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Objective: We aimed to investigate the clinical outcomes of endoscopic submucosal dissection (ESD) for the treatment of colorectal laterally spreading tumors (LSTs) and the factors related to technical difficulty. Methods: Consecutive patients who underwent ESD for colorectal LSTs between June 2013 and January 2019 were retrospectively included. Factors associated with difficult ESD procedures (defined as conversion to piecemeal resection or discontinuation of endoscopic procedure), and dissection with a slow speed (<8 mm2/min), were determined using the logistic regression analysis. Results: A total of 325 patients with 342 colorectal LSTs (median size 20.0 mm) were enrolled. The proportions of granular (LST‐G) and non‐granular LST (LST‐NG) were 62.9% and 37.1%, respectively. The overall en bloc and complete resection rates were 89.8% and 81.9%, respectively. The endoscopic procedure was discontinued in four lesions (1.2%), and 31 (9.1%) converted to piecemeal resection because of technical difficulty. Using multivariate analysis, positive non‐lifting sign (odds ratio [OR] 19.9, P < 0.001), tumor size ≥20 mm (OR 10.0, P < 0.001), and less experienced endoscopists (OR 3.7, P = 0.005) were independent factors for technically difficult procedure. Positive non‐lifting sign (OR 3.7, P = 0.004), lesion size <20 mm (OR 3.7, P < 0.001), LST‐NG type (OR 1.8, P = 0.034), and less colorectal ESD experience (OR 1.9, P = 0.016) were independent factors of slow‐speed dissection. Conclusions: ESD was feasible and safe for treating colorectal LSTs. Positive non‐lifting sign and tumor ≥20 mm indicated difficult ESD procedures. Technical failure was more likely to occur in lesions resected by less‐experienced endoscopists. Dissection speed might be improved with more experienced operators. [ABSTRACT FROM AUTHOR]

Introduction: The knives for endoscopic submucosal dissection (ESD) have their strengths as well as shortcomings. They need to be used in combination in most cases. The Dual knife is a relatively novel type of ESD knife produced in 2009, which can be used for completing the whole procedure of ESD. Aim: Colorectal laterally spreading tumors (LSTs) are a special subtype of colorectal neoplasms. We aimed to evaluate the clinical features and outcomes of ESD for colorectal LSTs only using the Dual knife from our experience. Material and methods: This retrospective study included 162 patients (each patient had 1 lesion) with colorectal LSTs treated by ESD with the Dual knife by a single endoscopist at our hospital between June 2015 and January 2018. We analyzed the clinical features and outcomes after resection. Results: We obtained the en bloc ESD of the colorectal LSTs and the complete histological assessment in all patients. The mean age of the patients was 53.9 years. The mean diameter of lesions was 46 mm. The most common location of LSTs was the rectum. The most common histological type was tubular adenoma with 63 cases. The mean operating time was 56 min. Perforation and bleeding rates were 0.6% and 0.6%, respectively. No cases of local persistence or recurrence were observed at a follow-up endoscopy 6 to 31 months after the en bloc resection. Conclusions: The ESD using the Dual knife only for colorectal LSTs has the advantages of safety, efficiency, and minimally invasiveness. It is worthy of widespread clinical application. [ABSTRACT FROM AUTHOR]