Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.

    Article  Google Scholar 

  2. Zauber AG, Winawer SJ, O’Brien MJ, et al. Colonoscopic polypectomy and long-term prevention of colorectal-cancer deaths. N Engl J Med. 2012;366:687–696.

    Article  CAS  Google Scholar 

  3. Gorgun E, Benlice C, Abbas MA, et al. Experience in colon sparing surgery in North America: advanced endoscopic approaches for complex colorectal lesions. Surg Endosc. 2018;32:3114–3121.

    Article  Google Scholar 

  4. Sauer M, Hildenbrand R, Oyama T, et al. Endoscopic submucosal dissection for flat or sessile colorectal neoplasia >  20 mm: a European single-center series of 182 cases. Endosc Int Open. 2016;4:E895–E900.

    Article  Google Scholar 

  5. Chiba H, Ohata K, Ohno A, et al. Perforation with retroperitoneal emphysema after endoscopic submucosal dissection for a rectal carcinoid tumor. Endoscopy. 2010;42:E85–E86.

    Article  Google Scholar 

  6. Arimoto J, Higurashi T, Chiba H, et al. Continued use of a single antiplatelet agent does not increase the risk of delayed bleeding after colorectal endoscopic submucosal dissection. Dig Dis Sci. 2018;63:218–227.

    Article  CAS  Google Scholar 

  7. Arimoto J, Higurashi T, Kato S, et al. Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study. Endosc Int Open. 2018;6:E342–E349.

    Article  Google Scholar 

  8. Chiba H, Ohata K, Tachikawa J, et al. Delayed bleeding after colorectal endoscopic submucosal dissection: When is emergency colonoscopy needed? Dig Dis Sci. 2018;64:880–887.

    Article  Google Scholar 

  9. Makino T, Kanmura S, Sasaki F, et al. Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography. Endosc Int Open. 2015;3:E363–E367.

    Article  Google Scholar 

  10. Imai K, Hotta K, Yamaguchi Y, et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc. 2016;83:954–962.

    Article  Google Scholar 

  11. Matsumoto A, Tanaka S, Oba S, et al. Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol. 2010;45:1329–1337.

    Article  Google Scholar 

  12. Tamegai Y, Kisihara T, Fukunaga Y, et al. Endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis in the submucosal layer. Gastroenterol Endosc. 2015;57:259–271.

    Google Scholar 

  13. Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27:417–434.

    Article  Google Scholar 

  14. Uraoka T, Saito Y, Matsuda T, et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006;55:1592–1597.

    Article  CAS  Google Scholar 

  15. Hotta K, Yamaguchi Y, Saito Y, et al. Current opinions for endoscopic submucosal dissection for colorectal tumors from our experiences: indications, technical aspects and complications. Dig Endosc. 2012;24:110–116.

    Article  Google Scholar 

  16. Watanabe T, Itabashi M, Shimada Y, et al. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2014 for treatment of colorectal cancer. Int J Clin Oncol. 2015;20:207–239.

    Article  Google Scholar 

  17. Mizushima T, Kato M, Iwanaga I, et al. Technical difficulty according to location, and risk factors for perforation, in endoscopic submucosal dissection of colorectal tumors. Surg Endosc. 2015;29:133–139.

    Article  Google Scholar 

  18. Kim ES, Cho KB, Park KS, et al. Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy. 2011;43:573–578.

    Article  CAS  Google Scholar 

  19. Isomoto H, Nishiyama H, Yamaguchi N, et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy. 2009;41:679–683.

    Article  CAS  Google Scholar 

  20. Hotta K, Oyama T, Shinohara T, et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc. 2010;22:302–306.

    Article  Google Scholar 

  21. Seo M, Yang DH, Kim J, et al. Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection. Turk J Gastroenterol. 2018;29:473–480.

    Article  Google Scholar 

  22. Iacopini F, Saito Y, Bella A, et al. Colorectal endoscopic submucosal dissection: predictors and neoplasm-related gradients of difficulty. Endosc Int Open. 2017;5:E839–E846.

    Article  Google Scholar 

  23. Pérez-Cuadrado-Robles E, Snauwaert C, Moreels TG, et al. Risk factors for conversion to snare resection during colorectal endoscopic submucosal dissection in an expert Western center. Endoscopy. 2019;51:152–160.

    Article  Google Scholar 

  24. Suzuki T, Hara T, Kitagawa Y, et al. Feasibility of endoscopic submucosal dissection for cecal lesions. Scand J Gastroenterol. 2018;53:359–364.

    Article  Google Scholar 

  25. Kim HG, Thosani N, Banerjee S, et al. Effect of prior biopsy sampling, tattoo placement, and snare sampling on endoscopic resection of large nonpedunculated colorectal lesions. Gastrointest Endosc. 2015;81:204–213.

    Article  Google Scholar 

  26. Fukunaga S, Nagami Y, Shiba M, et al. Impact of preoperative biopsy sampling on severe submucosal fibrosis on endoscopic submucosal dissection for colorectal laterally spreading tumors: a propensity score analysis. Gastrointest Endosc. 2019;89:470–478.

    Article  Google Scholar 

  27. Toyonaga T, Man-i M, Fujita T, et al. Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum. Endoscopy. 2010;42:714–722.

    Article  CAS  Google Scholar 

  28. Toyonaga T, Tanaka S, Man-I M, et al. Clinical significance of the muscle-retracting sign during colorectal endoscopic submucosal dissection. Endosc Int Open. 2015;3:E246–E251.

    Article  Google Scholar 

  29. Chiba H, Ohata K, Takita M, et al. Double-tunnel method for treatment of colorectal lesions with severe fibrosis with endoscopic submucosal dissection. Endoscopy. 2018;50:E168–E169.

    Article  Google Scholar 

  30. Fujihara S, Mori H, Kobara H, et al. The efficacy and safety of prophylactic closure for a large mucosal defect after colorectal endoscopic submucosal dissection. Oncol Rep. 2013;30:85–90.

    Article  Google Scholar 

  31. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest. Endosc. 2010;72:1217–1225.

    Article  Google Scholar 

  32. Ohata K, Nonaka K, Minato Y, et al. Endoscopic submucosal dissection for large colorectal tumor in a Japanese general hospital. J Oncol. 2013;2013:218670.

    Article  Google Scholar 

  33. Ohata K, Ito T, Chiba H, et al. Effective training system in colorectal endoscopic submucosal dissection. Dig Endosc. 2012;24:84–89.

    Article  Google Scholar 

  34. Chiba H, Tachikawa J, Kurihara D, et al. Safety and efficacy of simultaneous colorectal ESD for large synchronous colorectal lesions. Endosc Int Open. 2017;5:E595–E602.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-8527, Japan

    Hideyuki Chiba, Jun Tachikawa, Jun Arimoto, Hiroki Kuwabara, Michiko Nakaoka & Toru Goto

  2. Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, 236-0004, Japan

    Keiichi Ashikari & Atsushi Nakajima

  3. Department of Gastroenterology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-Ku, Tokyo, 141-8625, Japan

    Ken Ohata

Authors
  1. Hideyuki Chiba
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun Tachikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jun Arimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keiichi Ashikari
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroki Kuwabara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michiko Nakaoka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toru Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ken Ohata
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Atsushi Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideyuki Chiba.

Ethics declarations

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).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiba, H., Tachikawa, J., Arimoto, J. et al. Predictive Factors of Mild and Severe Fibrosis in Colorectal Endoscopic Submucosal Dissection. Dig Dis Sci 65, 232–242 (2020). https://doi.org/10.1007/s10620-019-05735-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-019-05735-y

Keywords

Search

Navigation