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. 2025 Oct 12:gutjnl-2024-332970.
doi: 10.1136/gutjnl-2024-332970. Online ahead of print.

Rectal versus colonic submucosal cancer rates and procedural outcomes in large non-pedunculated polyps: French ESD registry data

Veronique Van der Voort  1 , Marion Schaefer  2 , Timothee Wallenhorst  3 , Vincent Lepilliez  4 , Thibault Degand  5 , Yann Le Baleur  6 , Philippe Leclercq  7 , Arthur Berger  8 , Edouard Chabrun  9 , Bertrand Brieau  10 , Maximilien Barret  11 , Gabriel Rahmi  12 , Romain Legros  13 , Jérôme Rivory  14 , Sarah Leblanc  4 , Geoffroy Vanbiervliet  15 , Ludovico Alfarone  16 , Julien Magne  17 , Jean-Baptiste Zeevaert  7 , Jérémie Albouys  13 , Guillaume Perrod  12 , Clara Yzet  18 , Hugo Lepetit  13 , Arthur Belle  19 , Stanislas Chaussade  19 , Florian Rostain  18 , Martin Dahan  8 , Alexandru Lupu  14 , Jean-Baptiste Chevaux  18 , Mathieu Pioche  14 , Jérémie Jacques  13   20 ; FECCo Group collaborators
Collaborators, Affiliations

Rectal versus colonic submucosal cancer rates and procedural outcomes in large non-pedunculated polyps: French ESD registry data

Veronique Van der Voort et al. Gut. .

Abstract

Background: For large non-pedunculated rectal polyps, en bloc resection via endoscopic submucosal dissection (ESD) is typically recommended due to presumed higher risk of submucosal invasive cancer (SMIC) compared with the colon; however, data on cancer risk by location remain controversial.

Objective: Using the French ESD registry, we compared SMIC rates in large non-pedunculated colorectal polyps in the rectum versus colon. Procedural outcomes were also compared.

Design: From September 2019 to September 2022, all large non-pedunculated polyps resected by ESD in 13 centres were included. Oncological and procedural outcomes were analysed using propensity score matching (PSM) and inverse probability weighting, accounting for relevant influencing factors. A subgroup analysis was performed on cases from the three largest centres, where such polyps were exclusively treated with ESD.

Results: Among 3770 lesions, 3310 were analysed. Rectal lesions were larger (56.0 (40; 75) mm vs 47.0 (37; 62) mm), more often granular (80.0% vs 59.4%) and mixed nodular (54.0% vs 32.5%) (p<0.001). After PSM, submucosal cancer rates were not significantly different between rectal and colonic lesions of similar size and morphology (9.8% vs 8.9%, p=0.52). En bloc (97.7% vs 97.3%, p=0.757) and R0 resection rates (89.7% vs 89.5%, p=0.937) were also comparable. Perforation (5.5% vs 7.9%, p=0.057) and surgery for complications (0.1% vs 1.1%, p=0.051) showed a non-significant trend towards higher rates in colonic procedures. Subgroup analysis from the three centres exclusively performing ESD for large non-pedunculated polyps confirmed these findings.

Conclusion: In our multicentre registry, large non-pedunculated polyps do not show a higher prevalence of SMIC in the rectum compared with colon, when adjusted for relevant factors such as size and morphology. Therefore, risk features, rather than location, should guide the choice of resection technique. Technical outcomes were comparable between rectal and colonic ESD, with a trend for higher complication rates in the colon.

Trial registration number: NCT04592003.

Keywords: COLONIC POLYPS; COLORECTAL CARCINOMA; COLORECTAL NEOPLASIA; DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY; ENDOSCOPY.

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Conflict of interest statement

Competing interests: None declared.

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