Predictors of technical difficulty with duodenal ESD

Motohiko Kato; Motoki Sasaki; Mari Mizutani; Koshiro Tsutsumi; Yoshiyuki Kiguchi; Teppei Akimoto; Makoto Mutaguchi; Atsushi Nakayama; Kaoru Takabayashi; Ai Fujimoto; Yasutoshi Ochiai; Tadateru Maehata; Takanori Kanai; Naohisa Yahagi

doi:10.1055/a-0967-4744

Endoscopy International Open, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(12): E1755-E1760
DOI: 10.1055/a-0967-4744

Original article

Predictors of technical difficulty with duodenal ESD

Autor*innen

Motohiko Kato

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Motoki Sasaki

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Mari Mizutani

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
Koshiro Tsutsumi

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Yoshiyuki Kiguchi

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Teppei Akimoto

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Makoto Mutaguchi

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
Atsushi Nakayama

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Kaoru Takabayashi

³Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
Ai Fujimoto

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Yasutoshi Ochiai

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Tadateru Maehata

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan
Takanori Kanai

¹Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
Naohisa Yahagi

²Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Tokyo, Japan

Abstract

Background and study aims Duodenal endoscopic submucosal dissection (ESD) is still considered technically challenging; however, few studies have objectively analyzed predictors of the technical difficulty. Therefore, the aim of the current study was to elucidate predictors of the technical difficulty of duodenal ESD.

Patients and methods This was a retrospective observational study. From June 2010 to June 2017, a total of 174 consecutive patients with superficial duodenal epithelial neoplasia who underwent ESD were included in this study. We tried to identify predictors for technical difficulty of ESD by defining technical difficulty as either procedure time > 100 minutes or intraprocedural perforation. Moreover, we constructed a scoring system consisting of factors that were significant in the multivariate analysis.

Results The proportion of patients with technical difficulty was 34.5 %. In the multivariate analysis, lesion location in flexural part [odds ratio (OR), 2.61; 95 % confidence interval (CI), 1.02 – 6.68], larger lesion size (> 40 mm) (OR, 5.26; 95% CI, 2.15 – 12.9), and occupied circumference > 50 % of the duodenum (OR, 5.80; 95 % CI, 1.83 – 18.4) were associated with technical difficulty.

Conclusion A lesion location in flexural part, lesion size >40 mm and occupied circumference > 50 % were risk factors for technical difficulty of duodenal ESD.

Volltext

Referenzen

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