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DOI: 10.1055/s-0038-1637321
PREDICTIVE FACTORS FOR TECHNICALLY DIFFICULT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD). IMPLICATIONS FOR CASE SELECTION: A SPANISH PROSPECTIVE MULTICENTER COHORT STUDY
Publication History
Publication Date:
27 March 2018 (online)
Aims:
To identify the potential risk factors that are associated with a higher technical difficulty during ESD in a Western European setting.
Methods:
We prospectively recorded consecutive ESD cases performed by members of the ESD Working Group of the Spanish Society of Digestive Endoscopy. Demographic and clinical characteristics of the patients, location and morphology of the lesions, and technical factors were collected. We defined difficult ESD as those aborted procedures, time-consuming (duration > 180 min.) or when changing the technique to piecemeal resection was needed to remove the tumor.
Results:
We included 265 lesions in 265 patients [mean age ± SD: 69 ± 10 y; 150 males (56.6%)]. They were recruited in 15 Spanish University Hospitals between January 2016 and March 2017. Location of the lesions were: esophagus (n = 7; 2.6%), cardia (n = 5; 1.8%); stomach (n = 48; 18.1%); duodenal bulb (n = 1; 0,3%); colon (n = 144; 54.3%) and rectum (n = 60; 22.6%). Mean lesion size was 38.6 ± 18.5 mm. Median duration of the procedure was 105 min. (8 – 375). In 73 cases (27.5%) criteria for difficult ESD were fulfilled. Endoscopic resection was aborted in 7 cases (2.6%). When endoscopic resection was achieved (n = 258; 97.3%) both situations, duration > 3h and a piecemeal resection, were noted in 21 (8.1%) patients. Duration > 3h in 25 cases (9.7%) and unsuccessful en bloc resection in 20 (7.7%) were observed in isolation, respectively. The factors independently associated with technically difficult ESD (aborted procedures, time-consuming or finished with a piecemeal resection) were: lesion size > 30 mm, poor manoeuvrability, recurrent lesions and intraprocedural bleeding.
Conclusions:
Except for intraprocedural bleeding, the remaining factors can be identified during the first diagnostic endoscopy. Endoscopists who will start performing ESD should try to avoid these difficult procedures in the early part of their learning curves.