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Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study

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Abstract

Background and study aims

Conventional endoscopic resection (CER) includes polypectomy and endoscopic mucosal resection. The most common complications related to these techniques are post procedure bleeding and perforation. The aim of this study was to evaluate the outcomes of CER for colorectal neoplasms ≧20 mm and to clarify predictive factors for complications.

Patients and methods

We conducted a multicenter prospective study at 18 specialized institutes. From October 2007 to December 2010, 1,029 CERs were performed at participating institutes. We collected the data prospectively and analyzed gender, age, tumor size, gross appearance, mode of resection, etc.

Results

The mean size of polyps resected was 26.4 ± 8.6 mm (range 20–120 mm). The final pathology was Vienna classification category 1 or 2 in 24, category 3 in 502, and category 4 or 5 in 503 lesions. Post procedure bleeding and intra procedure perforation occurred, respectively, in 16 (1.6 %) and 8 cases (0.78 %). The overall complication rate was 2.3 %. Risk factors for bleeding in multivariate analysis were only patients under 60 years of age. Risk factors for perforation in multivariate analysis were en bloc resection and Vienna classification category 4–5. The difference of complication rate was not statistically significant regarding gender, size, tumor location, gross appearance, treatment method, and kind of insufflation.

Conclusion

CER is a safe, efficient, and effective minimally invasive therapy for large colorectal lesions. However, care should be taken for post procedure bleeding in patients under 60 years of age and for perforation in cases of Vienna classification category 4–5 or when an en bloc resection is tried.

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Acknowledgments

This study was carried out within the framework of a project undertaken by the Colorectal Endoscopic Resection Standardization Implementation Working Group supported by JSCCR Grants.

Facilities that participated the study

The patients were enrolled at the 18 institutions affiliated with the Colorectal Endoscopic Resection Standardization Implementation Working Group of JSCCR as follows, 1) Digestive Disease Center, Showa University Northern Yokohama Hospital, Kanagawa, Japan (Yoshiki Wada, Shin-ei Kudo, Hiroshi Kashida), 2) Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan (Shinji Tanaka), 3) Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan (Yutaka Saito), 4) Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan (Hiroyasu Iishi), 5) Department of Gastroenterology & Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan (Hiroaki Ikematsu), 6) Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan (Masahiro Igarashi), 7) Digestive disease center, Asahikawa City Hospital, Hokkaido, Japan (Yuusuke Saitoh), 8) Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan (Yuji Inoue), 9) Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan (Kiyonori Kobayashi), 10) Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan (Takashi Hisasbe), 11) Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan (Osamu Tsuruta), 12) Gastrointestinal Center, Sano Hospital, Hyogo, Japan (Yasushi Sano), 13) Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan (Hiro-o Yamano), 14) Department of Gastroenterology, JR West Osaka Railway Hospital, Osaka, Japan (Seiji Shimizu), 15) Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan (Naohisa Yahagi), 16) Department of Surgery, Teikyo University Hospital, Tokyo, Japan (Toshiaki Watanabe), 17) Department of Gastroenterology, Chofu Surgical Clinic, Tokyo, Japan (Hisashi Nakamura),18) Gastroenterology, Takahiro Fujii Clinic, Tokyo, Japan (Takahiro Fujii)

Disclosures

Yoshiki Wada, Shin-ei Kudo, Shinji Tanaka, Yutaka Saito, Hiroyasu Iishii, Hiroaki Ikematsu, Masahiro Igarashi, Yusuke Saitoh, Yuji Inoue, Kiyonori Kobayashi, Takashi Hisabe, Osamu Tsuruta, Hiroshi Kashida, Hideki Ishikawa and, Kenichi Sugihara have no conflicts of interests or financial ties to disclose.

Author information

Authors and Affiliations

  1. Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, 224-8503, Japan

    Yoshiki Wada, Shin-ei Kudo & Hiroshi Kashida

  2. Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan

    Shinji Tanaka

  3. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Yutaka Saito

  4. Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Hiroyasu Iishii

  5. Department of Gastroenterology & Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan

    Hiroaki Ikematsu

  6. Department of Endoscopy, Cancer Institute Ariake Hospital, Tokyo, Japan

    Masahiro Igarashi

  7. Digestive disease center, Asahikawa City Hospital, Hokkaido, Japan

    Yusuke Saitoh

  8. Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan

    Yuji Inoue

  9. Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Kanagawa, Japan

    Kiyonori Kobayashi

  10. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan

    Takashi Hisabe

  11. Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan

    Osamu Tsuruta

  12. Department of Molecular-Targeting Cancer Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Hideki Ishikawa

  13. Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

Authors
  1. Yoshiki Wada
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  2. Shin-ei Kudo
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  3. Shinji Tanaka
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  4. Yutaka Saito
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  7. Masahiro Igarashi
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  8. Yusuke Saitoh
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  9. Yuji Inoue
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  11. Takashi Hisabe
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  12. Osamu Tsuruta
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  13. Hiroshi Kashida
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  14. Hideki Ishikawa
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  15. Kenichi Sugihara
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Corresponding author

Correspondence to Yoshiki Wada.

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Wada, Y., Kudo, Se., Tanaka, S. et al. Predictive factors for complications in endoscopic resection of large colorectal lesions: a multicenter prospective study. Surg Endosc 29, 1216–1222 (2015). https://doi.org/10.1007/s00464-014-3799-9

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  • DOI: https://doi.org/10.1007/s00464-014-3799-9

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