UPmémoires

English

BACKGROUND AND AIMS: Endoscopic management is preferred to surgical management for large superficial colorectal lesions. However, the optimal endoscopic resection strategy for large superficial colorectal lesions (piecemeal endoscopic mucosal resection [pEMR] or endoscopic submucosal dissection [ESD]) is debated in particular from an economical point of view.

METHODS: A model was created to compare the cost-effectiveness of ESD and pEMR according to optical diagnosis (Japan NBI Expert Team [JNET], laterally spreading tumour [LST], CONECCT). We distinguished three groups from the same multicentre ESD cohort and compared the medical and economic outcomes: real-life ESD data (U-ESD) compared to modelled selective ESD (S-ESD JNET; S-ESD LST; S-ESD CONECCT) and exclusive pEMR strategies (U-EMR).

RESULTS: The en bloc, R0, and curative resection rates were 97.5%, 86.5%, and 82.6%, respectively in the real life ESD cohort of 833 lesions U-ESD was the least-expensive strategy was U-ESD, with a total cost of management of 2,849,204.62 €, i.e. 3,420.41 €/patient and was also the most effective strategy because it avoided 774 surgeries, which was more than any other strategy. It outperformed S-ESD CONNECT (total cost of management = 2,944,366.60 €, 3,534.62 €/patient, 765 surgeries avoided), S-ESD LST (total cost of management = 3,036,495.72 €, and 3,645.25 €/patient, 749 surgeries avoided), and S-ESD JNET (total cost of management = 3,526,202.45 € and 4,233.14 €/patient, 704 surgeries avoided) and U-EMR (total cost of management = 3,966,805.99 € and 4,762.07 €/patient, 617 surgeries avoided).

CONCLUSION: In the era of clip-and-rubber-band countertraction, ESD for all large LSTs is more cost-effective than pEMR, and S-ESD.