Impact of preoperative biopsy sampling on severe submucosal fibrosis on endoscopic submucosal dissection for colorectal laterally spreading tumors: a propensity score analysis

Fukunaga, Shusei; Nagami, Yasuaki; Shiba, Masatsugu; Sakai, Tetsuhiro; Maruyama, Hirotsugu; Ominami, Masaki; Otani, Koji; Hosomi, Shuhei; Tanaka, Fumio; Taira, Koichi; Tanigawa, Tetsuya; Yamagami, Hirokazu; Watanabe, Toshio; Fujiwara, Yasuhiro

doi:10.1016/j.gie.2018.08.051

Cited by 34 publications

(31 citation statements)

References 42 publications

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“…Previous studies demonstrated that biopsy history and delayed ESD after initial biopsy were independent predictive factors for endoscopic submucosal fibrosis ( 12 , 15 ). To test the hypothesis that biopsy is closely related to a higher risk of endoscopic submucosal fibrosis and thus results in more complications of ESD, we first investigated the relationship between biopsy and ESD outcomes.…”

Section: Resultsmentioning

confidence: 93%

“…As shown in Table 4 , to further validate whether the biopsy history is a predictor for submucosal fibrosis, as has been reported elsewhere ( 12 , 15 ), and investigate the other relevant clinicopathologic risk factors, we compared the nonsubmucosal (F0, n = 109) and submucosal fibrosis groups (F1/F2, n = 58). Univariate analysis demonstrated that the 2 groups did not differ significantly regarding average age, gender ratio, alcohol consumption, tumor location, circumferential extension, iodine staining history, and length of lesions (all P > 0.05), which suggested good comparability.…”

Section: Resultsmentioning

confidence: 99%

“…It has been previously reported that biopsy history and delay ESD are important risk factors for submucosal fibrosis ( 15 ), and thus, we included biopsy history, delay ESD, and other significant factors in a multivariate analysis (Table 5 ). Multivariate logistic regression analysis demonstrated that submucosal invasion vs intramucosal tumor (odds ratio [OR] = 4.534, P = 0.003) and current smoking vs nonsmoker (OR = 2.145, P = 0.043) were independent risk factors for endoscopic submucosal fibrosis.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding whether biopsy history and delay ESD had a promoting effect on submucosal fibrosis and thus resulted in more complications of ESD, there was no final conclusion. Fukunaga et al ( 15 ) reported that preoperative biopsy sampling for a colorectal laterally spreading tumor might cause severe submucosal fibrosis but had no adverse effect on ESD outcomes. Huh et al ( 12 ) demonstrated that delayed esophageal ESD is an independent risk factor for submucosal fibrosis, which led to more complications, and thus recommended immediate ESD after biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported that severe submucosal fibrosis leads to difficult separation of the submucosa and muscularis propria during colorectal ESD, which results in a higher incidence of perforation and incomplete resection, and a longer procedure time ( 8 , 14 ). Preoperative biopsy is believed to be an important cause of colorectal submucosal fibrosis ( 15 , 16 ); however, very few studies have focused on the relationship between the degree of submucosal fibrosis in SSEN and outcomes of ESD ( 12 ). In addition, whether a biopsy has a promoting effect on submucosal fibrosis in SSEN, and thus, results in a higher incidence of ESD complications, is still inconclusive.…”

Section: Introductionmentioning

confidence: 99%

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Predictors for Submucosal Fibrosis in Patients With Superficial Squamous Esophageal Neoplasia Undergoing Endoscopic Submucosal Dissection

Zhuang

Chen

et al. 2020

Clin Transl Gastroenterol

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INTRODUCTION: Submucosal fibrosis greatly hinders the success of endoscopic submucosal dissection (ESD). This study determined ESD outcomes in patients with esophageal submucosal fibrosis and further explored the predictors. METHODS: We retrospectively analyzed 163 patients with superficial squamous esophageal neoplasia. The degree of submucosal fibrosis was classified as follows: F0, none; F1, mild; and F2, severe. ESD outcomes as a function of the degree of submucosal fibrosis and biopsy were determined. The potential predictors of submucosal fibrosis were analyzed. RESULTS: En bloc resection, R0 resection, and procedure time were significantly different between the F0-F2 groups ( P = 0.009, P = 0.002, and P < 0.001, respectively). Perforation and immediate bleeding rates of F2 were significantly higher than the F0/F1 groups ( P < 0.001 and P < 0.001, respectively). However, the nonbiopsy group vs the biopsy group and the delayed ESD group (postbiopsy >21 days) vs the early ESD group (postbiopsy ≤21 days) showed no statistical differences regarding the en bloc resection, R0 resection, and ESD complications (all P > 0.05). Further analysis indicated that it was not the biopsy history and delayed ESD (both P > 0.05), rather submucosal invasion vs intramucosal tumor (odds ratio = 4.534, P = 0.003) and current smoker vs nonsmoker (odds ratio = 2.145, P = 0.043) were independent risk factors for endoscopic submucosal fibrosis. DISCUSSION: Esophageal submucosal fibrosis was shown to be closely related to unsatisfactory ESD outcomes. Biopsy history and delayed ESD had no adverse effect on submucosal fibrosis and ESD outcomes. Submucosal invasion and current cigarette smoking were predictors of submucosal fibrosis.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Predictors for Submucosal Fibrosis in Patients With Superficial Squamous Esophageal Neoplasia Undergoing Endoscopic Submucosal Dissection

Zhuang

Chen

et al. 2020

Clin Transl Gastroenterol

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Surgeon assessment of significant rectal polyps using white light endoscopy alone and in comparison to fluorescence-augmented AI lesion classification

Hardy,

Moynihan,

Dalli

et al. 2024

Langenbecks Arch Surg

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Purpose Perioperative decision making for large (> 2 cm) rectal polyps with ambiguous features is complex. The most common intraprocedural assessment is clinician judgement alone while radiological and endoscopic biopsy can provide periprocedural detail. Fluorescence-augmented machine learning (FA-ML) methods may optimise local treatment strategy. Methods Surgeons of varying grades, all performing colonoscopies independently, were asked to visually judge endoscopic videos of large benign and early-stage malignant (potentially suitable for local excision) rectal lesions on an interactive video platform (Mindstamp) with results compared with and between final pathology, radiology and a novel FA-ML classifier. Statistical analyses of data used Fleiss Multi-rater Kappa scoring, Spearman Coefficient and Frequency tables. Results Thirty-two surgeons judged 14 ambiguous polyp videos (7 benign, 7 malignant). In all cancers, initial endoscopic biopsy had yielded false-negative results. Five of each lesion type had had a pre-excision MRI with a 60% false-positive malignancy prediction in benign lesions and a 60% over-staging and 40% equivocal rate in cancers. Average clinical visual cancer judgement accuracy was 49% (with only ‘fair’ inter-rater agreement), many reporting uncertainty and higher reported decision confidence did not correspond to higher accuracy. This compared to 86% ML accuracy. Size was misjudged visually by a mean of 20% with polyp size underestimated in 4/6 and overestimated in 2/6. Subjective narratives regarding decision-making requested for 7/14 lesions revealed wide rationale variation between participants. Conclusion Current available clinical means of ambiguous rectal lesion assessment is suboptimal with wide inter-observer variation. Fluorescence based AI augmentation may advance this field via objective, explainable ML methods.

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Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study

et al. 2019

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Background and Aims: Although advanced high-volume centers have reported good outcomes of colorectal endoscopic submucosal dissection (ESD), a limited number of highly skilled experts in specialized institutions performed these procedures. We undertook a retrospective multicenter survey, which included nonspecialized hospitals, to investigate the clinical outcomes of colorectal ESD. Methods: We recruited 1233 consecutive patients with 1259 colorectal tumors resected by ESD at 12 institutions. We evaluated the en bloc resection rate, histologic complete resection rate, curative (R0) resection rate, adverse events, and the long-term prognoses, including local recurrence, metachronous tumor development, and survival rate. Results: The en bloc, histologic complete, and R0 resection rates were 92.6%, 87.4%, and 83.7%, respectively. The delayed bleeding, intraoperative perforation, and delayed perforation rates were 3.7%, 3.4%, and .4%, respectively. The long-term outcomes analysis included 1091 patients (88.4%). Local recurrences occurred in 1.7%, and metachronous tumors (>5 mm) developed in 11.0% of the patients. The 3-and 5-year overall survival rates were 95.1% and 92.3%, respectively. The number of colonic tumors, severe submucosal fibrosis, and en bloc resection rates were significantly higher in the high-volume centers (Group H) than those in the low-volume centers (Group L). The average tumor size in Group H was significantly larger than that in Group L. Conclusions: Colorectal ESDs are feasible, have acceptable adverse event risks, and favorable long-term prognoses. (Clinical trial registration number: UMIN000016197.) (Gastrointest Endosc 2018;87:714-22.) Abbreviations: ESD, endoscopic submucosal dissection; JSCCR, the Japanese Society for Cancer of the Colon and Rectum; LST-G, laterally spreading tumors of the granular type; LST-NG, laterally spreading tumors of the non-granular type; SD, standard deviation. DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. See CME section: p. 875. Use your mobile device to scan this QR code and watch the author interview. Download a free QR code scanner by searching "QR Scanner" in your mobile device's app store.

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Impact of preoperative biopsy sampling on severe submucosal fibrosis on endoscopic submucosal dissection for colorectal laterally spreading tumors: a propensity score analysis

Abstract: Preoperative biopsy sampling for colorectal LSTs might cause severe submucosal fibrosis but has no adverse influence on clinical outcomes of ESD.

Cited by 34 publications

References 42 publications

Predictors for Submucosal Fibrosis in Patients With Superficial Squamous Esophageal Neoplasia Undergoing Endoscopic Submucosal Dissection

Predictors for Submucosal Fibrosis in Patients With Superficial Squamous Esophageal Neoplasia Undergoing Endoscopic Submucosal Dissection

Surgeon assessment of significant rectal polyps using white light endoscopy alone and in comparison to fluorescence-augmented AI lesion classification

Real-world learning curve analysis of colorectal endoscopic submucosal dissection: a large multicenter study

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