Less recurrence seen with endoscopic submucosal dissection of large lesions

For patients with large benign colonic lesions, endoscopic submucosal dissection (ESD) is associated with reduced recurrence at six months compared with endoscopic mucosal resection (EMR), according to a study published online Dec. 12 in the Annals of Internal Medicine.

Jérémie Jacques, M.D., Ph.D., from Service d’Hepato-Gastro-Enterologie in Limoges, France, and colleagues compared ESD and EMR for large colonic adenomas in a multicenter study involving six French referral centers. Patients with large (≥25 mm) benign colonic lesions referred for resection were randomly assigned to ESD or EMR (178 and 182 patients, respectively). The primary end point was six-month local recurrence.

The researchers found that in the primary analysis set, which included 318 lesions in 318 patients, recurrence occurred after 0.6 and 5.1 percent of 161 ESDs and 157 EMRs, respectively (relative risk, 0.12).

After ESD, there were no recurrences observed in R0-resected cases. There were more adverse events after ESD than EMR (35.6 versus 24.5 percent; relative risk, 1.4).

“Patients and physicians should be aware of these study results not only to know when to choose endoscopic resection instead of surgery but also to choose the endoscopic resection strategy that best fits the patient according to the lesion, the acceptance of follow-up colonoscopy, and the available expertise at the center,” the authors write.

More information:
Jérémie Jacques et al, Endoscopic En Bloc Versus Piecemeal Resection of Large Nonpedunculated Colonic Adenomas, Annals of Internal Medicine (2023). DOI: 10.7326/M23-1812

Journal information:
Annals of Internal Medicine

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