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Factors influencing interruption of colorectal endoscopic submucosal dissection

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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.

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Abbreviations

ESD:

Endoscopic submucosal dissection

EMR:

Endoscopic mucosal resection

EPMR:

Endoscopic piecemeal mucosal resection

IRB:

Institutional Review Board

JGES:

Japan Gastroenterological Endoscopy Society

LST:

Laterally spreading tumor

OR:

Odds ratio

MRS:

Muscle-retracting sign

pSM2:

Submucosal deep invasive cancer (≥ 1000 µm)

INF:

Infiltration pattern

CI:

Confidence interval

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Authors and Affiliations

  1. Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Takehide Fukuchi, Kingo Hirasawa, Chiko Sato, Makomo Makazu, Ryosuke Kobayashi, Masafumi Nishio, Ryosuke Ikeda & Atsushi Sawada

  2. Department of Biostatistics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Hiroaki Kaneko & Masataka Taguri

  3. Department of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Shin Maeda

Authors
  1. Takehide Fukuchi
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  2. Kingo Hirasawa
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  3. Chiko Sato
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  4. Makomo Makazu
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  5. Hiroaki Kaneko
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  6. Ryosuke Kobayashi
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  7. Masafumi Nishio
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  8. Ryosuke Ikeda
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  9. Atsushi Sawada
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  10. Masataka Taguri
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  11. Shin Maeda
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Contributions

Conception and design (KH, TF); acquisition of data (KH, TF, CS, MM, HK, RI, AS, YO); analysis and interpretation of data (KH, TF, MT, SM); drafting of the article (KH); critical revision of the article (KH, SM); statistical analysis (MT, KH, TF); final approval of the article (KH, SM). All authors listed have contributed substantially to the design, data collection and analysis, and editing of the manuscript.

Corresponding author

Correspondence to Kingo Hirasawa.

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Disclosures

Dr. Takehide Fukuchi, Kingo Hirasawa, Chiko Sato, Makomo Makazu, Hiroaki Kaneko, Ryosuke Kobayashi, Masafumi Nishio, Ryosuke Ikeda, Atsushi Sawada, Masataka Taguri, and Shin Maeda have no conflicts of interest or financial ties to disclose.

Ethical approval

The study and its protocols were approved by the ethical review boards of our hospital (Yokohama City University Certified Institutional Review Board; D1602024). All patients were informed of the risks and benefits of treatment before they underwent the procedure.

Informed consent

Informed consent or alternative versions were obtained from all patients included in the study.

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Fukuchi, T., Hirasawa, K., Sato, C. et al. Factors influencing interruption of colorectal endoscopic submucosal dissection. Surg Endosc 35, 5497–5507 (2021). https://doi.org/10.1007/s00464-020-08042-0

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  • DOI: https://doi.org/10.1007/s00464-020-08042-0

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