https://gastroenterology.acponline.org/archives/2023/12/22/7.htm

Endoscopic strategies for large colonic adenomas compared

Endoscopic submucosal dissection reduces recurrence but carries more adverse event risk than endoscopic mucosal resection, a multicenter French trial found.


For large colonic adenomas, endoscopic submucosal dissection (ESD) reduces recurrence but increases adverse events compared to endoscopic mucosal resection (EMR), a trial found.

The trial was conducted at six French referral centers from November 2019 to February 2021 in 360 patients with benign colonic lesions of 25 mm or larger referred for resection. The patients were randomly assigned, with stratification by lesion location and center, to ESD or EMR. The primary end point was six-month local recurrence, and secondary end points were technical failure, en bloc R0 resection, and cumulative adverse events. Results were published by Annals of Internal Medicine on Dec. 12.

Recurrence occurred after only one ESD, compared to eight EMRs (0.6% vs. 5.1%; relative risk, 0.12 [95% CI, 0.01 to 0.96]). However, adverse events were more common after ESD than EMR (35.6% vs. 24.5%; relative risk, 1.4 [95% CI, 1.0 to 2.0]). “The potential advantage of ESD over EMR to reduce recurrence and follow-up colonoscopies must be balanced against a higher rate of adverse events,” the study authors said.

They cautioned that the findings might not be generalizable beyond expert centers or outside of France. The authors also noted that either of these procedures, but ESD more than EMR, is best performed in an expert center. “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,” they said.