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Multicenter Study
. 2025 Oct;23(11):1925-1934.e2.
doi: 10.1016/j.cgh.2025.02.021. Epub 2025 May 9.

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

Suchapa Arayakarnkul  1 , Hiroyuki Aihara  2 , Alessandro Repici  3 , Roberta Maselli  3 , Antonio Capogreco  4 , Leonardo Da Rio  4 , Fabio Shiguehissa Kawaguti  5 , Fauze Maluf-Filho  6 , Makoto Nishimura  7 , Sera Satoi  8 , Sayaka Nagao  7 , Shai Friedland  9 , Robert Bechara  10 , Norio Fukami  11 , Sonmoon Mohapatra  11 , Amit Bhatt  12 , Abel Joseph  13 , Alex Schlachterman  14 , Anand Kumar  14 , Andrew Y Wang  15 , Ross C D Buerlein  15 , Louis M Wong Kee Song  16 , Fnu Deepali  16 , Dennis Yang  17 , Muhammad K Hasan  17 , Nikhil A Kumta  18 , David L Diehl  19 , Edward J Despott  20 , Alberto Murino  20 , Alessandro Rimondi  20 , Laura Lucaciu  20 , Neil R Sharma  21 , Christina M Zelt  22 , Ashley Rumple  22 , David Leslie Carr-Locke  23 , Reem Z Sharaiha  23 , Srihari Mahadev  23 , Kamal M Hassan  23 , Mohamad-Noor Abu-Hammour  23 , Carlos Robles-Medranda  24 , Martha Arevalo-Mora  24 , Juan Alcivar-Vasquez  24 , Vivek Kumbhari  25 , Jongkyu Park  25 , Salmaan Jawaid  26 , Mai A Khalaf  27 , Kasenee Tiankanon  28 , Sarah S Al Ghamdi  29 , Mohamed O Othman  26 , Saowanee Ngamruengphong  30
Affiliations
Multicenter Study

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

Suchapa Arayakarnkul et al. Clin Gastroenterol Hepatol. 2025 Oct.

Abstract

Background & aims: 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 was 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%, the R0 rate was 76.2%, and the curative resection rate was 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%) patients, all managed endoscopically. A total of 25 (6.0%) patients had post-ESD AEs at a median of 5 (interquartile range, 1-24) days, most commonly being delayed bleeding (2.4%). Of 260 patients with follow-up data (median 49 [interquartile range, 25-72] weeks), local recurrence occurred in 18 (6.9%). Surgical referral was made in 25 (6.0%) patients 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.

Keywords: Adverse Events; Colorectal Neoplasms; Endoscopic Submucosal Dissection; Residual Neoplasm.

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