PTH-018 Short-term outcomes of a protocol of ESD/Hybrid-ESD as the primary resection strategy for rectal adenomas

Introduction ESD is rarely practiced in western centres. Given its technical difficulty, many western experts believe indications for ESD are limited. However, histopathologic diagnostic and treatment uncertainty resulting in over- or under-treatment can have grave consequences in the rectum. As a result, our unit recently opted for the exclusive use of ESD/Hybrid ESD to resect all large rectal adenomas. We report short term outcomes using this protocol for 12 months. Methods Endoscopic resection (ER) of large (≥20 mm) colorectal adenomas were analysed and outcomes compared after adoption of an exclusive ESD resection strategy for all rectal adenomas ≥20 mm for 12 months (Period 2) compared to earlier resections (Period 1) when resection strategy was based on lesion morphology, surface characteristics and ER experience. Results ER was performed for 185 rectal adenomas (period 1 n=154, Period 2 n=31) with a mean size of 63 mm (range 20–160 mm). ESD/Hybrid ESD was used for 97% of ER in Period 2 versus 61% in Period 1 (p Conclusions ESD/Hybrid ESD for all large rectal adenomas, even when incorporating ESD training, is feasible and safe with sufficient expertise and experience. Data for long term outcomes are desirable to evaluate potential benefits in oncological results, reduced recurrence and potential fewer additional procedures.