Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study

Abstract Background and study aims Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS). Patients and methods This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure. Results PECS occurred in 15/106 (14.2 %), and 10 were women (P = 0.01, OR: 7.74 [1.6 – 36.4]), 7 had lesions in the cecum (P < 0.001, OR: 20.6 [3.7 – 115.2]), and 9 in whom ESD operation time was > 90 min (P = 0.002, OR: 10.3 [2.4 – 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P < 0.001, OR: 38.9 [6.9 – 219.6]), and hospital stay was significantly longer in the PECS group. Conclusions Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS.

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Factors limiting the endoscopic submucosal dissection in colorectal tumors

Koloproktologia ◽

10.33878/2073-7556-2021-20-2-50-56 ◽

2021 ◽

Vol 20 (2) ◽

pp. 50-56

Author(s):

A. A. Likutov ◽

D. A. Mtvralashvili ◽

M. A. Nagudov ◽

O. M. Yugai ◽

Yu. E. Vaganov ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Submucosal Dissection ◽

Significant Risk ◽

Resection Margins ◽

R0 Resection ◽

Vascular Pattern ◽

Colorectal Tumors ◽

En Bloc ◽

Submucosal Dissection ◽

Median Size

Aim: to identify the risk factors for conversion of endoscopic submucosal dissection to abdominal surgery.Patients and methods: the prospective cohort study included 405 patients: 166 (40.9%) males and 239 (59.1%) females. The median age was 66 (59; 72) years old; the patients underwent endoscopic submucosal dissection of colorectal epithelial neoplasms.Results: the median size of the removed neoplasms was 3.0 (2.4; 4) cm, tumor was removed en bloc in 324/363 (89.2%) cases; and R0 resection margins were detected in 218/324 (67.3%) cases. Significant risk factors for conversion were: the tumor size ≥ 3.2 cm (OR 2.9, 95% CI 1.2–7.1, p = 0.017), lifting ≤ 3 mm (OR 41, 95% CI 15–105, p = 0.000002) and the tumor vascular pattern IIIa according Sano’s capillary pattern classification (OR 4.0, 95% CI 1.3–11.9, p = 0.013).Conclusion: endoscopic submucosal dissection is a safe way to remove colorectal neoplasms. However, the presence of conversion risk factors can influence the outcome of endoscopic treatment.

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FA03.03: RISK FACTORS FOR MALLORY-WEISS TEAR DURING ENDOSCOPIC SUBMUCOSAL DISSECTION OF SUPERFICIAL ESOPHAGEAL NEOPLASMS

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa03.03 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 6-6

Author(s):

Wei Chen ◽

Junchao Wu ◽

Tao Gan ◽

Jinlin Yang

Keyword(s):

Risk Factors ◽

Endoscopic Submucosal Dissection ◽

Esophageal Neoplasms ◽

Conflicts Of Interest ◽

Female Gender ◽

Mucosal Healing ◽

Clinicopathological Characteristics ◽

Massive Hemorrhage ◽

Submucosal Dissection ◽

Decompression Tube

Abstract Background Adverse events such as perforation and bleeding during endoscopic submucosal dissection (ESD) of superficial esophageal neoplasms have been well acquainted. However, Mallory Weiss Tear (MWT) during esophageal ESD is still under obscurity. Therefore, this study was carried out to elucidate the incidence and risk factors for MWT during esophageal ESD. Methods Patients received ESD for superficial esophageal neoplasms from June, 2014 to July 2017 in our institution were retrospectively analyzed. Clinicopathological characteristics of the patients were collected. Patients were allocated into MWT group or non-MWT group based on the presence of MWT occurred during ESD. The incidence of MWT was determined and the risk factors for MWT were identified. Results A total of 337 patients with 373 lesions treated by ESD were analyzed. 20 patients developed MWT during ESD (5.4%). Multivariate analysis identified female gender (OR = 5.36, 95%CI: 1.47–19.50, P = 0.011) and procedure time (OR = 1.01, 95%CI: 1.00–1.02, P = 0.048) were independent risk factors for MWT during ESD. The characteristics of the esophageal lesions had no influence on the development of MWT. The vast majority of patients with MWT did not receive endoscopic treatment for the laceration and seven of the MWT patients received endoscopic hemostasis using APC, hemoclips, or hemoclips combined with endoloop. All the patients recovered satisfactorily without surgery for the laceration. We believe the placement of gastrointestinal decompression tube and the use of PPI and hemostatic drugs after ESD contributed to the hemostasis and mucosal healing. Conclusion The incidence of MWT during esophageal ESD was much higher than expected. Although most cases had a benign course, fetal conditions such as massive hemorrhage may also occur. We recommend an inspection of the stomach after ESD procedure in order to take timely management in case of bleeding MWT or even perforation outside the procedure region. Disclosure All authors have declared no conflicts of interest.

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Lesion size and circumferential range identified as independent risk factors for esophageal stricture after endoscopic submucosal dissection

Surgical Endoscopy ◽

10.1007/s00464-020-07368-z ◽

2020 ◽

Vol 34 (9) ◽

pp. 4065-4071 ◽

Cited By ~ 2

Author(s):

Meihong Chen ◽

Yini Dang ◽

Chao Ding ◽

Jiajia Yang ◽

Xinmin Si ◽

...

Keyword(s):

Risk Factors ◽

Endoscopic Submucosal Dissection ◽

Esophageal Stricture ◽

Lesion Size ◽

Submucosal Dissection ◽

Independent Risk Factors

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The risk factors for prolonged hemostatic clip retention after endoscopic submucosal dissection for gastric neoplasm

Surgical Endoscopy ◽

10.1007/s00464-021-08379-0 ◽

2021 ◽

Author(s):

Sang Hoon Kim ◽

Jun Kyu Lee ◽

Yun Jeong Lim ◽

Jae Hak Kim

Keyword(s):

Risk Factors ◽

Endoscopic Submucosal Dissection ◽

Gastric Neoplasm ◽

Submucosal Dissection

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Endoscopic submucosal dissection of early-stage rectal cancer using full-time red dichromatic imaging to minimize and avoid significant bleeding

VideoGIE ◽

10.1016/j.vgie.2020.12.001 ◽

2021 ◽

Author(s):

Aoi Kita ◽

Hirohito Tanaka ◽

Hemchand Ramberan ◽

Shiko Kuribayashi ◽

Toshio Uraoka

Keyword(s):

Rectal Cancer ◽

Endoscopic Submucosal Dissection ◽

Early Stage ◽

Full Time ◽

Submucosal Dissection

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Acceptability of endoscopic submucosal dissection for sessile serrated lesions: comparison with non-sessile serrated lesions

Endoscopy International Open ◽

10.1055/a-1268-7353 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1832-E1839

Author(s):

Yuichiro Kuroki ◽

Toshiyuki Endo ◽

Kenta Iwahashi ◽

Naoki Miyao ◽

Reika Suzuki ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Postoperative Bleeding ◽

En Bloc Resection ◽

Tumor Location ◽

Proximal Colon ◽

R0 Resection ◽

Resection Rate ◽

En Bloc ◽

Submucosal Dissection ◽

Serrated Lesions

Abstract Background and study aims Sessile serrated lesions (SSL) are major precursor lesions of serrated pathway cancers, and appropriate treatment may prevent interval colorectal cancer. Studies have reported the outcomes of endoscopic mucosal resection (EMR) for SSL; however, there are insufficient reports on endoscopic submucosal dissection (ESD). We examined the characteristics and outcomes of SSL and compared them to those of non-SSL in ESD. Patients and methods We reviewed 370 consecutive cases in 322 patients who underwent colorectal ESD between January 2016 and March 2020 at our hospital. There were 267 0-IIa lesions that were stratified into 41 SSL and 226 non-SSL (intramucosal cancer, adenoma) cases. We used propensity matching to adjust for the variances in the factors affecting treatment between the SSL and non-SSL groups. Results In the baseline cases, young women and proximal colon tumor location were significantly more common in the SSL group. There were no statistically significant differences between the SSL and non-SSL groups in terms of en bloc resection rate (97.6 % vs. 99.6 %; P = 0.28), R0 resection rate (92.7 % vs. 93.4 %; P = 0.74), perforation (0 % vs. 0.9 %; P > 0.99), and postoperative bleeding (2.4 % vs. 1.8 %; P = 0.56). Thirty-eight pairs were matched using propensity score, and the median dissection speed (12 vs. 7.7 cm2/h; P = 0.0095) was significantly faster in the SSL than in the non-SSL group. Conclusions ESD for SSL was safely performed, and SSL was smoother to remove than non-SSL. ESD might be an acceptable endoscopic treatment option for SSL.

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