The learning curve of the endoscopic submucosal dissection for the treatment of large colorectal neoplasms by: a European single-center study.

Objective: ESD is rarely used in Europe due to its high complication rate and long learning curve. This study analyzed the ESD learning curve at a single European treatment center.Methods: This retrospective study analyzed ESD and hybrid-ESD (hESD) procedures used to treat large colonic lesions that could not be resected in one piece by other endoscopic methods. The procedure duration and speed, en bloc and complete (R0) resection rates, and complication rates were analyzed. Results: ESD procedures were performed in 58 patients (31men, 53.4%). Most lesions were located in the rectum (n=37, 63.8%). The mean lesion diameter was 36.3 +/- 1.14 mm, the median procedure duration was 50.0 min (IQR 30.0-98.5), the median treatment speed was 9.75 min/cm2 (IQR 6.75-19.95). The en bloc resection rate was 87.9% (51/58), the R0 resection rate was 82.8% (48/58). The procedure speed increased significantly after 30 cases (p=0.012). The hybrid-ESD speed was better than the ESD speed: 6.7 min/cm2 (IQR 5.7-13.6) vs. 12.1 min/cm2 (IQR 7.1-20.1, p=0.042). The only complication was bleeding 6.9% (4/58); no perforation occurred. Recurrence was detected during follow-up (median 30.0 months, IQR 12-48) in just 1 patient (1.7%). Conclusions: These results confirm that ESD is useful and safe for resection of large colorectal polyps. The procedure speed increased greatly after 25 procedures. Hybrid-ESD was faster than ESD with a high therapeutic resection rate.