Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms

Isomoto, Hajime; Nishiyama, Hitoshi; Yamaguchi, Naoyuki; Fukuda, Eiichiro; Ishii, Hiroyuki; Ikeda, Kenji; Ohnita, Ken; Nakao, Kazuwa; Kohno, Shigeru; Shikuwa, Saburo

doi:10.1055/s-0029-1214979

Cited by 200 publications

(191 citation statements)

References 13 publications

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“…Delayed perforation as a serious complication after ESD was demonstrated in several studies, with rates ranging from 0.3-0.7%. 25,26,33 No case of delayed perforation was verified in our study.…”

Section: Discussionmentioning

confidence: 48%

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Lee

Kim

Park

et al. 2014

Korean J Gastroenterol

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Background/Aims: Endoscopic submucosal dissection (ESD) is an effective procedure for en-bloc curative resection of the colorectal tumor. As it requires high technical skills and experience in therapeutic endoscopy, it is important to understand learning curve of ESD technique. The aim of this study was to retrospectively describe the clinical results of ESD and to evaluate learning curve for the ESD of colorectal tumors. Methods: A total of 90 patients with 90 colorectal neoplasms, who had undergone ESD at a tertiary referral hospital from July 2009 to December 2012, were enrolled. The ESD was performed by a single endoscopist. All ESD cases were divided into three periods: first, cases 1-30; second, cases 31-60; and third, cases 61-90. Results: The en-bloc resection rates in third period (100%) was significantly higher than that of the first (93.3%) and second period (80%) (p=0.025). The perforation rate in third period (0%) also significantly decreased compared with that of the first (13.3%) and second period (20%) (p=0.032). To calibrate the difference of tumor size among periods, proficiency was calculated, as the procedure time per specimen area (min/cm 2 ). The proficiency in third period (4.3) was significantly shorter than that of the first (16.8) and second period (10.2) (p=0.004). Conclusions: The learning curve of colorectal ESD in our study shows that at least 60 cases of ESD have to be conducted to acquire sufficient skill of degree without perforation. (Korean J Gastroenterol 2014;64:198-205)

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Section: Discussionmentioning

confidence: 48%

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Lee

Kim

Park

et al. 2014

Korean J Gastroenterol

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“…Factors such as large tumor size, laterally spreading tumors, tumor location (right-sided colon), submucosal injection without hyaluronic acid, severe fibrosis, and deep-submucosally invasive cancer were associated with a higher rate of perforation in other studies [8,10,20,21] . On the other hand, poor endoscopic operability was also reported to be related with perforation [22] .…”

mentioning

confidence: 67%

“…tumors and fibrosis were significantly associated with incomplete en bloc resection [20] . Another study reported that poor endoscopic operability and deep submucosal invasion were significantly related to incomplete en bloc resection [21] . Similar to these reports, our present study showed that severe fibrosis and difficult manipulation were related to incomplete resection.…”

Section: Discussionmentioning

confidence: 99%

Difficult Manipulation is One of the Risk Factors for Incomplete Resection in Colorectal Endoscopic Submucosal Dissection

Yoshida

Fernandopulle

Murakami

et al. 2016

Journal of Gastroenterology and Hepatology Research

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AIM:Colorectal endoscopic submucosal dissection (ESD) remains a difficult procedure, even for experts. Difficult manipulation during procedure is one of the most important problems in colorectal ESD. In this study, we analyzed the risk factors for incomplete resection in colorectal ESD, focusing on difficult manipulation. MATERIALS AND METHODS:We retrospectively analyzed 405 consecutive tumors for which ESD was performed at the Kyoto Prefectural University of Medicine from 2010 to 2013 by a single expert endoscopist with extensive ESD experiences. The relationship between incomplete resection and clinicopathological factors were examined. Additionally, multivariate analysis was performed to examine risk factors of difficult manipulation. RESULTS:The rate of incomplete resection was 3.2%. The rates of severe fibrosis, difficult manipulation, and perforation were 10.8%, 23.5%, and 2.7%, respectively. Multivariate analyses showed that severe fibrosis (OR: 26.395, 95% CI: 6.587-105.764, p < 0.

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“…In Japan and some other Western and Asian countries, endoscopic submucosal dissection (ESD) is reported to be an efficient treatment with a high rate of en bloc resection for large colorectal tumors and it is considered less invasive than laparoscopic colectomy (LAC) [75][76][77][78][79][80][81][82][83]. However, ESD can be a time-consuming procedure and carries a higher risk of perforation than EMR [81,82].…”

Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

“…Thirdly, lesions other than these cases can be an indication for ESD, including mucosal lesions with fibrosis caused by prolapse due to biopsy or peristalsis of the lesions, local residual early cancer after endoscopic resection, and sporadic localized tumors in chronic inflammation such as ulcerative colitis. The rate of en bloc resection for large colorectal tumors by ESD has been reported to be 80-98.9% [75][76][77][78][79][80][81][82][83] (Table 6). However, the procedure has not been standardized because of its associated technical difficulties.…”

Section: Endoscopic Submucosal Dissectionmentioning

confidence: 99%

Therapeutic and Diagnostic Approaches in Colonoscopy

Yoshida¹,

Yagi²,

Inada³

et al. 2013

Endoscopy of GI Tract

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Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms

Abstract: The present study provides useful information for predicting risks for incomplete resection and complication in colorectal ESD.

Cited by 200 publications

References 13 publications

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Chronological Outcomes and Learning Curve of Endoscopic Submucosal Dissection for Colorectal Tumors

Difficult Manipulation is One of the Risk Factors for Incomplete Resection in Colorectal Endoscopic Submucosal Dissection

Therapeutic and Diagnostic Approaches in Colonoscopy

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