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Published in:

01-04-2017

Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD

Authors: Ji Ha Kim, Hyeong Seok Nam, Cheol Woong Choi, Dae Hwan Kang, Hyung Wook Kim, Su Bum Park, Su Jin Kim, Sun Hwi Hwang, Si Hak Lee

Published in: Surgical Endoscopy | Issue 4/2017

Abstract

Background and study aim

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for superficial gastric neoplasms. Difficult ESD can lead to complications, such as bleeding and perforation. To predict difficult ESD procedures, we analyzed the factors associated with difficult ESD.

Patients and methods

The medical records of 1052 ESD procedures were retrospectively reviewed. Difficult ESD was defined by any one of three end points: longer procedure time (≥60 min), piecemeal resection, incomplete (R1) resection, or gastric wall perforation. To determine the factors associated with difficult ESD, clinical and pathologic features and endoscopic findings were analyzed.

Results

The rates of en bloc resection and curative (R0) resection were 93.3 and 92.4 %, respectively. The mean procedure time was 27.7 ± 16.7 min. After multivariate analysis, larger tumor size (≥20 mm) was an independent risk factor for longer procedure time (OR 4.1, P < 0.001), for piecemeal resection (OR 2.3, P = 0.003) and incomplete (R1) resection (OR 2.1, P = 0.005). Location of the lesion (upper third) was an independent risk factor for longer procedure time (OR 5.8, P < 0.001), for piecemeal resection (OR 4.1, P < 0.001) and incomplete (R1) resection (OR 4.5, P < 0.001). Submucosal fibrosis was an independent risk factor for longer procedure time (OR 9.7, P < 0.001), for piecemeal resection (OR 2.4, P < 0.001) and incomplete (R1) resection (OR 2.6, P < 0.001). Finally, submucosal invasive gastric cancer was an independent risk factor for piecemeal resection (OR 2.6, P = 0.008), for perforation (OR 19.3, P = 0.001) and for incomplete (R1) resection (OR 2.7, P = 0.001).

Conclusions

Difficult ESD procedures are a function of the lesion size and location, submucosal fibrosis, and submucosal invasive cancer. When a difficult ESD procedure is expected, appropriate preparations should be considered, including consultation with more experienced endoscopists.

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Title: Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD
Authors: Ji Ha Kim
Hyeong Seok Nam
Cheol Woong Choi
Dae Hwan Kang
Hyung Wook Kim
Su Bum Park
Su Jin Kim
Sun Hwi Hwang
Si Hak Lee
Publication date: 01-04-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 4/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5149-6

At a glance: The STEP trials

Springer Medicine

Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD

Abstract

Background and study aim

Patients and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background and study aim

Patients and methods

Results

Conclusions

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