Yang D, Hasan M, Jawaid S, Singh G, Xiao Y, Khalaf M, Tomizawa Y, Sharma N, Draganov P, Othman M.
The American Journal of Gastroenterology 2024 June
The American Journal of Gastroenterology 2024 June
HIGHLIGHTS
- Recent studies demonstrated that a higher proximal serrated polyp detection rate (PSPDR) among endoscopists is associated with a lower risk of post-colonoscopy colorectal cancer (PCCRC) incidence and death for their patients. The objective of the study was to evaluate the effect of an e-learning resource on PSPDR.
- Hybrid endoscopic submucosal dissection (H-ESD) is a modified technique that utilizes ESD knife along with snare-based resection, introduced as a potential alternative to conventional ESD (C-ESD).
- The authors conducted a multicenter randomized controlled trial to compare H-ESD and C-ESD (Short-ESD trial). Patients with colorectal lesions between 20 and 50 mm in size were randomly assigned (1:1) to H-ESD or C-ESD.
- The primary outcome was procedure time/speed, and the secondary outcomes were en bloc and complete (R0) resection rates and adverse event rates.
- The study enrolled 89 patients, with median age 63 years, 49% woman, with a median polyp size of 30mm, that underwent H-ESD (n=40) and C-ESD (n=49).
- The mean procedure time was significantly shorter for H-ESD than for C-ESD (P= 0.007). The en bloc and R0 resection rates were not significantly different in the H-ESD vs C-ESD groups (P= 0.46). Adverse event rate was similar between both groups (P=1.00).
- Limitations included a protocol with a standardized approach to the H-ESD technique; the amount of submucosal dissection performed before snare resection for H-ESD significantly impacts resection outcomes, and variations in the type and size of the snare could influence results. Also, further studies are needed to optimize lesion selection for H-ESD to assure the best possible resection outcomes.
- The authors concluded that both H-ESD and C-ESD were safe and effective for resection of large colorectal lesions.
- H-ESD is associated with a shorter procedure time and speed, particularly for lesions proximal to the rectum.
- H-ESD has the main advantage of easier applicability of a snare-based technique, and thus may constitute a viable alternative to c-ESD for selected lesions.