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Factors Predictive of Complete Excision of Large Colorectal Neoplasia Using Hybrid Endoscopic Submucosal Dissection: A KASID Multicenter Study
- Source :
- Digestive Diseases and Sciences. 63:2773-2779
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- Endoscopic submucosal dissection (ESD) with snaring (hybrid ESD) bridges the gap between ESD and endoscopic mucosal resection. We evaluated factors predictive of en bloc and complete resection of large colorectal neoplasms using hybrid ESD.This was a prospective clinical study of 78 patients who underwent hybrid ESD for excision of colorectal neoplasms (≥ 2 cm) between May 2015 and September 2016 at six university hospitals. We evaluated lesion and patient characteristics, endoscopist experience level ( 50 or ≥ 50 cases with colorectal ESD), and technical factors such as concurrent fibrosis, completion of a circumferential incision, degree of submucosal dissection ( 50 or ≥ 50%), and visualization during snaring ( 50 or ≥ 50%).Multivariate analyses showed that the en bloc resection rate was significantly related to the degree of visualization during snaring (odds ratio (OR) 7.811, 95% confidence interval [CI] 1.722-35.426; p = 0.008) and the presence of fibrosis (OR 0.258, 95% CI 0.68-0.993; p = 0.049). The complete resection rate was significantly related to the colorectal ESD endoscopist skill level (OR 5.626, 95% CI 1.485-21.313; p = 0.011) and gross lesion type (OR 0.145, 95% CI 0.022-0.936; p = 0.042). When all three technical factors, i.e., completion of circumferential incision, ≥ 50% submucosal dissection, and ≥ 50% visualization during snaring, were satisfied performing hybrid ESD, the en bloc resection rate (87.5%) was similar to that of ESD.Visualization during snaring, presence of fibrosis, gross lesion type, and endoscopist colorectal ESD experience level affect en bloc or complete resection of large colorectal neoplasia using hybrid ESD.
- Subjects :
- Male
medicine.medical_specialty
Endoscopic Mucosal Resection
Physiology
Endoscopic mucosal resection
Risk Assessment
Complete resection
03 medical and health sciences
0302 clinical medicine
Transplant surgery
Internal medicine
Outcome Assessment, Health Care
Republic of Korea
medicine
Humans
Prospective Studies
Intestinal Mucosa
Aged
business.industry
Gastroenterology
En bloc resection
Endoscopic submucosal dissection
Middle Aged
Hepatology
Surgery
Treatment Outcome
Multicenter study
030220 oncology & carcinogenesis
Female
030211 gastroenterology & hepatology
Colorectal Neoplasms
business
Subjects
Details
- ISSN :
- 15732568 and 01632116
- Volume :
- 63
- Database :
- OpenAIRE
- Journal :
- Digestive Diseases and Sciences
- Accession number :
- edsair.doi.dedup.....86270df37d09a5fd46779fae6092c346