Authors: Koichiro Sato Sayo Ito Tomoyuki Kitagawa Mitsuru Kato Kenji Tominaga Takeshi Suzuki Iruru Maetani
Publish Date: 2014/05/23
Volume: 28, Issue: 10, Pages: 2959-2965
Abstract
Endoscopic submucosal dissection ESD for colorectal tumors is technically difficult due to the anatomy of the large intestine with its narrow lumen thin walls and redundancy Here we assessed factors associated with incomplete resection and difficult colorectal ESDBetween November 2009 and April 2013 we performed ESD on 151 consecutive colorectal tumors in 147 patients We evaluated the clinical outcomes of all cases and conducted multiple logistic regression analysis of the following factors related to incomplete resection and difficult procedure age gender location right colon left colon or rectum tumor size diameter ≥40 or 40 mm operation time morphology granulartype laterally spreading tumor LSTG nongranulartype laterally spreading tumor LSTNG or protruded type fibrosis and paradoxical movement during the procedure A procedure that required more than 120 min was defined as a difficult colorectal ESDAverage tumor size was 321 ± 107 mm and the average procedure length was 718 ± 495 min The rate of en bloc resection was 947 while that of en bloc curative resection was 868 Perforation occurred in 13 of the ESD procedures Multivariate logistic regression analysis revealed that only severe fibrosis odds ratio OR 451 95 confidence interval CI 136–1491 p = 0014 contributed to incomplete resection and that a tumor size exceeding 40 mm OR 573 95 CI 166–1974 p = 0006 severe fibrosis OR 2331 95 CI 659–8254 p 0001 and paradoxical movement OR 426 95 CI 111–1644 p = 0035 were independent factors exacerbating the difficulty of colorectal ESDSevere fibrosis contributed to both incomplete resection and difficult colorectal ESD Larger tumor size and paradoxical movement during the procedure were independent factors contributing to the difficulty of colorectal ESD These factors might enable endoscopists to develop strategies for treating colorectal ESD
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