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

IF 1.7 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Scandinavian Journal of Gastroenterology Pub Date : 2025-08-30 DOI:10.1080/00365521.2025.2553279

Jens Aksel Nilsen, Frederik Emil Juul, Anders Egeland, Petter Tandberg, Espen Norvard, Terje Lund-Iversen, Johannes Kurt Schultz, Mette Kalager, Svein Oskar Frigstad

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引用次数: 0

Abstract

Background and aims: Endoscopic submucosal dissection (ESD) enables en-bloc resection of large (>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.

Methods: 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 en-bloc and complete (R0) resection rates as well as curative rate and complications. Additional outcomes were dissection time and speed. Outcomes were compared in three equal periods.

Results: In total, 131 procedures were performed, 105 (83%) were outpatient procedures and 123 (94%) were completed. En-bloc 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 (n = 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.

Conclusion: Colorectal ESD can be safely and effectively implemented in the Nordic setting.

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北欧社区医院结肠直肠ESD：学习曲线和临床结果

背景和目的：内镜下粘膜下剥离（ESD）可以实现大（bbb20厘米）结直肠病变的整体切除。尽管证明了可持续发展的好处，但在许多国家仍未得到充分利用。我们评估了在挪威内窥镜中心实施该技术期间结肠直肠ESD切除术的质量和安全性。方法：该单中心队列研究纳入了从2021年3月至2025年3月在挪威一家社区医院进行的所有静电放电手术。出于质量和安全目的，所有数据均进行前瞻性登记。主要结果为整体和完全（R0）切除率、治愈率和并发症。其他结果是解剖时间和速度。结果在三个相同的时期进行比较。结果：共完成131例手术，其中门诊105例（83%），完成123例（94%）。整体切除117例（95%），R0切除98例（80%），治愈性切除84例（68%）。并发症19例（15%），术中5例（4%），术后14例（11%）。所有术中穿孔（n = 3）均经内镜处理。1例患者（0.7%）因怀疑穿孔而紧急手术（Clavien-Dindo评分IIIb）。15例（11%）患者需要择期完成手术。第一期中位解剖时间为135 min（四分位间距[IQR]: 100-195），第三期中位解剖时间为80 min （IQR: 56-110）。解剖速度（单位：mm2/min）由第一阶段的13 （IQR: 10 ~ 20）增加到第三阶段的26 （IQR: 19 ~ 38）。结论：结直肠ESD在北欧地区可以安全有效地实施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Scandinavian Journal of Gastroenterology 医学-胃肠肝病学

CiteScore

3.40

自引率

5.30%

发文量

222

审稿时长

3-8 weeks

期刊介绍： The Scandinavian Journal of Gastroenterology is one of the most important journals for international medical research in gastroenterology and hepatology with international contributors, Editorial Board, and distribution