{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:01:40Z","timestamp":1789776100079,"version":"4.0.1"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"CP","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background and Study Aim Endoscopic submucosal dissection (ESD) is recommended for selected colorectal lesions, especially those with superficial submucosal invasion, enabling en-bloc resection and accurate histopathologic assessment. However, the management of high-risk lesions following ESD, especially regarding additional surgery versus surveillance, remains debated. This study evaluated outcomes after ESD for pT1 colorectal carcinoma, comparing surgical versus conservative management.<\/jats:p>\n                  <jats:p>Patients\/Materials and Methods This retrospective multicenter study included 92 patients with pT1 colorectal carcinoma treated by ESD at 14 German referral centers (January 2017\u2013December 2020). Patients were classified as low-risk (n = 34) or high-risk (n = 58) based on histopathologic criteria. Long-term outcomes were compared between low- and high-risk patients, as well as between high-risk patients undergoing additional surgery versus conservative management.<\/jats:p>\n                  <jats:p>Results The overall three-year disease-free survival was 82.6%, without a significant difference between the low-risk (88.2%) and high-risk groups (79.3%; p = 0.276). Among high-risk patients, 56.9% received additional surgery and 43.1% were managed conservatively. Recurrences occurred exclusively in the high-risk group (5.2%). The R0 resection rate after ESD was higher in patients managed without additional surgery than in those who subsequently underwent surgery (76.0% vs. 45.5%; p = 0.019).<\/jats:p>\n                  <jats:p>Conclusion ESD is effective for curative management of selected early colorectal cancers (pT1), particularly in low-risk cases. In high-risk patients, surgery remains the standard, with no recurrences observed after additional surgery in our cohort. A substantial proportion of high-risk patients did not undergo surgery in clinical practice and showed a recurrence rate of 12% (3\/25). These findings support current recommendations while reflecting real-world treatment patterns.<\/jats:p>","DOI":"10.1055\/a-2949-2685","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:05:52Z","timestamp":1789772752000},"source":"Crossref","is-referenced-by-count":0,"special_numbering":"S","title":["Endoscopic Submucosal Dissection for Early Colorectal Carcinoma with High-risk Criteria: Long-term Follow-up from the German Multicenter Registry"],"prefix":"10.1055","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4024-635X","authenticated-orcid":false,"given":"Sara","family":"Moser","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Bayern, Germany","place":["Augsburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1486-9298","authenticated-orcid":false,"given":"Andreas","family":"Probst","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Bayern, Germany","place":["Augsburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanna","family":"Ebigbo","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Bayern, Germany","place":["Augsburg"],"department":["Department of Gastroenterology"]},{"name":"St. Josef-Hospital, Germany","place":["Bochum"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Steinbr\u00fcck","sequence":"additional","affiliation":[{"name":"Evangelisches Diakoniekrankenhaus Freiburg, Baden-W\u00fcrttemberg, Germany","place":["Freiburg"],"department":["Medical Department"]},{"name":"Asklepios Klinik Barmbek, HH, Germany","place":["Hamburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Peter","family":"Allgaier","sequence":"additional","affiliation":[{"name":"Evangelisches Diakoniekrankenhaus Freiburg, Baden-W\u00fcrttemberg, Germany","place":["Freiburg"],"department":["Medical Department"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrgen","family":"Pohl","sequence":"additional","affiliation":[{"name":"Asklepios Klinik Altona, HH, Germany","place":["Hamburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Reinehr","sequence":"additional","affiliation":[{"name":"Elbe-Elster Klinikum Herzberg, Germany","place":["Herzberg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Rempel","sequence":"additional","affiliation":[{"name":"St. Anna Hospital Herne, Germany","place":["Herne"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Anzinger","sequence":"additional","affiliation":[{"name":"Krankenhaus Barmherzige Br\u00fcder M\u00fcnchen, Bayern, Germany","place":["M\u00fcnchen"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz Ludwig","family":"Dumoulin","sequence":"additional","affiliation":[{"name":"Gemeinschaftskrankenhaus Bonn, Germany","place":["Bonn"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Schirra","sequence":"additional","affiliation":[{"name":"University Hospital, Ludwig Maximilians-University, Germany","place":["Munich"],"department":["Medical Department II"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dani","family":"Dakkak","sequence":"additional","affiliation":[{"name":"Elisabeth-Krankenhaus-Essen, Germany","place":["Essen"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Denzer","sequence":"additional","affiliation":[{"name":"University Hospital Marburg, HE, Germany","place":["Marburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9660-1323","authenticated-orcid":false,"given":"Andreas","family":"Wannhoff","sequence":"additional","affiliation":[{"name":"Klinikum Ludwigsburg, BW, Germany","place":["Ludwigsburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Sulk","sequence":"additional","affiliation":[{"name":"University Hospital Carl Gustav Carus, Germany","place":["Dresden"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegbert","family":"Faiss","sequence":"additional","affiliation":[{"name":"Sana Klinikum Lichtenberg, Berlin, Germany","place":["Berlin"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Muzalyova","sequence":"additional","affiliation":[{"name":"University Hospital of Augsburg, Bayern, Germany","place":["Augsburg"],"department":["Institute of Digital Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carola","family":"Fleischmann","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Bayern, Germany","place":["Augsburg"],"department":["Department of Gastroenterology"]},{"name":"Klinikum N\u00fcrnberg, Bayern, Germany","place":["Nuremberg N\u00fcrnberg"],"department":["Department of Gastroenterology, Hepatology and Endocrinology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Messmann","sequence":"additional","affiliation":[{"name":"University Hospital Augsburg, Bayern, Germany","place":["Augsburg"],"department":["Department of Gastroenterology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1055\/a-1811-7025","article-title":"Endoscopic submucosal dissection for superficial gastrointestinal lesions: European Society of Gastrointestinal Endoscopy (ESGE) guideline - update 2022","volume":"54","author":"P Pimentel-Nunes","year":"2022","journal-title":"Endoscopy"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1038\/s41379-019-0443-1","article-title":"Pathological assessment of endoscopic resections of the gastrointestinal tract: a comprehensive clinicopathologic review","volume":"33","author":"M P Kumarasinghe","year":"2020","journal-title":"Mod Pathol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1111\/j.1440-1746.2011.06942.x","article-title":"Matched case-control study comparing endoscopic submucosal dissection and endoscopic mucosal resection for colorectal tumors","volume":"27","author":"K Nozomu","year":"2012","journal-title":"J Gastroenterol Hepatol"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"e0291916","DOI":"10.1371\/journal.pone.0291916","article-title":"Comparing endoscopic mucosal resection with endoscopic submucosal dissection in colorectal adenoma and tumors: meta-analysis and system review","volume":"18","author":"N Wang","year":"2023","journal-title":"PLoS One"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.14309\/ajg.0000000000002715","article-title":"Treatment decision for locally resected T1 colorectal carcinoma\u2013verification of the Japanese guideline criteria for additional surgery based on long-term clinical outcomes","volume":"119","author":"S Oka","year":"2024","journal-title":"Am J Gastroenterol"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"12353","DOI":"10.1038\/s41598-024-63129-1","article-title":"Clinical outcomes of colorectal neoplasm with positive resection margin after endoscopic submucosal dissection","volume":"14","author":"H H Oh","year":"2024","journal-title":"Sci Rep"},{"issue":"10","key":"ref7","first-page":"971","article-title":"Endoscopic surveillance after surgical or endoscopic resection for colorectal cancer: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Digestive Oncology (ESDO) guideline","volume":"51","author":"C Hassan","year":"2019","journal-title":"Endoscopy"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10147-019-01485-z","article-title":"Japanese Society for Cancer of the colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer","volume":"25","author":"Y Hashiguchi","year":"2020","journal-title":"Int J Clin Oncol"},{"issue":"05","key":"ref9","first-page":"1378","article-title":"Endoscopic full-thickness resection versus surgery for T1 colorectal cancers with deep submucosal invasion: a meta-analysis","volume":"163","author":"L W Zwager","year":"2022","journal-title":"Gastroenterology"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"8534","DOI":"10.1038\/s41598-023-35407-x","article-title":"Patients\u2019 preferences in therapeutic decision-making in digestive oncology: a single Centre cross-sectional observational study","volume":"13","author":"P Nizet","year":"2023","journal-title":"Sci Rep"},{"issue":"10","key":"ref11","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1016\/j.annonc.2020.06.022","article-title":"Localised colon cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"31","author":"G Argil\u00e9s","year":"2020","journal-title":"Ann Oncol"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"337","DOI":"10.5946\/ce.2024.263","article-title":"Classification of image-enhanced endoscopy in colon tumors","volume":"58","author":"O Z Kim","year":"2025","journal-title":"Clin Endosc"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.gie.2017.02.024","article-title":"Clinical outcomes after endoscopic submucosal dissection for colorectal neoplasia: a systematic review and meta-analysis","volume":"86","author":"L Fuccio","year":"2017","journal-title":"Gastrointest Endosc"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1055\/a-1866-8080","article-title":"Diagnostic endoscopic submucosal dissection for colorectal lesions with suspected deep invasion","volume":"55","author":"A Patenotte","year":"2023","journal-title":"Endoscopy"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2949-2685.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T23:05:55Z","timestamp":1789772755000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2949-2685"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":14,"journal-issue":{"issue":"CP","published-online":{"date-parts":[[2026,1,13]]},"published-print":{"date-parts":[[2026]]}},"alternative-id":["a29492685"],"URL":"https:\/\/doi.org\/10.1055\/a-2949-2685","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"value":"2364-3722","type":"print"},{"value":"2196-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}