Background and Aims The risk of postresection colorectal stenosis significantly increases when more than 90% of the circumference is involved. We aimed to evaluate postresection stenosis incidence and predictive factors in patients undergoing colorectal endoscopic submucosal dissection (ESD) for whole circumferential lesions. Methods We retrospectively analyzed prospective data from patients undergoing ESD for colorectal lesions involving ≥90% of the luminal circumference at 29 worldwide tertiary referral centers between June 2018 and September 2024. The primary end point was to evaluate the incidence and predictive factors of postresection stenoses. Secondary end points included assessing the effectiveness and safety of the ESD procedure. Results A total of 315 patients were included, with 269 (85.4%) rectal and 46 (14.6%) colonic lesions, and a median lesion size of 95 mm (IQR, 71-130). Complete (100%) circumferential involvement was observed in 116 cases (36.8%). En bloc, complete resection with negative margins, and oncological curative resection rates were 85.1%, 81.8%, and 80.3%, respectively. Of the 315 lesions, 31 (9.2%) were referred for surgery, and the remaining 284 (90.2%) were included in the final analysis. Stenosis occurred in 97 of 284 cases (34.2%), with a higher incidence for rectal than colonic lesions (38.2% vs 11.6%, P < .001). All stenoses were effectively managed with endoscopic treatments, achieving complete resolution of symptoms and luminal patency in all treated cases, with no need for surgical intervention. At multivariable analysis, rectal location (odds ratio [OR], 4.40; 95% CI, 1.62-12.06; P = .004), 100% circumferential resection (OR, 2.44; 95% CI, 1.41-4.21; P < .001), and larger lesion size (OR, 1.01; 95% CI, 1.01-1.02; P = .005) were independently associated with stenosis occurrence. Conclusions The risk of stenosis after circumferential ESD for colorectal lesions ≥90% is high in the rectum but can be effectively managed endoscopically. Despite this, the technique remains highly feasible and safe.
Stenosis development after circumferential colorectal endoscopic submucosal dissection: a multicenter analysis of predictive factors and outcomes
Andrisani, Gianluca;Di Matteo, Francesco Maria;
2025-01-01
Abstract
Background and Aims The risk of postresection colorectal stenosis significantly increases when more than 90% of the circumference is involved. We aimed to evaluate postresection stenosis incidence and predictive factors in patients undergoing colorectal endoscopic submucosal dissection (ESD) for whole circumferential lesions. Methods We retrospectively analyzed prospective data from patients undergoing ESD for colorectal lesions involving ≥90% of the luminal circumference at 29 worldwide tertiary referral centers between June 2018 and September 2024. The primary end point was to evaluate the incidence and predictive factors of postresection stenoses. Secondary end points included assessing the effectiveness and safety of the ESD procedure. Results A total of 315 patients were included, with 269 (85.4%) rectal and 46 (14.6%) colonic lesions, and a median lesion size of 95 mm (IQR, 71-130). Complete (100%) circumferential involvement was observed in 116 cases (36.8%). En bloc, complete resection with negative margins, and oncological curative resection rates were 85.1%, 81.8%, and 80.3%, respectively. Of the 315 lesions, 31 (9.2%) were referred for surgery, and the remaining 284 (90.2%) were included in the final analysis. Stenosis occurred in 97 of 284 cases (34.2%), with a higher incidence for rectal than colonic lesions (38.2% vs 11.6%, P < .001). All stenoses were effectively managed with endoscopic treatments, achieving complete resolution of symptoms and luminal patency in all treated cases, with no need for surgical intervention. At multivariable analysis, rectal location (odds ratio [OR], 4.40; 95% CI, 1.62-12.06; P = .004), 100% circumferential resection (OR, 2.44; 95% CI, 1.41-4.21; P < .001), and larger lesion size (OR, 1.01; 95% CI, 1.01-1.02; P = .005) were independently associated with stenosis occurrence. Conclusions The risk of stenosis after circumferential ESD for colorectal lesions ≥90% is high in the rectum but can be effectively managed endoscopically. Despite this, the technique remains highly feasible and safe.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
