Response to: ‘Rectal versus colonic submucosal cancer rates and procedural outcomes in large non-pedunculated polyps: French ESD registry data’ by Van der Voort et al

We read with great interest the recent article by Van der Voort et al in GUT comparing submucosal invasive cancer (SMIC) rates in rectal and colonic lesions in a large French endoscopic submucosal dissection (ESD) registry.1 The claim that SMIC risk is equivalent after adjusting for size and morphology warrants critical appraisal due to (1) inconsistent statistical findings, (2) analytical, systematic and referral biases, (3) overclassification of high-risk lesions, (4) lack of segmental stratification and (5) notable rate of colonic perforation.