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Introduction

Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different techniques are feasible including endoscopic full thickness resection (EFTR) with the FTRD system and Endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of both techniques for the treatment of those lesions.

Aims & Methods

All consecutive patients with a RCN treated either by FTRD or ESD were retrospectively included in this multicenter study. The primary outcome was the R0 resection rate defined as an En Bloc resection with histological free lateral and deep margins.

Results

A total of 275 patients (median age 70 years, 161 men) who underwent 177 ESD and 98 FTRD for RCN lesions were included among 19 centers. R0 resection was achieved in respectively 83.3% and 77.6% for ESD and FTRD (p=0.245). However, lesions treated by ESD were meanly larger compared with FTRD (p<0.001).The R0 rate in the ESD and FTRD group forlesions from 20 to 30 mm and 30 to 40 mm were respectively 83.9% and 57.1% and 93.6% and 33.3%. In multivariable analysis, ESD procedure was statistically associated with higher en-bloc and R0 resection rates after adjustment on lesion size (p=0.017 and <0.001). The adverse event rate was higher in the ESD group (12.1% vs 6.1%) due mostly to intra operative perforations.

Conclusion

ESD is effective to achieve R0 resection for RCN whatever the size and the localization of the lesions. When residual lesions are smaller than 20 mm, EFTR is an effective alternative.