Selective Use of Endoscopic Submucosal Dissection for Large Laterally Spreading Colorectal Lesions in a Prospective Study

What this Trial Is About

Researchers are evaluating a selective strategy using Endoscopic Submucosal Dissection ESD for treating large laterally spreading lesions LSL of the colorectum, which are at high risk of progressing to cancer. These lesions, especially those 20mm or larger, have a higher chance of malignancy and recurrence after removal. The study focuses on lesions with overt signs of submucosal invasive cancer SMIC or those at high risk for covert SMIC, aiming to improve histological staging and potentially reduce the need for surgery. The study compares two procedures ESD, which allows for en-bloc resection and precise histopathological assessment, and Endoscopic Mucosal Resection EMR, the current standard treatment that often requires piecemeal resection. Patients with lesions showing overt or high risk 10% of covert SMIC are selected for ESD, while others with low-risk lesions may receive EMR. The research team will follow a prospective cohort design to assess this selective approach in the Western population. Participants will be monitored for outcomes including surgical referral rates at three months post-procedure, resection success rates, procedure duration, and adenoma recurrence rates over three years. The study involves detailed assessments of lesion removal quality and patient follow-up to evaluate the safety and effectiveness of the selective ESD strategy compared to EMR. Participation includes consenting adults referred for colorectal lesion resection and undergoing the assigned treatment with ongoing evaluations.

ESD for Colorectal LSL Using a Selective Strategy - a Prospective Cohort Study