Comparison of clinical outcomes among different endoscopic resection methods for treating colorectal neoplasia

Background/Aim: Endoscopic treatments of colorectal neoplasms have yet to be standardized. This study aimed to compare efficacy and tolerability of different endoscopic resection methods for colorectal epithelial tumors. Methods: Patients with non-pedunculated colorectal tumors undergoing endoscopic treatments were consecutively enrolled, and their medical records were reviewed retrospectively. The resection methods were classified into three groups: endoscopic mucosal resection with circumferential precutting (EMR-P), endoscopic submucosal dissection with snaring (ESD-S), and endoscopic submucosal dissection alone (ESD). We compared en bloc resection, pathological complete resection, and complications associated with these methods. Results: Overall, 206 lesions from 203 patients were included in the study (mean size 25.2 ± 10.1 mm). The number of lesions treated with EMR-P, ESD-S, and ESD was 91 (44.2 %), 57 (27.7 %), and 58 (28.2 %), respectively. There was a significant difference in both the en bloc resection rates (EMR-P, 61.5 %; ESD-S, 64.9 %; ESD, 96.6 %; p = 0.001) and complete resection rates (EMR-P, 51.6 %; ESD-S, 54.4 %; ESD, 75.9 %; p = 0.009). Bleeding and perforation were less frequently observed in the EMR-P group. In the subgroup-analysis of lesions less than 20 mm, however, these differences were not observed. Conclusions: All endoscopic resection methods, including EMR-P, ESD-S, and ESD, were effective and safe for the treatment of colorectal neoplasms. Technically demanding ESD with high en bloc and complete resection rate should be reserved for the suspicious cancer lesion, which requires the precise histological evaluation. EMR-P with good feasibility can be considered an alternative to ESD for the lesions less than 20 mm.