Feasibility and Outcomes of Endoscopic Submucosal Dissection for Colorectal Premalignant and Early-Stage Malignant Lesions at a Community Hospital Serving Rural Population.

BACKGROUND AND AIMS: Shortage of specialists and distance to facility are known barriers associated with reduced colorectal cancer screening in rural America. Although data are sparse, rural patients are at risk for undergoing colectomy for a nonmalignant polyp due to lack of local expertise with advanced endoscopic resection techniques. We aim to study the feasibility and clinical outcomes of an endoscopic submucosal dissection (ESD) at a rural US health system.

METHODS

ESD was introduced in a planned manner at our community hospital that predominantly serves a rural population. Procedure data and clinical outcomes were reviewed for consecutive patients who underwent attempted ESD for colorectal premalignant and early-stage malignant lesions from February 2021 to January 2024.

RESULTS

Of 92 attempted ESDs, standard ESD technique was successful in 82 lesions (90.2%), while hybrid ESD-endoscopic mucosal resection technique was required for 9 lesions (9.8%) and 1 ESD was aborted. Forty-four (47.8%) lesions were in the right colon. For those who underwent standard ESD without hybrid technique, resection rates were en bloc 81 (98.7%), R0 62 (75.6%), and curative 58 (70.7%). Adverse events occurred in 4 (4.8%). There were no delayed perforations. Final pathology showed tubular or tubulovillous adenoma in 51 (62.2%), sessile serrated lesion in 2 (2.4%), high-grade dysplasia in 14 (17.1%), and adenocarcinoma in 15 (18.3%), with adenocarcinomas being staged T1 with low-risk features in 9 (11%) and ≥T1 with high-risk features in 6 (7.3%). Surveillance colonoscopy or surgical pathology was available in 44 (53.7%). Recurrent or residual polyp was noted in 1 (1.2%).

CONCLUSION

ESD can be introduced at a community hospital with a high level of safety and efficacy.