Clinical outcomes of endoscopic submucosal dissection for residual neoplasia after incomplete resection of large nonpedunculated colorectal polyps: a large multicenter propensity match study (with video)

Ernesto Robalino Gonzaga¹, Yiyang Zhang², Abdul S Mohammed¹, Baha Aldeen Bani Fawwaz¹, Aimen Farooq¹, Nihal I Khan³, William W King⁴, Salmaan A Jawaid⁵, Mohamed O Othman⁵, Mai A Khalaf⁵, Shai Friedland⁶, Abel Joseph⁶, Joo Ha Hwang⁶, A Aziz Aadam⁷, Mark A Solinski⁷, Robert Bechara⁸, Jade Marhaba⁹, Lionel S D'Souza⁹, Ahmed Saeed¹⁰, Sherif A Andrawes¹¹, Yutaka Tomizawa¹², Aqsa Khan¹³, Neil Sharma¹³, Frances Dang¹⁴, Jason B Samarasena¹⁴, Sayaka Nagao¹⁵, Makoto Nishimura¹⁵, Piraka Cyrus¹⁶, Zuchelli Tobias¹⁶, Saurabh Chandan¹⁷, Abdullah Abbasi¹⁷, Sagar Pathak¹⁷, Natalie Cosgrove¹⁷, Jain Deepanshu¹⁷, Arain M Mustafa¹⁷, Kambiz Kadkhodayan¹⁷, Maham Hayat¹⁷, Muhammad K Hasan¹⁷, Hiroyuki Aihara¹⁸, Peter V Draganov⁴, Dennis Yang¹⁹

Affiliations

¹ Gastroenterology and Hepatology, AdventHealth Medical Group, Orlando, Florida, USA.
² Center for Collaborative Research, AdventHealth Research Institute, Orlando, Florida, USA.
³ Internal Medicine, AdventHealth Medical Group, Orlando, Florida, USA.
⁴ Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.
⁵ Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA.
⁶ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
⁷ Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois, USA.
⁸ Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
⁹ Department of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA.
¹⁰ HCA Midwest Health, Kansas City, Kansas, USA.
¹¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
¹² Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
¹³ Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA.
¹⁴ H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, California, USA.
¹⁵ Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
¹⁶ Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA.
¹⁷ Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
¹⁸ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁹ Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA. Electronic address: dennis.yang.md@adventhealth.com.

PMID: 40706906
DOI: 10.1016/j.gie.2025.07.026

Clinical outcomes of endoscopic submucosal dissection for residual neoplasia after incomplete resection of large nonpedunculated colorectal polyps: a large multicenter propensity match study (with video)

Ernesto Robalino Gonzaga et al. Gastrointest Endosc. 2025.

. 2025 Jul 22:S0016-5107(25)01846-2.

doi: 10.1016/j.gie.2025.07.026. Online ahead of print.

Authors

Affiliations

¹ Gastroenterology and Hepatology, AdventHealth Medical Group, Orlando, Florida, USA.
² Center for Collaborative Research, AdventHealth Research Institute, Orlando, Florida, USA.
³ Internal Medicine, AdventHealth Medical Group, Orlando, Florida, USA.
⁴ Division of Gastroenterology and Hepatology, University of Florida, Gainesville, Florida, USA.
⁵ Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA.
⁶ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
⁷ Division of Gastroenterology and Hepatology, Northwestern University Medical Center, Chicago, Illinois, USA.
⁸ Division of Gastroenterology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
⁹ Department of Gastroenterology and Hepatology, Stony Brook University Hospital, Stony Brook, New York, USA.
¹⁰ HCA Midwest Health, Kansas City, Kansas, USA.
¹¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA.
¹² Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.
¹³ Division of Interventional Oncology and Surgical Endoscopy (IOSE), Parkview Cancer Institute, Fort Wayne, Indiana, USA.
¹⁴ H.H. Chao Comprehensive Digestive Disease Center and Division of Gastroenterology/Hepatology, University of California, Irvine, California, USA.
¹⁵ Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
¹⁶ Division of Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, Michigan, USA.
¹⁷ Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA.
¹⁸ Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁹ Center for Interventional Endoscopy, AdventHealth, Orlando, Florida, USA. Electronic address: dennis.yang.md@adventhealth.com.

PMID: 40706906
DOI: 10.1016/j.gie.2025.07.026

Abstract

Background and aims: Data on endoscopic submucosal dissection (ESD) for residual neoplasia after incomplete endoscopic resection (ER) of large nonpedunculated colorectal polyps (LNPCPs) remain scarce. We aimed to evaluate and compare outcomes of ESD in patients with treatment-naïve (control) lesions versus those with previous failed ER.

Methods: This was a multicenter propensity-score (PS) match study of ESDs performed for LNPCPs between January 2021 and September 2024. The following covariates were used for PS calculation: age, sex, and lesion characteristics (size, location, morphology, histology). End points included rates of en-bloc and R0 resection, adverse events, and neoplasia recurrence on surveillance.

Results: A total of 1447 consecutive patients underwent ESD during the study period. PS match resulted in the selection of 361 (control) and 184 (previous failed ER) strictly matched 2:1 pairs. En-bloc and R0 resection rates were similar between the control and previous failed ER arms: 91.7% versus 89.7%; P = .44 and 80.9% versus 81.0%; P = .98, respectively. There was no difference in the rate of perforation between the control and previous failed ER arms (4.7% vs 4.4%; P = 1.00), whereas there was a nonstatistically significant trend toward greater delayed bleeding in the previous failed ER group (1.63% vs 0.83%, relative risk: 1.96; P = .40). Neoplasia recurrence on surveillance was 3.6% in the control and 5.8% in the previous failed ER group (P = .32).

Conclusions: ESD can be performed safely and effectively as a salvage therapy after failed attempt at ER of LNPCPs. ESD may be selectively considered as part of our endoscopic armamentarium for the management of these difficult-to-treat lesions. Our findings reinforce current guideline recommendations that endorse the use of ESD for managing residual neoplasia following an incomplete ER.

PubMed Disclaimer

Conflict of interest statement

Disclosure The following authors disclosed financial relationships: D. Yang: Consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, Microtech, ERBE, 3D-Matrix, Aspero Medical, and Neptune Medical; and research support from Microtech, 3D-Matrix, and Boston Scientific. M. K. Hasan: Consultant for Boston Scientific, Olympus, and Microtech. N. Cosgrove: Consultant for Boston Scientific and Cook Medical. M. A Arain: Consultant for Olympus, Boston Scientific, Cook Medical, and Medtronic. P. V. Draganov: Consultant for Olympus, Boston Scientific, Fujifilm, 3D-Matrix, Medtronic, Microtech, and Cook Medical. N Sharma: Consultant for Boston Scientific, Medtronic, Steris, and Olympus. J. H. Hwang: C consultant for Boston Scientific, Olympus, Medtronic, Fujifilm, and Microtech. S. Jawaid: Consultant for Lumendi, Creo Medical, and ConMed. M. Othman: Consultant for Olympus, Boston Scientific, Creo Medical, Apollo Endosurgery, Lumendi, AbbVie, and Nestle. M Othman: Research support from Boston Scientific, ConMed, Lucid Diagnostics, AbbVie, and Nestle. R. Bechara: Consultant for Medtronic, Olympus, Pentax, and Pendopharm. A. Aadam: Consultant for Boston Scientific, Steris, and ERBE. A. Saeed: Consultant for Boston Scientific, Olympus, Endogastric Solutions, and Medtronic. S. Andrawes: Consultant for Boston Scientific, Olympus, and Ovesco Endoscopy USA. S. Nagao: Member of a laboratory that has received research funding from AI Medical Service Inc. S. Nagao and M. Nishimura were supported in part through the MSKCC National Institutes of Health/National Cancer Institute Cancer Center Support Grant [P30 CA008748]. H. Aihara: Consultant for Olympus, Fujifilm, Boston Scientific, Medtronic, 3D Matrix, ConMed, Microtech, BioDevek, Johnson & Johnson MedTech, and EndoQuest Robotics. J. Salmaan: Consultant for Boston Scientific, Microtech, and 3D Matrix. J. Samarasena: Consultant for Olympus, Neptune Medical, Boston Scientific, Applied Medical, and Mauna Kea. J. Samarasena: Research support from Cook Medical and stockholder for SatisfAI Health. S. Ahmed: Consultant for Boston Scientific, Olympus, Endogastric Solutions, and Medtronic. A. A. Aadam: Consultant for Boston Scientific, Steris, and ERBE. A. Sherif: Consultant for Boston Scientific, Olympus, and Ovesco Endoscopy. S. Friedland: Consultant for Intuitive and Capsovision. J. H. Hwang: Consultant for Boston Scientific, Olympus, Medtronic, Fujifilm, and Microtech. L. D'Souza: Consultant for Boston Scientific and Olympus. Y. Tomizawa: Consultant for Boston Scientific and Medtronic. T. Zuchelli: Consultant for Boston Scientific. All other authors have nothing to disclose.

LinkOut - more resources

Full Text Sources
- ClinicalKey
- Elsevier Science
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Clinical outcomes of endoscopic submucosal dissection for residual neoplasia after incomplete resection of large nonpedunculated colorectal polyps: a large multicenter propensity match study (with video)

Affiliations

Clinical outcomes of endoscopic submucosal dissection for residual neoplasia after incomplete resection of large nonpedunculated colorectal polyps: a large multicenter propensity match study (with video)

Authors

Affiliations

Abstract

Conflict of interest statement

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous