TOPLINE:

The saline-immersion/irrigation technique (SITE) in colorectal endoscopic submucosal dissection (ESD), combined with the pocket-creation method (PCM), showed curative resection rates of over 90% and low rates of adverse events. The method was feasible under conscious sedation, with only one case of local recurrence noted.

METHODOLOGY:

• ESD is a technique for the en bloc resection of gastrointestinal lesions, showing high curative resection and low recurrence rates. The SITE was introduced in combination with the PCM to improve ESD by enhancing visualization and procedural stability.
• Researchers conducted a single-center cohort study (2017-2024) analyzing 181 colorectal lesions (≥ 2 cm or histologically confirmed rectal neuroendocrine tumors) in 177 patients (mean age, 65.2 years; 43.6% women). The lesions were resected using the SITE combined with the PCM.
• During the procedures, intraluminal gas was replaced with continuous irrigation of isotonic saline solution. Procedures were performed under conscious sedation or general anesthesia, with a median procedure time of 120 minutes.
• Follow-up included histopathologic analysis and endoscopic assessment; resection was defined as R0 with lesion-free vertical and lateral margins of 1000 μm or R1 with evidence of lesion cells on the vertical or lateral margins.
• Adverse events were monitored, with a focus on intraprocedural perforations and delayed bleeding.

TAKEAWAY:

• The SITE achieved an R0 resection rate of 92.3% and a curative resection rate of 90.6%. The R0 resection rate was 91.2% for lesions in the rectum and 93.1% for those in the colon.
• The rate of adverse events was low, with only 4.4% of cases having complications, such as intraprocedural perforations, which were managed endoscopically; 35.9% of patients were admitted post-procedure.
• The majority of procedures (93.4%) were performed under conscious sedation, with no procedure interrupted because of patient discomfort.
• Histopathologic analysis revealed high-risk features in 5% of patients; 3.9% of lesions were deeply invasive (≥ 1000 μm) submucosal carcinomas, and 8.8% of the resected lesions were neuroendocrine tumors. Only one patient experienced a local recurrence, which was successfully treated with endoscopic mucosal resection.

IN PRACTICE:

“Our data reflect that SITE-ESD appears to be a safe and effective technique for en bloc resection of complex colorectal lesions, achieving high R0 and curative resection rates while maintaining GA [general anesthesia]-free patient comfort and a low incidence of adverse events. Given this efficacy, safety, and patient-centered profile, in our opinion, SITE-ESD has the potential to become more widely adopted to provide optimal outcomes for colorectal ESD,” the authors wrote.

SOURCE:

The study was led by Elisabet Maristany Bosch and Georgios Kalopitas, The Royal Free Hospital and University College London Institute for Liver and Digestive Health in London, England. It was published online in the Journal of Gastroenterology and Hepatology.

LIMITATIONS:

The study’s single-center design may limit the generalizability of the findings to other settings. The relatively modest resection speed should be considered in the context of the lesion complexity. Follow-up data were available for only 58.8% of patients.

DISCLOSURES:

The study did not receive any specific funding. Some authors reported consultancy and receiving honoraria, grants, royalties, personal payments, or educational grants from various sources including Fujifilm Healthcare, Pentax, and Olympus Medical.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.