HYBRID VERSUS CONVENTIONAL ENDOSCOPIC SUBMUCOSAL DISSECTION FOR LATERAL SPREADING COLORECTAL LESIONS: A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL (SHORT-ESD)

Background: Hybrid endoscopic submucosal dissection (H-ESD), which incorporates ESD with endoscopic mucosal resection, has been developed and is increasingly utilized to overcome the technical complexity of conventional ESD (C-ESD). This study aimed to determine if H-ESD is superior to C-ESD for non-pedunculated lateral spreading colorectal lesions (LSCLs)
Methods: We conducted a multi-center, prospective, open-label, randomized controlled trial to compare the treatment outcomes of H-ESD and C-ESD (Short-ESD Trial). Patients with LSCLs between 2 to 6 cm were randomly assigned to H-ESD or C-ESD. The primary outcome was ESD time. Secondary outcomes included en-bloc and complete (R0) resection rate and adverse events.
Results: A total of 89 patients (median age 63 years; 49.3% women) with median polyp size of 30 mm (interquartile range [IQR]: 25-40 mm) were randomized to H-ESD (n=40) or C-ESD (n=49). There were no statistically significant differences between the two groups in terms of polyp size, location, morphology, degree of submucosal fibrosis during ESD, or final histopathology (Table 1). The median ESD time was significantly shorter for H-ESD (41.5 min; IQR: 26.3-61 min) compared to C-ESD (56.5 min; IQR: 41-84.5) (p=0.04). When compared to C-ESD, H-ESD trended towards lower resection rates for en-bloc (77.5% H-ESD vs 87.8% C-ESD; p=0.26) and R0 (72.5% H-ESD vs. 85.7% C-ESD; p=0.18). All cases of incomplete (R1) resection in the H-ESD group (n=9) were due to focally positive lateral margins. In aggregate, there were 2 cases of post-ESD bleeding (2.2%), both occurring in the H-ESD group and without requiring additional interventions. There was no statistically significant difference in the rate of perforation between the H-ESD and C-ESD groups (5% vs. 8.2%; p=0.69). All perforations were adequately closed endoscopically at the time of the ESD without additional interventions.
Conclusion: This multicenter randomized trial demonstrated that H-ESD for LSCLs was associated with shorter procedure time and similar adverse events when compared with C-ESD. However, there was a non-statistically significant trend towards lower rates of en-bloc and complete resection with H-ESD. Hence, while H-ESD may be a potential alternative to C-ESD, future studies focused on lesion selection are needed to further stratify the most suitable technique based on LSCL characteristics.