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

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.