Yuki Kamigaichi1, Shiro Oka2, Shinji Tanaka3, Shinji Nagata4, Masaki Kunihiro5, Toshio Kuwai6, Yuko Hiraga7, Akira Furudoi8, Seiji Onogawa9, Hideharu Okanobu10, Takeshi Mizumoto11, Tomohiro Miwata12, Shiro Okamoto13, Kenichi Yoshimura14, Kazuaki Chayama1. 1. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Minami-ku, Kasumi, Hiroshima, 734-8551, Japan. 2. Department of Gastroenterology and Metabolism, Hiroshima University Hospital, 1-2-3, Minami-ku, Kasumi, Hiroshima, 734-8551, Japan. oka4683@hiroshima-u.ac.jp. 3. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. 4. Department of Gastroenterology, Hiroshima City Asa Citizens Hospital, Hiroshima, Japan. 5. Department of Internal Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 6. Department of Gastroenterology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan. 7. Department of Endoscopy, Hiroshima Prefectural Hospital, Hiroshima, Japan. 8. Department of Gastroenterology, Hiroshima General Hospital, Hiroshima, JA, Japan. 9. Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan. 10. Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan. 11. Department of Gastroenterology, Miyoshi Central Hospital, Hiroshima, Japan. 12. Department of Gastroenterology, Chugoku Rosai Hospital, Hiroshima, Japan. 13. Department of Gastroenterology, Kure Kyosai Hospital, Hiroshima, Japan. 14. Division of Regeneration and Medicine Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
Abstract
BACKGROUND: Endoscopic submucosal dissection (ESD) has become a widely accepted treatment method for colorectal tumors; however, there are some persistent problems. This multi-center study aimed to characterize the risk factors for incomplete resection and perforation in standardized colorectal ESD procedures. METHODS: This study included 2423 consecutive patients who underwent ESD for 2592 colorectal tumors between August 2013 and December 2018 at 11 institutions (1 academic hospital and 10 affiliated hospitals) from the Hiroshima GI Endoscopy Research Group. We evaluated the risk factors for interruption, piecemeal resection, and perforation of standardized colorectal ESD in relation to clinicopathologic and endoscopic characteristics. RESULTS: The incidences of interruption, piecemeal resection, and perforation were 0.7%, 2.9%, and 3.0%, respectively. Multivariate analysis identified the following risk factors for interruption: perforation during the procedure, deep submucosal invasion (> 1000 μm), poor scope operability, and severe submucosal fibrosis. The risk factors for piecemeal resection included poor scope operability, severe submucosal fibrosis, and procedure time (≥ 85 min). The risk factors for perforation during the procedure were severe submucosal fibrosis, poor scope operability, procedure time (≥ 85 min), and tumor size (≥ 40 mm). Independent risk factors for severe submucosal fibrosis included a history of biopsy and lesions located on the fold or flexure. CONCLUSIONS: Severe submucosal fibrosis and poor scope operability are the common risk factors for interruption, piecemeal resection, and perforation in standardized colorectal ESD.
BACKGROUND: Endoscopic submucosal dissection (ESD) has become a widely accepted treatment method for colorectal tumors; however, there are some persistent problems. This multi-center study aimed to characterize the risk factors for incomplete resection and perforation in standardized colorectal ESD procedures. METHODS: This study included 2423 consecutive patients who underwent ESD for 2592 colorectal tumors between August 2013 and December 2018 at 11 institutions (1 academic hospital and 10 affiliated hospitals) from the Hiroshima GI Endoscopy Research Group. We evaluated the risk factors for interruption, piecemeal resection, and perforation of standardized colorectal ESD in relation to clinicopathologic and endoscopic characteristics. RESULTS: The incidences of interruption, piecemeal resection, and perforation were 0.7%, 2.9%, and 3.0%, respectively. Multivariate analysis identified the following risk factors for interruption: perforation during the procedure, deep submucosal invasion (> 1000 μm), poor scope operability, and severe submucosal fibrosis. The risk factors for piecemeal resection included poor scope operability, severe submucosal fibrosis, and procedure time (≥ 85 min). The risk factors for perforation during the procedure were severe submucosal fibrosis, poor scope operability, procedure time (≥ 85 min), and tumor size (≥ 40 mm). Independent risk factors for severe submucosal fibrosis included a history of biopsy and lesions located on the fold or flexure. CONCLUSIONS: Severe submucosal fibrosis and poor scope operability are the common risk factors for interruption, piecemeal resection, and perforation in standardized colorectal ESD.