Stenosis development after circumferential colorectal endoscopic submucosal dissection: a multicenter analysis of predictive factors and outcomes - 16/07/26
, Giulio Calabrese, MD 1, Marcello Maida, MD 2, 3, Gianluca Andrisani, MD, PhD 4, Ahmad Madkour, MD, PhD 5, Mathieu Pioche, MD, PhD 6, David J. Tate, MD, PhD 7, 8, Shaimaa Elkholy, MD, PhD 9, Francesco Vito Mandarino, MD, PhD 10, Romain Legros, MD 11, Jeremie Albouys, MD 11, Pedro Barreiro, MD 12, 13, Eduardo Albéniz, MD, PhD 14, 15, Alberto Murino, MD 16, Edward Despott, MD 16, Arnaud Lemmers, MD, PhD 17, Michel Kahaleh, MD 18, Michal F. Kaminski, MD, PhD 19, George Tribonias, MD, PhD 20, Paolo Cecinato, MD 21, 22, Francesco Pugliese, MD 23, Federico Barbaro, MD, PhD 24, Cristiano Spada, MD, PhD 24, Giuseppe Grande, MD 25, Oleksandr Kiosov, MD 26, Rui Morais, MD, PhD 27, Joao Santos-Antunes, MD, PhD 27, Ricardo Küttner-Magalhães, MD 28, 29, 30, Sridhar Sundaram, MBBS, MD, DM 31, Antonio Capogreco, MD 32, Giovanni Barbara, MD, PhD 21, 33, Romano Sassatelli, MD 22, Francesco Maria Di Matteo, MD, PhD 4, Roberto Di Mitri, MD 1, Alessandro Repici, MD 32, 34, Jeremie Jacques, MD, PhD 11, ∗, Roberta Maselli, MD, PhD 32, 34, ∗CIRCLE-ESD (Circumferential Colorectal ESD) Study Group
Abstract |
Background and Aims |
The risk of postresection colorectal stenosis significantly increases when more than 90% of the circumference is involved. We aimed to evaluate postresection stenosis incidence and predictive factors in patients undergoing colorectal endoscopic submucosal dissection (ESD) for whole circumferential lesions.
Methods |
We retrospectively analyzed prospective data from patients undergoing ESD for colorectal lesions involving ≥90% of the luminal circumference at 29 worldwide tertiary referral centers between June 2018 and September 2024. The primary end point was to evaluate the incidence and predictive factors of postresection stenoses. Secondary end points included assessing the effectiveness and safety of the ESD procedure.
Results |
A total of 315 patients were included, with 269 (85.4%) rectal and 46 (14.6%) colonic lesions, and a median lesion size of 95 mm (IQR, 71-130). Complete (100%) circumferential involvement was observed in 116 cases (36.8%). En bloc, complete resection with negative margins, and oncological curative resection rates were 85.1%, 81.8%, and 80.3%, respectively. Of the 315 lesions, 31 (9.2%) were referred for surgery, and the remaining 284 (90.2%) were included in the final analysis. Stenosis occurred in 97 of 284 cases (34.2%), with a higher incidence for rectal than colonic lesions (38.2% vs 11.6%; P < .001). All stenoses were effectively managed with endoscopic treatments, achieving complete resolution of symptoms and luminal patency in all treated cases, with no need for surgical intervention. At multivariable analysis, rectal location (odds ratio [OR], 4.40; 95% CI, 1.62-12.06; P = .004), 100% circumferential resection (OR, 2.44; 95% CI, 1.41-4.21; P < .001), and larger lesion size (OR, 1.01; 95% CI, 1.01-1.02; P = .005) were independently associated with stenosis occurrence.
Conclusions |
The risk of stenosis after circumferential ESD for colorectal lesions ≥90% is high in the rectum but can be effectively managed endoscopically. Despite this, the technique remains highly feasible and safe.
Il testo completo di questo articolo è disponibile in PDF.Graphical abstract |
Abbreviations : AE, BD, CCI, EBD, ESD, ESGE, IBD, JNET, LST, OR, R0, TLI, TS, TAMIS
Mappa
| CIRCLE-ESD (Circumferential Colorectal ESD) Study Group: Vladyslav Yakovenko, MD (Department of Modern Technologies of Medical Diagnostics and Treatment, Bogomolets National Medical University, Kyiv, Ukraine; Department of Endoscopy and Minimal Invasive Surgery, Oberig Hospital, Kyiv, Ukraine), Georgios Mavrogenis, MD (Unit of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece), Amol Bapaye, MD, FASGE, FJGES, FISG, MSGE (Shivanand Desai Center for Digestive Disorders, Deenanath Mangeshkar Hospital and Research Center, Pune, India), Miguel Fraile-López, MD (Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain), Andrea Sorge, MD (Department of Gastroenterology and Hepatology, University Hospital of Ghent, Ghent, Belgium; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy), Alessandro Rimondi, MD (Royal Free Unit for Endoscopy, The Royal Free Hospital and University College, London, UK), Vincent Huberty, MD, PhD (Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Hôpital Universitaire de Bruxelles H.U.B, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium), Nastazja Pilonis, MD, PhD (Department of Oncological Gastroenterology, National Research Institute of Oncology, Warsaw, Poland), Enrique Rodríguez de Santiago, MD, PhD (Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain), Mattia Corradi, MD (Operative Digestive Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy), Ernesto Fasulo, MD (Gastroenterology and Gastrointestinal Endoscopy Division, IRCCS San Raffaele Institute, Milan, Italy), Riccardo Casciola, MD (Gastroenterology and Digestive Endoscopy Unit - Azienda Ospedaliero Universitaria of Modena, Modena, Italy), Sofia Bizarro-Ponte, MD (Department of Gastroenterology, Santo António Hospital, Unidade Local de Saúde Santo António, Porto, Portugal), Brian Iván Zurita Céspedes, MD (Gastroenterology Deparment, Instituto Gastroenterológico de Cuarto Nivel, La Paz, Bolivia), Beatriz Peñas García, MD (Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain), Sofía Parejo Carbonell, MD (Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain), Raquel R Mendes, MD (Gastroenterology Department, Unidade Local de Saúde de Lisboa Ocidental, Lisbon, Portugal; Advanced Endoscopy Center in Lisbon, Lisbon, Portugal), Sanjana Bhagwat Gokhale, MD (Unit of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece), Priyansh Bhayani, MD (Unit of Hybrid Interventional Endoscopy, Department of Gastroenterology, Mediterraneo Hospital, Athens, Greece), Mohamed El-Sherbiny, MD (Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt), Karim Essam, MD (Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt), Hany Haggag, MD (Gastroenterology Division, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt), Amr Fouly, MD (Faculty of Medicine, Helwan University, Helwan, Egypt). |
Vol 104 - N° 2
P. 266-276 - agosto 2026 Ritorno al numero
Articolo precedente
- Breaking free from fluoroscopy: Is radiation-free cholangioscopy an achievable dream?
- Barbara Braden
- Computer-aided polyp detection multicenter international randomized controlled study with a focus on community clinics: Gastroenterology Artificial INtelligence system for detecting colorectal polyps
- Cadman L. Leggett, R. Scooter Plowman, Lindsey Surace, Emmanuel Gorospe, Jesse Lachter, Dana Ben-Ami Shor, Keith Friedenberg, David A. Leiman, Simon Schlachter, Anil Patwardhan, Roman Goldenberg, Ehud Rivlin, Leera Choi, Nayantara Coelho-Prabhu, Tonya Kaltenbach, Michael Wallace
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?