The learning curve of ESD procedure in the European settings. Analysis of 45 consecutive cases of colorectal ESDs done in the single academic institution in Poland.

Background: Endoscopic submucosal dissection (ESD) in colon is technically difficult and carries a high risk of complications. The aim of the study was to analyze early results and complications of colorectal ESDs performed at single, specialized in colorectal surgery institution in Poland.Methods: The first ESD in our department was performed in June 2013, preceded by the training in Japanese expert center. 45 consecutive cases of colorectal ESDs were performed between June 2013 and February 2014. En block rate, perforations, bleeding and the percentage of accurate assessments based on Kudo scale were analyzed. Results: The average size of the removed tumors was 36.3 mm (range 15 to 75 mm). In 30 cases, en bloc resection was achieved. In this group, 97% cases were R0 resection. In four cases a discrepancy between Kudo qualification and the results of histological examination were observed. Perforation occurred in 3 cases (6,6 %). Two of them were managed with endoclips. In three cases significant bleeding occurred. Conclusions: Our results clearly show that ESD is a demanding procedure, connected with the risk of serious complication. Proper training in expert Japanese center leads not only to proper assessment of the lesions, but also it enables to handle with the complications connected with this procedure.