# Outcomes of Endoscopic Resection of Circumferential Colorectal Laterally Spreading Lesions: A Western Experience

## TL;DR

This study shows that endoscopic submucosal dissection (ESD) is a safe and effective treatment for large, circumferential colorectal lesions in a Western medical center.

## Contribution

The study provides new data on ESD outcomes for circumferential colorectal lesions in a Western setting, where such procedures are less common.

## Key findings

- ESD achieved curative resection in 75% of adenocarcinoma cases.
- En bloc resection was achieved in 96.2% of cases with 100% R0 resection.
- Post-ESD stricture occurred in 18.9% of cases but was successfully managed endoscopically.

## Abstract

Background: Circumferential or near-circumferential colorectal lesions are challenging to remove endoscopically; therefore, they are often surgically managed. There are limited data on the outcomes of endoscopic submucosal dissection (ESD) for these lesions, usually from Eastern settings, where ESD is more well established. Objective: The objective of the study was to retrospectively analyze the outcomes of circumferential colorectal ESD in a Western center. Methods: Consecutive patients referred for endoscopic resection of colorectal lesions between January 2015 and April 2025 were included if they had undergone ESD for colorectal laterally spreading tumors with ≥90% involvement of the luminal circumference. Results: Overall, 53 patients were enrolled (26 females, 49.1%; 70.6 ± 9.3 years). Mean lesion size was 91.8 ± 25.3 mm. The most frequent lesion location was the rectum (n = 36, 67.9%). Thirty-three lesions (62.3%) were circumferential, and twenty (37.7%) were near-circumferential. Median procedural time was 160.0 min (IQR 112.0–200.0 min). Histological analysis revealed high-grade dysplasia in 25/53 cases (47.2%) and adenocarcinoma in 28 patients (52.8%). Resection was en bloc in 51 cases (96.2%) and R0 in all cases (100%). Curative resection was achieved in 21 out of 28 adenocarcinoma patients (75%). Adverse events were intra-procedural major bleeding (n = 19, 18.9%), post-procedural bleeding (n = 2, 3.8%), delayed bleeding (n = 1, 1.9%), and intra-procedural perforation (n = 3, 5.7%). Post-ESD stricture was observed in 18.9% of cases (10/53); three of these (30%) were asymptomatic. All were successfully managed endoscopically. Patients who developed strictures had a longer median procedural time (206 min vs. 145 min, p = 0.0061) and a larger mean lesion size (110 mm vs. 90 mm, p = 0.035). Conclusions: ESD for colorectal circumferential and near-circumferential lesions was safe and effective in a Western expert center, supporting the use of this technique in this subset of lesions. Strictures are a common consequence that can be effectively managed endoscopically.