Endoscopic Submucosal Dissection for Previously Attempted Colorectal Lesions: An International Multicenter Experience.

Objective: Salvage endoscopic submucosal dissection (ESD) has been proposed for previously attempted colorectal lesions (PACLs), yet the extensive submucosal fibrosis impacts procedural difficulty and resection outcomes. The aim of this study is to evaluate the efficacy and safety of salvage ESD for the treatment of PACLs.

Methods: This international, multicenter study enrolled consecutive patients who underwent ESD to manage PACLs. Rates of en bloc, R0 resection, and local recurrence were assessed for efficacy. Safety was assessed by adverse events (AEs), procedure-related mortality, and the need for surgical management.

Results: Of 415 lesions, en bloc rate was 83.4%, R0 76.2%, and curative resection 73.5%. AEs occurred in 48 (11.8%) patients, the most common being intraprocedural perforation (n=19; 4.6%). Two patients required surgical management and 17 were managed endoscopically. Significant intraprocedural bleeding occurred in 3 (0.7%), all managed endoscopically. 25 patients (6.0%) had post-ESD AEs at the median of 5 (IQR 1-24) days, most commonly being delayed bleeding (2.4%). Of 260 patients with follow-up data (median 49 (25-72) weeks), local recurrence occurred in 18 (6.9%). Surgical referral was made in 25 patients (6.0%) due to noncurative resection (5%), intraprocedural perforation (0.4%), and post-ESD AEs (0.4%, colonic stricture and fistula formation). There was no mortality from procedure-related or colorectal cancer.

Conclusions: Salvage ESD is highly effective in the treatment of PACLs. When performed by experts, AEs were uncommon and mostly managed endoscopically.