C0463 - Endoscopic Resection Technique Outcomes for Non-Lifting Colorectal Lesions: A Systematic Review

Monday, October 24, 2022

3:00 PM – 5:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Billy Zhao, MD

University of British Columbia
Vancouver, BC, Canada

Billy Zhao, MD, Hyun Jae Kim, MD, Fergal Donnellan, MD, Eric Lam, MD, Neal Shahidi, MD
University of British Columbia, Vancouver, BC, Canada

Introduction: Endoscopic mucosal resection (EMR) is dependent on submucosal injectate expansion to allow for effective and safe tissue capture. Non-lifting polypoid tissue can render colorectal neoplasia recalcitrant to EMR. A number of alternative resection modalities and auxiliary techniques targeting non-lifting polypoid tissue have been described. We therefore sought to perform a systematic comparative analysis of existing techniques for non-lifting colorectal neoplasia.

Methods: Two authors (BZ, HJK) independently searched MEDLINE and EMBASE (Inception to April 2022) for citations evaluating endoscopic resection technique outcomes for non-lifting colorectal neoplasia. Eligible outcomes included technical success (removal of all visible polypoid tissue), R0 resection, intra-procedural perforation (IPP), clinically significant post-endoscopic resection bleeding (CSPEB), delayed perforation and recurrence. Categorical variables were expressed as frequency (%), with ranges estimated for the outcomes of interest, stratified by their respective techniques.

Results: 2395 citations were identified in our search strategy, of which 18 citations provided endoscopic resection technique outcomes for non-lifting colorectal neoplasia (7 endoscopic full-thickness resection (EFTR), 3 endoscopic submucosal dissection (ESD), 3 hybrid resection techniques (2 hybrid EFTR and 1 dissection-enabled scaffold-assisted resection), 2 avulsion techniques, 2 cap-assisted EMR (C-EMR), and 1 ablative technique). Technical success ranged from 79–100% (EFTR: 80-100%, ESD: 79-91%, hybrid technique: 98-100%, avulsion: 100%, C-EMR: 97%, ablation: 96%). R0 for applicable modalities ranged from 54-100% (EFTR: 57-100%, ESD: 54-63%). IPP ranged from 0-9% (EFTR: 0-4%, ESD: 0-9%, hybrid technique: 0-2%, avulsion: 0-3%, C-EMR: 0-9%, ablation: 0%). CSPEB ranged from 0-29% (EFTR: 0-29%, ESD: 0%, hybrid technique: 0-4%, avulsion: 5-6%, C-EMR: 9%, ablation: 4%). Delayed perforation was between 0 -14% (EFTR: 0-14%, ESD: 0-9%, hybrid technique: 0%, avulsion: 0%, C-EMR: 0%, ablation: 0%). Recurrence ranged from 0-43% (EFTR: 0-43%, ESD: 0-4%, hybrid technique: 0-17%, avulsion: 15-17%, C-EMR: 19%, ablation: 26%).

Discussion: Endoscopic resection techniques are effective for non-lifting colorectal lesions. Given the frequency of technical success comparative analyses between existing techniques focusing on the frequency of low-risk T1 colorectal cancer histopathology post-resection and adverse outcomes are needed.

Modaility	Number of Studies	Number of Lesions	Technical Success	R0	Intra-procedure Perforation	CSPEB¹	Delayed Perforation	Recurrence
EFTR²	7	106	80-100%	57-100%	0-4%	0-29%	0-14%	0-43%
ESD³	3	46	79-91%	54-63%	0-9%	0%	0-9%	0-4%
Hybrid technique⁴	3	84	98-100%	N/A	0-2%	0-4%	0%	0-17%
Avulsion	2	121	100%	N/A	0-3%	5-6%	0%	15-17%
Cap-assisted EMR⁵	2	82	97%	N/A	0-9%	9%	0%	19%
Ablation	1	26	96%	N/A	0%	4%	0%	26%

Table: Table 1: Outcomes and complications of different auxiliary techniques for non-lifting colorectal neoplasia

1 clinically significant post-endoscopic resection bleeding
2 Endoscopic full-thickness resection
3 Endoscopic submucosal dissection
4 Includes hybrid EFTR and Dissection enabled scaffold-assisted resection
5 Includes cap-assisted EMR alone and cap-assisted EMR ± cold avulsion ± ablation

Disclosures:

Billy Zhao indicated no relevant financial relationships.

Hyun Jae Kim indicated no relevant financial relationships.

Fergal Donnellan indicated no relevant financial relationships.

Eric Lam indicated no relevant financial relationships.

Neal Shahidi indicated no relevant financial relationships.

Billy Zhao, MD, Hyun Jae Kim, MD, Fergal Donnellan, MD, Eric Lam, MD, Neal Shahidi, MD. C0463 - Endoscopic Resection Technique Outcomes for Non-Lifting Colorectal Lesions: A Systematic Review, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.