum (31%) followed by transverse colon (17%). The approaches used and complication rates comparisons are shown in table 1. When techniques were compared, there were only significant differences in the rate of intraprocedural bleeding (IB). The approach with higher IB risk was the FM. Multivariate analysis showed an increased risk of IB in patients that underwent FM and were AAG or had I-s lesions. OR= 3.48 (1.12-10.8) and 3.47 (1.1-10.9) respectively, (p=0.03). There were no related deaths to ESD. In terms of the rate of curative ESD no differences were found among techniques ([ Table 1 ]). Table 1 Conclusions Regarding complication rates among c-ESD methods, there were only differences in the rate of IB. The FM was the one with higher risk. In this group, antiaggregation or I-s lesions increased the chance of IB. No differences were found in the curative c-ESD rate. Publication History Article published online: 14 April 2023 © 2023. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany