Outcomes of Endoscopic Resection of Circumferential Colorectal Laterally Spreading Lesions: A Western Experience

<b>Background</b>: Circumferential or near-circumferential colorectal lesions are challenging to remove endoscopically; therefore, they are often surgically managed. There are limited data on the outcomes of endoscopic submucosal dissection (ESD) for these lesions, usually from Eastern settings, where ESD is more well established. <b>Objective</b>: The objective of the study was to retrospectively analyze the outcomes of circumferential colorectal ESD in a Western center. <b>Methods</b>: Consecutive patients referred for endoscopic resection of colorectal lesions between January 2015 and April 2025 were included if they had undergone ESD for colorectal laterally spreading tumors with ≥90% involvement of the luminal circumference. <b>Results</b>: Overall, 53 patients were enrolled (26 females, 49.1%; 70.6 ± 9.3 years). Mean lesion size was 91.8 ± 25.3 mm. The most frequent lesion location was the rectum (<i>n</i> = 36, 67.9%). Thirty-three lesions (62.3%) were circumferential, and twenty (37.7%) were near-circumferential. Median procedural time was 160.0 min (IQR 112.0-200.0 min). Histological analysis revealed high-grade dysplasia in 25/53 cases (47.2%) and adenocarcinoma in 28 patients (52.8%). Resection was en bloc in 51 cases (96.2%) and R0 in all cases (100%). Curative resection was achieved in 21 out of 28 adenocarcinoma patients (75%). Adverse events were intra-procedural major bleeding (<i>n</i> = 19, 18.9%), post-procedural bleeding (<i>n</i> = 2, 3.8%), delayed bleeding (<i>n</i> = 1, 1.9%), and intra-procedural perforation (<i>n</i> = 3, 5.7%). Post-ESD stricture was observed in 18.9% of cases (10/53); three of these (30%) were asymptomatic. All were successfully managed endoscopically. Patients who developed strictures had a longer median procedural time (206 min vs. 145 min, <i>p</i> = 0.0061) and a larger mean lesion size (110 mm vs. 90 mm, <i>p</i> = 0.035). <b>Conclusions</b>: ESD for colorectal circumferential and near-circumferential lesions was safe and effective in a Western expert center, supporting the use of this technique in this subset of lesions. Strictures are a common consequence that can be effectively managed endoscopically.