The Saline‐Immersion/Irrigation TEchnique for Endoscopic Submucosal Dissection of Colorectal Lesions: Outcomes From a Large Western Cohort

BACKGROUND AND STUDY AIMS: Endoscopic submucosal dissection (ESD) is increasingly used for the resection of complex lesions of the gastrointestinal tract. However, its adoption in the management of colonic lesions in Western practice remains challenging, mainly due to the anatomical complexities of the colon. The saline-immersion/irrigation technique (SITE), combined with the pocket-creation method (PCM) may help to overcome these challenges. This study evaluates outcomes of SITE-PCM ESD in a Western tertiary center. METHODS: We analyzed consecutive colorectal ESD procedures performed at our center between 2017 and 2024. SITE-PCM was used in all cases. Lesion characteristics, procedural outcomes, histopathological findings, adverse events, and follow-up data were analyzed. RESULTS: A total of 181 lesions in 177 patients were resected en bloc using SITE-PCM ESD. Sixty lesions (33.1%) were located in the proximal colon, while 79 (43.6%) were rectal lesions. R0 and curative resection rates were 92.3% and 90.6%, respectively. The median procedure time was 120 min. Adverse events occurred in 4.4% of cases, with only three patients necessitating hospitalization and nonsurgical intervention due to delayed bleeding, and one patient requiring surgical management after a delayed perforation. Notably, 93.4% of the procedures were performed under conscious sedation. CONCLUSIONS: In our experience SITE-PCM-ESD appears to be a safe and effective minimally invasive approach for complex colorectal lesions. It achieves high R0 and curative resection rates with low adverse events and is feasible under conscious sedation. These findings support broader adoption of SITE-PCM in Western practice and justify prospective multicenter validation.