Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasia with or without the hybrid technique

Aim The main aim of this study was to compare the long-term outcome of a conventional colorectal endoscopic submucosal dissection (ESD) in which submucosal dissection was continued throughout until the completion of resection (ESD-T) to hybrid endoscopic submucosal dissection (ESD-H) in the colorectum. Method Medical records of 836 colorectal neoplasia patients treated by ESD-T or ESD-H were reviewed. ESD-H was defined as colorectal ESD with additional snaring in the final stage of the procedure. Primary outcomes were the overall and metastatic recurrence rates. Secondary outcomes were short-term outcomes such as theen blocresection rate, procedure time and adverse events. Results The overall recurrence rate was higher in the ESD-H than in the ESD-T group (5.7%vs0.7%,P = 0.001). The metastatic recurrence rate showed no significant difference between these groups (1.4%vs1.4%,P = 1.000). Multivariate analysis revealed that a faileden blocresection (hazard ratio 24.097; 95% CI 5.446-106.237;P < 0.001) and larger tumour size (hazard ratio 1.042; 95% CI 1.014-1.070;P = 0.003) were independently associated with overall recurrence. The ESD-H group showed a loweren blocresection rate (56.8%vs96.5%,P < 0.001), shorter procedure time (45.6vs54.3 min,P < 0.001) and higher perforation rate (10.3%vs6.0%,P = 0.029). Conclusion Although long-term outcomes in terms of overall recurrence are inferior following ESD-H, a faileden blocresection and large tumour size are the only independent risk factors for recurrence. Further investigations are warranted to improve the long-term outcomes of ESD-H.