Background/Objectives: The management of non-lifting colorectal lesions (NLCLs), often resulting from previous unsuccessful treatments or biopsies, remains challenging due to submucosal fibrosis that prevents adequate lifting. Endoscopic submucosal dissection (ESD) is a viable option for achieving complete resection in such cases. However, when standard ESD is not feasible, conversion to hybrid ESD (H-ESD) has been proposed as a rescue strategy. This study aimed to assess ESD’s feasibility, effectiveness, and safety for NLCLs, including cases requiring conversion to H-ESD, when performed by experienced endoscopists in tertiary referral centers.Methods: In this multicenter retrospective study, data from patients with NLCLs treated by ESD/H-ESD between January 2009 and September 2022 were analyzed. The primary endpoint was the recurrence rate (RR). Secondary endpoints included the adverse event (AE) rate, technical success (TS) rate (en bloc resection regardless of technique), complete resection (CR), curative resection (cR) rates, and surgical intervention rate. Predictors of ESD technical success were identified.Results: In total, 178 patients with NLCLs were included (52 previously biopsied, 126 recurrent after previous resection). ESD was used in 111 (62.4%) and H-ESD in 67 (37.6%) cases. During a median follow-up of 373 days (IQR 540), the overall RR was 3.6%. The overall AE rate was 13.4%, and perforation was the most frequent (8.4%). All AEs were successfully managed endoscopically. The TS rate was 71.9%, significantly higher in previously biopsied lesions compared to recurrent ones (78.8% vs. 55.6%,p= 0.04). On multivariate analysis, rectal location (p< 0.001), F1 fibrosis (p= 0.026), and previously biopsied lesions (p= 0.006) predicted ESD TS without the need for conversion to H-ESD.Conclusions: ESD/H-ESD is feasible and safe for NLCLs when performed by experienced operators, with low RR amenable to endoscopic treatment. Previously biopsied lesions, rectal location, and low fibrosis predict ESD TS.
**背景/目的：** 非抬举性结直肠病变（NLCLs）常因既往治疗失败或活检导致黏膜下层纤维化，无法充分抬举，其处理仍具挑战性。内镜黏膜下剥离术（ESD）是此类病变实现完整切除的可行选择。然而，当标准ESD不可行时，转为混合ESD（H-ESD）已被提议作为一种补救策略。本研究旨在评估由三级转诊中心的经验丰富内镜医师操作时，ESD（包括需转为H-ESD的病例）治疗NLCLs的可行性、有效性和安全性。 **方法：** 在这项多中心回顾性研究中，分析了2009年1月至2022年9月期间接受ESD/H-ESD治疗的NLCLs患者数据。主要终点是复发率（RR）。次要终点包括不良事件（AE）发生率、技术成功率（TS）（无论采用何种技术实现整块切除）、完全切除（CR）率、治愈性切除（cR）率以及外科干预率。同时确定了ESD技术成功的预测因素。 **结果：** 共纳入178例NLCLs患者（52例既往接受过活检，126例为既往切除后复发）。其中111例（62.4%）采用ESD，67例（37.6%）采用H-ESD。在中位随访373天（四分位距540天）期间，总体RR为3.6%。总体AE发生率为13.4%，穿孔最常见（8.4%）。所有AE均成功通过内镜处理。TS率为71.9%，既往仅接受活检的病变显著高于复发性病变（78.8% vs. 55.6%，p=0.04）。多变量分析显示，直肠部位（p<0.001）、F1级纤维化（p=0.026）以及既往仅接受活检的病变（p=0.006）可预测ESD技术成功，而无需转为H-ESD。 **结论：** 由经验丰富的操作者实施时，ESD/H-ESD治疗NLCLs是可行且安全的，复发率低且适合内镜治疗。既往仅接受活检的病变、直肠部位以及低度纤维化可预测ESD技术成功。
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