Factors influencing interruption of colorectal endoscopic submucosal dissection
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and Other Interventional Techniques
Factors influencing interruption of colorectal endoscopic submucosal dissection Takehide Fukuchi1 · Kingo Hirasawa1 · Chiko Sato1 · Makomo Makazu1 · Hiroaki Kaneko2 · Ryosuke Kobayashi1 · Masafumi Nishio1 · Ryosuke Ikeda1 · Atsushi Sawada1 · Masataka Taguri2 · Shin Maeda3 Received: 30 September 2019 / Accepted: 22 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background and aims Although colorectal endoscopic submucosal dissection (ESD) has become a standardized procedure worldwide, the difficulty of the procedure is well known. However, there have been no studies assessing the causes of treatment interruption. The present study aimed to evaluate the factors involved in the interruption of colorectal ESD. Methods We retrospectively analyzed 1116 consecutive superficial colorectal neoplasms of 1012 patients who were treated with ESD between August 2008 and September 2018. The clinicopathological characteristics and treatment outcomes were analyzed. Results Interrupted ESD was reported in 14 lesions (1.3%) of the total study population. Univariate analysis of clinical characteristics indicated that age, 0–I macroscopic-type tumor, and tumor location on the left side colon were risk factors for interruption. Multivariate analysis revealed that 0–I macroscopic-type tumor was the sole preoperative independent risk factor for interruption. Univariate analysis revealed that the presence of muscle-retracting sign (MRS), deep submucosal tumor invasion, and intermediate invasive growth pattern represented the etiology of interruption. Multivariate analysis indicated that MRS can be a sole key sign for the interruption. Additionally, the resectability and curability of 0–I type tumors were significantly inferior to those of predominantly lateral spreading tumors. Observations of 0–I macroscopic-type tumors, MRS, and submucosal deep invasion were significantly more frequent in interrupted cases. Conventional endoscopic images without magnification endoscopy were more associated with interruption than irregular surfaces or Vi pit patterns in cases with 0–I type tumors. Conclusion ESD of 0–I type tumors is highly disruptive, and undiagnosable submucosal infiltration can reduce the curability. Keywords Colorectal neoplasm · Endoscopic submucosal dissection · Interruption · Protruding tumor · Muscle-retracting sign Abbreviations ESD Endoscopic submucosal dissection EMR Endoscopic mucosal resection EPMR Endoscopic piecemeal mucosal resection IRB Institutional Review Board * Kingo Hirasawa kingo_h@yokohama‑cu.ac.jp 1
Division of Endoscopy, Yokohama City University Medical Center, 4‑57 Urafune‑cho, Minami‑ku, Yokohama 232‑0024, Japan
2
Department of Biostatistics, Yokohama City University Graduate School of Medicine, 3‑9 Fukuura, Kanazawa‑ku, Yokohama 236‑0004, Japan
3
Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3‑9 Fukuura, Kanazawa‑ku, Yokohama 236‑0004, Japan
JGES Japan Gastroent
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