Endoscopic submucosal dissection safer, more cost-effective than transanal endoscopic microsurgery

In patients with early rectal cancer (ERC), endoscopic submucosal dissection (ESD) appears safer and is associated with shorter hospital stay than transanal endoscopic microsurgery (TEM), results of a recent study have shown.

A group of researchers sought to identify ideal candidates for each procedure in this study. They assessed a total of 204 ERC patients managed with either ESD (n=101) or TEM (n=103) at seven international centres between January 2016 and November 2019. Analyses were conducted for the following data: clinical success, tumour characteristics, procedure info, and recurrence rates.

Median tumour size was significantly larger in patients in the TEM arm than those in the ESD arm (56 vs 40 mm; p<0.00001). The TEM group also had a shorter average procedure time than the ESD group (104.9 vs 131.5 min; p=0.000347), but patients managed with ESD had much shorter average hospital stay than their TEM counterparts (3.3 vs 4.7 days; p<0.00001).

In terms of safety, the TEM arm experienced more adverse events than the ESD arm (24 percent vs 6.8 percent). Notably, no significant between-group difference was observed in the rate of en bloc resection, technical success, tumour location, necessity of additional procedures, and tumour recurrence rates.

“ESD and TEM are minimally invasive procedures that treat ERC,” the researchers said. “Both are effective treatments, yet there are very few studies comparing them.”