Prediction of technically difficult endoscopic submucosal dissection for large superficial colorectal tumors: a novel clinical score model

Predictors of the difficulty for endoscopic resection of gastric gastrointestinal stromal tumor and follow‐up data

“…The difficult procedure is defined with reference to the published literature as (i) a prolonged procedure time (> 90 min, about two times of the median procedure time) or (ii) the presence of clinically significant bleeding (repeated endoscopic hemostasis with a postoperative hemoglobin drop of ≥ 2 g/dL or the need for surgical assistance). 25,26 Procedure time is defined as the time from the start of incision to the completion of closure of the gastric defect after complete tumor removal.…”

Colorectal Endoscopic Submucosal Dissection: An Update on Best Practice

“…Their proposed clinical score comprised the following: tumor size of 30 to 50 mm (1 point) or ≥50 mm (2 points); ≥2/3 circumference of the lesion (2 points); location in the cecum ( easy (score = 0), intermediate (score = 1), difficult (score = 2-3), and very difficult (score ≥4). 48…”

What is important for a smooth implementation of endoscopic submucosal dissection?

“…If the specific procedure is predicted to be risky by this system, we can assign a much more experienced operator for the procedure. By contrast, Li et al 6 developed another scoring model in a Chinese highvolume center that can predict the probability of successful (defined as resection in 60 minutes) colorectal ESD. They identified tumor size, circumference of the lesion, unfavorable anatomic location, and morphology as predictors.…”

“…Especially when the biopsy specimen is taken from the peripheral part of a large and inhomogeneous lesion, it is usually underestimated. Second, it is necessary to check the parameters mentioned by Li et al, 6 the presence of a fold and the presence of fibrosis. All of these parameters are subjective metrics that might be able to be judged by artificial intelligence in the near future.…”

“…If the procedure is judged to be very difficult and maneuverability is also bad, it is a case only for super-experts with extended time schedules or the patient may be a candidate for laparoscopic surgery. Under these circumstances, the scoring model of Li et al 6 in this issue of Gastrointestinal Endoscopy includes most objective parameters and seems useful for planning ESD. However, these data are from a high-level Asian institution; therefore, they are not directly applicable to most Western institutions.…”