Colorectal ESD in a nordic community hospital: learning curves and clinical outcomes

Endoscopic submucosal dissection (ESD) enables <i>en-bloc</i> resection of large (&gt;2cm) colorectal lesions. Despite its proven benefits, ESD remains underutilized in many countries. We evaluated the quality and safety of colorectal ESD resections during the implementation of this technique in a Norwegian endoscopy centre. This single centre cohort study included all ESD-procedures performed from March 2021 until March 2025 in a Norwegian community hospital. All data were registered prospectively for quality and safety purposes. Main outcomes were <i>en-bloc and complete (</i>R0) <i>resection rates</i> as well as <i>curative rate</i> and <i>complications</i>. Additional outcomes were dissection time and speed. Outcomes were compared in three equal periods. In total, 131 procedures were performed, 105 (83%) were outpatient procedures and 123 (94%) were completed. <i>En-bloc</i> resection was achieved in 117 (95%), R0 resections in 98 (80%) and curative resections in 84 (68%). Complications occurred in 19 (15%) patients, intraprocedural in five (4%) and post-procedural in 14 (11%). All intraprocedural perforations (<i>n</i> = 3) were managed endoscopically. One patient (0,7%) had emergency surgery due to a suspicion of perforation (Clavien-Dindo score IIIb). Elective completion surgery was required in 15 patients (11%). Median dissection time was 135 min (interquartile range [IQR]: 100–195) in the first period and 80 min (IQR: 56–110) in the third period. Dissection speed (in mm²/min) increased from 13 (IQR: 10–20) in the first period, to 26 (IQR: 19–38) in the third period. Colorectal ESD can be safely and effectively implemented in the Nordic setting.

内镜黏膜下剥离术（Endoscopic submucosal dissection, ESD）可实现大型（＞2cm）结直肠病变的整块（en-bloc）切除。尽管其临床获益已得到证实，但ESD在诸多国家仍未得到充分推广应用。本项单中心队列研究于挪威一家内镜中心开展，旨在评估该技术推广期间结直肠ESD切除术的质量与安全性。本研究纳入了2021年3月至2025年3月间，该挪威社区医院开展的所有ESD手术病例，所有数据均前瞻性登记，用于质量与安全管控。本研究的主要结局指标包括整块及完全（R0）切除率、治愈性切除率与并发症发生率，次要结局指标包括剥离时长与剥离速度。研究将所有病例按时间均分为三个阶段，对结局指标进行对比分析。本研究共纳入131例手术，其中105例（83%）为门诊手术，123例（94%）手术顺利完成。整块切除成功率达117例（95%），R0切除率为98例（80%），治愈性切除率为84例（68%）。共有19例（15%）患者出现并发症，其中术中并发症5例（4%），术后并发症14例（11%）。所有术中穿孔病例（n=3）均通过内镜下处理完成。1例患者（0.7%）因疑似穿孔接受急诊手术（Clavien-Dindo分级Ⅲb级）。15例患者（11%）需行择期补做手术。第一阶段的中位剥离时长为135分钟（四分位距[IQR]：100~195），第三阶段为80分钟（四分位距[IQR]：56~110）；剥离速度（单位：mm²/min）从第一阶段的13（IQR：10~20）提升至第三阶段的26（IQR：19~38）。本研究结果表明，结直肠ESD可在北欧医疗环境中安全且有效地推广应用。