Colorectal ESD in a nordic community hospital: learning curves and clinical outcomes

Endoscopic submucosal dissection (ESD) enables en-bloc resection of large (>2cm) colorectal lesions. Despite its proven benefits, ESD remains underutilized in many countries. We evaluated the quality and safety of colorectal ESD resections during the implementation of this technique in a Norwegian endoscopy centre. This single centre cohort study included all ESD-procedures performed from March 2021 until March 2025 in a Norwegian community hospital. All data were registered prospectively for quality and safety purposes. Main outcomes were en-bloc and complete (R0) resection rates as well as curative rate and complications. Additional outcomes were dissection time and speed. Outcomes were compared in three equal periods. In total, 131 procedures were performed, 105 (83%) were outpatient procedures and 123 (94%) were completed. En-bloc resection was achieved in 117 (95%), R0 resections in 98 (80%) and curative resections in 84 (68%). Complications occurred in 19 (15%) patients, intraprocedural in five (4%) and post-procedural in 14 (11%). All intraprocedural perforations (n = 3) were managed endoscopically. One patient (0,7%) had emergency surgery due to a suspicion of perforation (Clavien-Dindo score IIIb). Elective completion surgery was required in 15 patients (11%). Median dissection time was 135 min (interquartile range IQR: 100-195) in the first period and 80 min (IQR: 56-110) in the third period. Dissection speed (in mm2/min) increased from 13 (IQR: 10-20) in the first period, to 26 (IQR: 19-38) in the third period. Colorectal ESD can be safely and effectively implemented in the Nordic setting.