PREDICTIVE FACTORS FOR TECHNICALLY DIFFICULT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD). IMPLICATIONS FOR CASE SELECTION: A SPANISH PROSPECTIVE MULTICENTER COHORT STUDY

JC Marín-Gabriel; F Ramos-Zabala; F Múgica-Aguinaga; A Herreros de Tajada-Echanojauregui; E Albéniz Arbizu; J de la Peña-García; Ó Nogales-Rincón; A Sánchez-Yagüe; G Fernández-Esparrach; C Dolz-Abadía; A Álvarez-Delgado; H Cortés-Pérez; C Guarner-Argente; AJ del Pozo-García; J Díaz-Tasende

doi:10.1055/s-0038-1637321

Endoscopy, Table of Contents

Endoscopy 2018; 50(04): S99
DOI: 10.1055/s-0038-1637321

ESGE Days 2018 oral presentations

21.04.2018 – Endoscopic submucosal dissection

Georg Thieme Verlag KG Stuttgart · New York

PREDICTIVE FACTORS FOR TECHNICALLY DIFFICULT ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD). IMPLICATIONS FOR CASE SELECTION: A SPANISH PROSPECTIVE MULTICENTER COHORT STUDY

Authors

JC Marín-Gabriel

¹‘12 de Octubre’ University Hospital, Gastroenterology. Endoscopy Unit, Madrid, Spain

²‘HM Sanchinarro’ University Hospital, Gastroenterology. Endoscopy Unit, Madrid, Spain
F Ramos-Zabala

³‘HM Montepríncipe’ University Hospital, Gastroenterology. Endoscopy Unit, Boadilla del Monte, Spain
F Múgica-Aguinaga

⁴Donostia University Hospital, Gastroenterology. Endoscopy Unit, Donostia, Spain
A Herreros de Tajada-Echanojauregui

⁵‘Puerta de Hierro – Majadahonda’ University Hospital, Gastroenterology. Endoscopy Unit, Majadahonda, Spain

⁶MD Anderson Cancer Centre, Gastroenterology. Endoscopy Unit, Madrid, Spain
E Albéniz Arbizu

⁷Complejo Hospitalario de Navarra, Gastroenterology. Endoscopy Unit, Pamplona, Spain
J de la Peña-García

⁸‘Marqués de Valdecilla’ University Hospital, Gastroenterology. Endoscopy Unit, Santander, Spain
Ó Nogales-Rincón

⁹‘Gregorio Marañón’ University Hospital, Gastroenterology. Endoscopy Unit, Madrid, Spain
A Sánchez-Yagüe

¹⁰‘Costa del Sol’ University Hospital, Gastroenterology. Endoscopy Unit, Marbella, Spain
G Fernández-Esparrach

¹¹Hospital Clínic i Provincial de Barcelona, Gastroenterology. Endoscopy Unit, Barcelona, Spain
C Dolz-Abadía

¹²Hospital Son Llatzer, Gastroenterology. Endoscopy Unit, Palma, Spain
A Álvarez-Delgado

¹³Complejo Asistencial Universitario de Salamanca. IBSAL, Gastroenterology. Endoscopy Unit, Salamanca, Spain
H Cortés-Pérez

¹⁴‘Cruces’ University Hospital, Gastroenterology. Endoscopy Unit, Baracaldo, Spain
C Guarner-Argente

¹⁵Hospital Santa Creu i Sant Pau, Gastroenterology. Endoscopy Unit, Barcelona, Spain
AJ del Pozo-García

¹‘12 de Octubre’ University Hospital, Gastroenterology. Endoscopy Unit, Madrid, Spain
J Díaz-Tasende

¹‘12 de Octubre’ University Hospital, Gastroenterology. Endoscopy Unit, Madrid, Spain

²‘HM Sanchinarro’ University Hospital, Gastroenterology. Endoscopy Unit, Madrid, Spain

Abstract

Full Text

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.