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International Journal of Colorectal Disease

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01-10-2014 | Original Article

Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort

Authors: Yoji Takeuchi, Hiroyasu Iishi, Shinji Tanaka, Yutaka Saito, Hiroaki Ikematsu, Shin-ei Kudo, Yasushi Sano, Takashi Hisabe, Naohisa Yahagi, Yusuke Saitoh, Masahiro Igarashi, Kiyonori Kobayashi, Hiroo Yamano, Seiji Shimizu, Osamu Tsuruta, Yuji Inoue, Toshiaki Watanabe, Hisashi Nakamura, Takahiro Fujii, Noriya Uedo, Toshio Shimokawa, Hideki Ishikawa, Kenichi Sugihara

Published in: International Journal of Colorectal Disease | Issue 10/2014

Abstract

Background

Colorectal endoscopic submucosal dissection (C-ESD) is a promising but challenging procedure. We aimed to evaluate the factors associated with technical difficulties (failure of en bloc resection and procedure time, ≥2 h) and adverse events (perforation and bleeding) of C-ESD.

Methods

We conducted a retrospective exploratory factor analysis of a prospectively collected cohort in 15 institutions. Eight-hundred sixteen colorectal neoplasms larger than 20 mm from patients who underwent C-ESD were included. We assessed the outcomes of C-ESD and risk factors for technical difficulties and adverse events.

Results

Of the 816 lesions, 767 (94 %) were resected en bloc, with a median procedure time of 78 min. Perforation occurred in 2.1 % and bleeding in 2.2 %. Independent factors associated with failure of en bloc resection were low-volume center (<30 neoplasms), snare use, and poor lifting after submucosal injection. Factors significantly associated with long procedure time (≥2 h) were large tumor size (≥4 cm), low-volume center, less-experienced endoscopist, CO₂ insufflation, and use of two or more endoknives. Poor lifting was the only factor significantly associated with perforation, whereas rectal lesion and lack of a thin-type endoscope were factors significantly associated with bleeding. Poor lifting after submucosal injection occurred more frequently for nongranular-type laterally spreading tumors (LST) and for protruding and recurrent lesions than for granular-type LST (LST-G).

Conclusions

Poor lifting after submucosal injection was the risk factor most frequently associated with technical difficulties and adverse events on C-ESD. Less experienced endoscopists should start by performing C-ESDs on LST-G lesions.

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Title: Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort
Authors: Yoji Takeuchi
Hiroyasu Iishi
Shinji Tanaka
Yutaka Saito
Hiroaki Ikematsu
Shin-ei Kudo
Yasushi Sano
Takashi Hisabe
Naohisa Yahagi
Yusuke Saitoh
Masahiro Igarashi
Kiyonori Kobayashi
Hiroo Yamano
Seiji Shimizu
Osamu Tsuruta
Yuji Inoue
Toshiaki Watanabe
Hisashi Nakamura
Takahiro Fujii
Noriya Uedo
Toshio Shimokawa
Hideki Ishikawa
Kenichi Sugihara
Publication date: 01-10-2014
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 10/2014
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-014-1947-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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