Predictive Factors of Mild and Severe Fibrosis in Colorectal Endoscopic Submucosal Dissection

Chiba, Hideyuki; Tachikawa, Jun; Arimoto, Jun; Ashikari, Keiichi; Kuwabara, Hiromichi; Nakaoka, Michiko; Goto, Toru; Ohata, Ken; Nakajima, Atsushi

doi:10.1007/s10620-019-05735-y

Cited by 31 publications

(30 citation statements)

References 33 publications

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“…In addition, among such polyps, seven (24.1 %) exhibited F2 fibrosis. Endoscopic technology and instruments are improving, but ESD for polyps with severe fibrosis remains challenging [6].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study

Chiba¹,

Tachikawa²,

Arimoto³

et al. 2020

Endoscopy

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Abstract Background Endoscopic resection of large pedunculated colorectal polyps is technically difficult, especially when the polyp is large and has such a thick stalk that it is either too difficult or impossible to resect prophylactically by a conventional snare. Here, we evaluated the feasibility of ESD for large pedunculated polyps with wide stalks. Methods 29 patients with large pedunculated polyps that were not resectable by polypectomy or endoscopic mucosal resection were enrolled in the study. Results En bloc resection was achieved in 28/29 polyps. One suspended case was due to severe fibrosis with muscle retraction signs. The mean diameter of the 29 polyp heads was 39.7 (standard deviation 6.9) mm. Submucosal fibrosis was present in 16 polyps (9 mild; 7 severe). The stalks of severely fibrotic polyps were significantly thicker than those of polyps with no or mild fibrosis. The curative resection rate was 85.7 % without severe complications. Conclusions ESD is feasible for the removal of large pedunculated polyps with wide stalks when conventional snare resection is difficult or impossible.

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“…In addition, among such polyps, seven (24.1 %) exhibited F2 fibrosis. Endoscopic technology and instruments are improving, but ESD for polyps with severe fibrosis remains challenging [6].…”

Section: Discussionmentioning

confidence: 99%

“…We evaluated the outcomes of ESD for large pedunculated lesions, and also investigated the characteristics of lesions with fibrosis, especially severe fibrosis, which occurs with high incidence in large protruded lesions [6].…”

Section: Methodsmentioning

confidence: 99%

Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study

Chiba¹,

Tachikawa²,

Arimoto³

et al. 2020

Endoscopy

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“…The second important risk factor was pretreatment biopsy (severe fibrosis: ORs 8.30, mild fibrosis: ORs 7.21). Few studies have examined the association of submucosal fibrosis and pretreatment biopsy [20-22]. Kim et al [18] reported a lack of association between pretreatment biopsy and submucosal fibrosis in 158 cases (91 cases of biopsy).…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Fibrosis during Colorectal Endoscopic Submucosal Dissection: Does Pretreatment Biopsy Potentially Elicit Submucosal Fibrosis and Affect Endoscopic Submucosal Dissection Outcomes?

et al. 2020

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Background: Submucosal fibrosis observed during colorectal endoscopic submucosal dissection (ESD) is an important factor related to incomplete resection. Biopsy is generally accepted as having the potential to elicit submucosal fibrosis, but few reports have presented definitive proof. This study investigated the relation between submucosal fibrosis and colorectal ESD outcomes and assessed factors related to fibrosis, including pretreatment biopsy. Methods: After reviewing 369 records of colorectal ESD performed between January 2011 and December 2016, we assessed the relation between fibrosis and ESD outcomes. Multiple logistic regression analysis revealed fibrosis risk factors. Results: Severe fibrosis was related significantly to ESD outcomes such as the mean procedure time (p < 0.001), en bloc resection rate (p < 0.001), and R0 resection rate (p = 0.011). Multivariate analyses indicated residual lesions (ORs 175.4, p < 0.001), pretreatment biopsy (ORs 8.30, p = 0.002), nongranular-type laterally spreading tumors (LST-NG; ORs 5.86, p = 0.025), and invasive carcinoma (ORs 5.83, p = 0.03) as independent risk factors of severe fibrosis. In each macroscopic type, LST-NG was more strongly related to fibrosis induced by pretreatment than granular-type laterally spreading tumors with adjust ORs of 50.8 and 4.69. Conclusions: Pretreatment biopsy causes submucosal fibrosis resulting in prolonged procedure times and incomplete resection. These findings suggest important benefits of avoiding biopsy before ESD.

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“…The expert took over the operation from the trainee when any of the following conditions were met: (1) the total procedure time exceeded about 2 h; (2) perforation occurred or was likely to have occurred; (3) continuation of the procedure seemed difficult; or (4) a better resection method needed to be taught. The mucosal incision was made using the End-cut I mode (effect 2, duration 2, interval 2), and the submucosal dissection was performed primarily in the End-cut I mode and sometimes in swift coagulation mode (effect 2, 45 W) for submucosal areas rich in vessels or fat tissue [9].…”

Section: Esd Proceduresmentioning

confidence: 99%

“…Although ESD for large lesions has become possible, mainly in Japan and Asia [7], such procedures remain challenging in Western countries. Several reports have described the difficulties of treating such lesions, including fibrosis and poor scope manipulation [8,9], but no reports have examined the relationship between ESD and obesity. According to a Korean study, gastric ESD in obese patients was associated with a longer procedure time; however, no differences in the complication rates and en bloc resection rates were seen [10].…”

Section: Introductionmentioning

confidence: 99%

Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study

Tachikawa

Chiba²,

Okada³

et al. 2021

BMC Gastroenterol

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Background When performing colorectal endoscopic submucosal dissection (ESD) in obese patients, technically difficult cases are sometimes experienced because of difficulty with the insertion of the colonoscope, poor scope maneuverability, or an abundance of fat tissue in the submucosal layer. Since the association between obesity and colorectal ESD has not been investigated, we evaluated the clinical impact of obesity in patients who underwent colorectal ESD. Methods We retrospectively reviewed 535 patients who underwent colorectal ESD between April 2012 and February 2019. Patients were divided into three groups based on their body mass index (BMI): a control group (BMI < 25 kg/m2), an overweight group (25 kg/m2 ≤ BMI < 30 kg/m2), and an obese group (BMI ≥ 30 kg/m2), and the short-term clinical outcomes were analyzed to assess the safety and difficulty of colorectal ESD. Results No significant difference in the procedure times, en bloc resection rates, pathological diagnoses, or complications were seen among the groups. While the amount of sedative per body weight was significantly lower in the group with a higher BMI (flunitrazepam: 1.75 × 10−2 [1.27 × 10−2–2.34 × 10−2] mg/kg vs. 1.48 × 10−2 [1.08 × 10−2–2.03 × 10−2] mg/kg vs. 1.16 × 10−2 [0.98 × 10−2–1.54 × 10−2] mg/kg, P < 0.001; pethidine: 0.63 [0.55–0.72] mg/kg vs. 0.50 [0.46–0.56] mg/kg vs. 0.39 [0.32–0.45] mg/kg, P < 0.001), a reduction in percutaneous arterial oxygen saturation occurred significantly more frequently in the group with a higher BMI (123 [30.2%] vs. 43 [43.9%] vs. 10 [55.6%], P = 0.005). When the procedures were performed by trainees, the number of cases that required a procedure time of longer than 90 min was significantly larger in the group with a higher BMI (27 [10.8%] vs. 14 [21.9%] vs. 3 [25.0%], P = 0.033). Conclusions This study showed that colorectal ESD could be performed safely and effectively in obese patients. However, ESD in obese patients requires attention, particularly to changes in respiratory conditions.

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Predictive Factors of Mild and Severe Fibrosis in Colorectal Endoscopic Submucosal Dissection

Cited by 31 publications

References 33 publications

Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study

Endoscopic submucosal dissection of large pedunculated polyps with wide stalks: a retrospective multicenter study

Factors Associated with Fibrosis during Colorectal Endoscopic Submucosal Dissection: Does Pretreatment Biopsy Potentially Elicit Submucosal Fibrosis and Affect Endoscopic Submucosal Dissection Outcomes?

Impact of obesity in colorectal endoscopic submucosal dissection: single-center retrospective cohort study

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