Endoscopic Submucosal Resection (ESR) - a technique using novel devices for incision and resection of neoplastic lesions

Background and study aims: Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are established techniques for the treatment of superficial gastrointestinal neoplasia. Limitations of EMR are the low en bloc resection rates for larger lesions resulting in frequent recurrences. Major disadvantages of ESD are technical difficulty and long procedure times. Here, we evaluated technical feasibility and safety of newly designed devices to perform en bloc resection of lesions sized between ca. 20-40 mm. The method will be referred to as Endoscopic Submucosal Resection (ESR). Patients and methods: This case series included 93 lesions from different localizations (11x stomach, 25x colon, 57x rectum) with a median size of 29 (10-70) mm. ESR was carried out with two novel instruments for circumferential mucosal incision and for deep submucosal resection. Results: Resection by ESR was feasible in all cases. En bloc and R0 rates were insufficient when ESR was attempted without prior circumferential mucosal incision. However, en bloc and R0 resection rates were 70% and 63%, respectively when mucosal incision was done before application of the device for submucosal resection. We observed 3 complications (2 delayed bleedings, one microperforation) but no case of emergency surgery and no 30-day mortality. Conclusions: The series demonstrates feasibility and excellent safety of ESR using two novel devices for en bloc resection of early gastrointestinal neoplasia. The technique holds the promise of relative technical ease combined with high efficacy.