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

  • Hideyuki ChibaEmail author
  • Jun Tachikawa
  • Jun Arimoto
  • Keiichi Ashikari
  • Hiroki Kuwabara
  • Michiko Nakaoka
  • Toru Goto
  • Ken Ohata
  • Atsushi Nakajima
Original Article

Abstract

Background and Study Aims

Varying degrees of fibrosis in colorectal endoscopic submucosal dissection (ESD) make the procedure difficult. Consensus on the predictive factors of fibrosis degree (mild or severe) has not been established. We conducted a study to identify the predictive factors and to examine the feasibility of ESD for fibrotic lesions.

Patients and Methods

We included 518 patients who had undergone ESD for 558 lesions from April 2012–September 2018. Patients were classified into fibrosis or no-fibrosis groups, and logistic regression analysis was performed to identify predictive factors of fibrosis. Subgroup analyses were performed for fibrosis degree.

Results

The total incidence of fibrosis was 21.1% (mild: 14.1%; severe: 7.1%). Although the curative resection rate (free margin: invasion depth less than 1000 μm: no lymphatic invasion, vascular involvement) was lower in the fibrosis group compared with the control (80.7% vs. 97.6%), neither the en bloc resection rate (99.1% vs. 100%) nor incidence of perforation (0.9% vs. 0.2%) differed between the two groups. Multivariate analysis revealed that a cecal location, preoperative biopsy, straddling fold, laterally spreading tumor–non-granular-pseudo-depressed (LST-NG-PD) type were predictive of mild fibrosis. The presence of a straddling fold and a protruded lesion were independent predictive factors of severe fibrosis.

Conclusions

We identified the predictive factors of mild and severe fibrosis. It is preferable that a more experienced physician performs ESD for the lesions with F2 fibrosis.

Keywords

Fibrosis Endoscopic submucosal dissection Colorectal cancer Complication 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

The study was conducted in accordance with the principles laid down in the Declaration of Helsinki, and with the approval of the Institutional Review Board of our hospital (No.18-45).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyOmori Red Cross HospitalOta-KuJapan
  2. 2.Department of Gastroenterology and HepatologyYokohama City University School of MedicineYokohamaJapan
  3. 3.Department of GastroenterologyNTT Medical Center TokyoShinagawa-KuJapan

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