Clinical usefulness of hybrid endoscopic submucosal dissection for T1b colorectal carcinomas ≤20 mm to ensure adequate vertical margins

Abstract Objective To evaluate endoscopic resection strategies for cT1b colorectal carcinomas (CRCs) ≤20 mm to determine strategies that enable adequate vertical margins (VMs). Methods We enrolled 128 consecutive patients with cT1b colorectal carcinomas ≤20 mm resected by endoscopic mucosal resection or hybrid endoscopic submucosal dissection (ESD). Tumor lifting conditions after submucosal injection were classified into type A (lifting, soft dome‐like), type B (lifting, hard trapezoid‐like), and non‐lifting (positive non‐lifting sign). Predictors of positive VMs (VM 1) and adequate VMs were identified. Results All non‐lifting tumors were resected by hybrid ESD and VMs were ≥500 µm. Vertical margin 1 tumors were only found in the endoscopic mucosal resection group, in which, the proportion of type B tumors with VM 1 was significantly higher than that of tumors with negative VMs ( p < 0.01). Type A tumors showed no significant between‐group differences. Among type B tumors, the proportion of VMs ≥500 µm was significantly higher ( p < 0.01) and the VM distance was significantly longer ( p < 0.01) in the hybrid ESD group than in the endoscopic mucosal resection group. Conclusions Hybrid ESD can be selected for type B tumors to ensure adequate VMs.