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17-05-2022

Factors for conversion risk of colorectal endoscopic submucosal dissection: a multicenter study

Authors: Yuki Kamigaichi, Shiro Oka, Shinji Tanaka, Shinji Nagata, Masaki Kunihiro, Toshio Kuwai, Yuko Hiraga, Akira Furudoi, Seiji Onogawa, Hideharu Okanobu, Takeshi Mizumoto, Tomohiro Miwata, Shiro Okamoto, Kenichi Yoshimura, Kazuaki Chayama

Published in: Surgical Endoscopy | Issue 8/2022

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.

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Title: Factors for conversion risk of colorectal endoscopic submucosal dissection: a multicenter study
Authors: Yuki Kamigaichi
Shiro Oka
Shinji Tanaka
Shinji Nagata
Masaki Kunihiro
Toshio Kuwai
Yuko Hiraga
Akira Furudoi
Seiji Onogawa
Hideharu Okanobu
Takeshi Mizumoto
Tomohiro Miwata
Shiro Okamoto
Kenichi Yoshimura
Kazuaki Chayama
Publication date: 17-05-2022
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2022
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-022-09250-6

At a glance: The STEP trials

Springer Medicine

Factors for conversion risk of colorectal endoscopic submucosal dissection: a multicenter study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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