Abstract
Western data to help guide surveillance recommendations following colorectal endoscopic submucosal dissection (ESD) remains scarce. In this multicenter study, we evaluate and stratify the risk of local recurrence following colorectal ESD.
Retrospective analysis of colorectal ESD at 13 centers between January 2015 to September 2025. Local recurrence was defined as neoplasia at the ESD site during surveillance colonoscopy (SC). Recurrence risk was calculated for the following groups: category 1 (R0 resection of low-grade dysplasia [LGD]), category 2 (R0 resection of high-grade dysplasia), category 3 (R1/Rx resection of non-invasive neoplasia), and category 4 (curative resection of T1a cancer). Multivariable logistic regression was performed to identify factors associated with recurrence.
2182 patients underwent colorectal ESD (median lesion size of 34 mm). En-bloc and R0 resection rates were 93.6% and 81.1%, respectively. SC was available in 1478 out of the 2182 patients. Local recurrence occurred in 1.5% (22/1478) at a median of 14 months: 1.5% (12/775) in category 1, 0.9% (3/330) in category 2, 2.2% (6/279) in category 3, and 1.1% (1/94) in category 4. Recurrence in very low-risk lesions (defined as <40 mm in size with only LGD on histology) was 0.8% (4/478). Severe fibrosis was a risk factor for local recurrence (OR:2.40; 95%CI:1.12-4.89; p=0.019) whereas R0 resection was associated with a lower likelihood (OR:0.30; 95%CI:0.15-0.58; p<0.001).
In this multicenter non-Asian study, local recurrence after colorectal ESD was 1.5% and 0.8% for very low-risk lesions. Severe submucosal fibrosis and R1/Rx resection were independently associated with local recurrence. Our data support current recommendations for SC at 12 months after ESD and raises the possibility of a longer interval for very low-risk lesions.