Save the injection needle for colorectal ESD: a multicenter feasibility study of the needleless injection technique using short-tip endoknife.

backgroundThis study evaluated the efficacy and safety of a novel needleless injection technique for colorectal endoscopic submucosal dissection (NIT-ESD).

methodsIn this multicenter retrospective study, 182 patients who underwent colorectal endoscopic submucosal dissection (ESD) at three institutions between 2019 and 2024 were analyzed. Patients were assigned to the NIT-ESD group (n = 118) or the conventional ESD group (n = 64). The primary outcome was dissection speed. Secondary outcomes included en bloc and R0 resection rates, hybrid ESD conversion rates, and adverse events. Multivariable linear regression was performed to identify independent predictors of dissection speed.

resultsThe mean dissection speed was lower with NIT-ESD than with conventional ESD (28.0 ± 32.6 versus 42.9 ± 37.8 min; P = 0.006). En bloc and R0 resection rates were comparable between the two groups (both 98. 3% versus 95.3%; P = 0.238). The incidence of severe adverse events was also similar (10.2% versus 4.7%; P = 0.327), and only one patient required surgery for delayed perforation. In a multivariable analysis, the operating endoscopist (P < 0.001) and the use of traction (P = 0.002)-but not the use of an injection needle (P = 0.361)-were independently associated with dissection speed.

conclusionsNIT-ESD appears to be a safe and effective alternative to conventional ESD, achieving comparable clinical outcomes with shorter procedure times and potential environmental benefits. Prospective studies are warranted to confirm these findings, assess the learning curve, and evaluate the cost-effectiveness of NIT-ESD in clinical practice.