Negative Effect of Prior Lesion Manipulation on Colorectal Endoscopic Submucosal Dissection Outcomes: A Retrospective Cohort Study.

INTRODUCTION

Endoscopic submucosal dissection (ESD) is a minimally invasive technique for en-bloc resection of superficial gastrointestinal lesions. However, the influence of prior manipulations, such as tattooing or endoscopic mucosal resection (EMR), on ESD outcomes is not well understood.

METHODS

This retrospective cohort study evaluated 763 patients (mean age 64 years, 52% female) who underwent colorectal ESD at Brigham and Women's Hospital between 2014 and 2024. Outcomes included rates of en-bloc, R0, curative resection, and adverse events. Multivariable regression analysis identified factors associated with unsuccessful outcomes.

RESULTS

The mean lesion diameter was 50 mm, with 54.4% located in the right colon. Prior tattooing occurred in 7% of cases while prior EMR was reported in 17% of lesions. En-bloc resection was achieved in 95% of cases, R0 resection in 89%, and curative resection in 88%. The mean procedure time was 64 min, with adverse events including delayed bleeding (3.3%), muscle injury (0.9%), and perforation (0.8%). Factors linked to unsuccessful en-bloc resection were prior tattooing (OR 0.30, 95% CI 0.09-0.98; P = 0.047), prior EMR (OR 0.31, 95% CI 0.12-0.82; P = 0.017), and submucosal fibrosis (OR 0.20, 95% CI 0.07-0.53; P = 0.001). Submucosal fibrosis also reduced R0 and curative resection rates. No statistically significant associations between procedural adverse events and fibrosis, prior EMR, or tattooing were found.

CONCLUSIONS

These findings highlight the importance of avoiding unnecessary pre-procedural manipulations and emphasize the need for urgent planning to optimize ESD outcomes.