Pilot Study Finds Submucosal Thickness Is Greater With Colorectal EMR Than ESD

Pilot Study Finds Submucosal Thickness Is Greater With Colorectal EMR Than ESD

Douglas K. Rex, MD, MASGE, reviewing Clees N, et al. Endosc Int Open 2022 Jun.

Discussions of colorectal endoscopic mucosal resection (EMR) versus endoscopic submucosal dissection (ESD) usually focus on en bloc resection and recurrence rates. Little is known about submucosal thickness with the two techniques. Submucosal thickness can affect R0 resection (deep margin). 

In a pilot study from a single German center, specimens were resected from the right side of the colon by ESD (n=6), all en bloc, versus EMR (n=6), of which 3 were en bloc and 3 were piecemeal. Minimum submucosal thickness in the EMR specimens was 934 microns versus 319 microns for ESD. Maximum submucosal thickness was similar for EMR (2218 microns) versus ESD (2055 microns). The fraction of all measurements with submucosal thickness >1000 microns was 91.2% for EMR and 47.1% for ESD (P=.018).

Douglas K. Rex, MD, FASGE


Experts teaching colorectal ESD do not, in my experience, emphasize dissection along the muscularis propria to the same extent as in gastric ESD. The results reported here indicate more study of this issue is needed because it bears on the ESD-versus-EMR discussion and debate.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Clees N, Várnai-Händel AD, Hildenbrand R, Grund KE, Metter K, Dumoulin FL. Colorectal submucosa thickness in specimens obtained by EMR versus ESD: a retrospective pilot study. Endosc Int Open 2022;10:E721-E726. (https://doi.org/10.1055/a-1816-6381)

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