Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training

Background and Aims The technical difficulties inherent in endoscopic submucosal dissection (ESD) for colorectal neoplasms may result in the failure of en bloc resection or perforation. The aim of this retrospective study was to assess the predictors of en bloc resection failure or perforation by us...

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Published in:Gastrointestinal endoscopy 2016-05, Vol.83 (5), p.954-962
Main Authors: Imai, Kenichiro, MD, Hotta, Kinichi, MD, Yamaguchi, Yuichiro, MD, Kakushima, Naomi, MD, PhD, Tanaka, Masaki, MD, Takizawa, Kohei, MD, Kawata, Noboru, MD, Matsubayashi, Hiroyuki, MD, PhD, Shimoda, Tadakazu, MD, Mori, Keita, PhD, Ono, Hiroyuki, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Clinical Competence
Colon - pathology
Colonic Neoplasms - pathology
Colonic Neoplasms - surgery
Dissection - adverse effects
Dissection - education
Endoscopy, Gastrointestinal - adverse effects
Endoscopy, Gastrointestinal - education
Female
Gastroenterology and Hepatology
Humans
Intestinal Mucosa - surgery
Intestinal Perforation - etiology
Male
Middle Aged
Preoperative Period
Rectal Neoplasms - pathology
Rectal Neoplasms - surgery
Rectum - pathology
Retrospective Studies
Risk Assessment
Risk Factors
Treatment Failure
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creator Imai, Kenichiro, MD
Hotta, Kinichi, MD
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Kakushima, Naomi, MD, PhD
Tanaka, Masaki, MD
Takizawa, Kohei, MD
Kawata, Noboru, MD
Matsubayashi, Hiroyuki, MD, PhD
Shimoda, Tadakazu, MD
Mori, Keita, PhD
Ono, Hiroyuki, MD, PhD
description Background and Aims The technical difficulties inherent in endoscopic submucosal dissection (ESD) for colorectal neoplasms may result in the failure of en bloc resection or perforation. The aim of this retrospective study was to assess the predictors of en bloc resection failure or perforation by using preoperatively available factors. Methods Between September 2002 and March 2013, 716 colorectal ESDs in 673 consecutive patients were performed at a tertiary cancer center. Patient characteristics, tumor location, tumor type, colonoscopy-related factors, and endoscopist experience were assessed based on a prospectively recorded institutional ESD database. Logistic regression analysis was performed to identify predictors of failure of en bloc resection or perforations, with subgroup analyses of ESDs performed by endoscopists less experienced in colorectal ESD (
doi_str_mv 10.1016/j.gie.2015.08.024
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The aim of this retrospective study was to assess the predictors of en bloc resection failure or perforation by using preoperatively available factors. Methods Between September 2002 and March 2013, 716 colorectal ESDs in 673 consecutive patients were performed at a tertiary cancer center. Patient characteristics, tumor location, tumor type, colonoscopy-related factors, and endoscopist experience were assessed based on a prospectively recorded institutional ESD database. Logistic regression analysis was performed to identify predictors of failure of en bloc resection or perforations, with subgroup analyses of ESDs performed by endoscopists less experienced in colorectal ESD (&lt;40 cases) and for colonic lesions only. Results On multivariate analysis, independent predictors of failure of en bloc resection or perforations were the presence of fold convergence (odds ratio [OR] 4.4; 95% confidence interval [95% CI], 1.9-9.9), protruding type (OR 3.6; 95% CI, 1.8-7.1), poor endoscope operability (OR 3.5; 95% CI, 1.8-6.9), right-sided colonic lesions (OR 3.0; 95% CI, 1.5-6.3 vs rectal lesions), left-sided colonic lesions (OR 3.2; 95% CI, 1.7-6.3, vs rectal lesions), the presence of an underlying semilunar fold (OR 2.1; 95% CI, 1.3-3.6), and a less-experienced endoscopist (OR 2.1; 95% CI, 1.3-3.6). Among less-experienced endoscopists, colonic lesions were independent predictors (right-sided colonic lesions 8.1; 95% CI, 2.9-25.1; left-sided colonic lesions 8.1; 95% CI, 2.5-28.3 vs rectal lesions). For colonic lesions, the presence of fold convergence (OR 3.7; 95% CI, 1.6-8.6), poor endoscope operability (OR 3.6; 95% CI, 1.8-7.2), a less-experienced endoscopist (OR 3.0; 95% CI, 1.7-1.8), and the presence of an underlying semilunar fold (OR 2.7; 95% CI, 1.5-4.7) were identified predictors. Conclusion This study successfully identified predictors of en bloc resection failure or perforation. Understanding these indicators could help to accurately stratify lesions according to technical difficulty and to appropriately select endoscopists.</description><identifier>ISSN: 0016-5107</identifier><identifier>EISSN: 1097-6779</identifier><identifier>DOI: 10.1016/j.gie.2015.08.024</identifier><identifier>PMID: 26297870</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Clinical Competence ; Colon - pathology ; Colonic Neoplasms - pathology ; Colonic Neoplasms - surgery ; Dissection - adverse effects ; Dissection - education ; Endoscopy, Gastrointestinal - adverse effects ; Endoscopy, Gastrointestinal - education ; Female ; Gastroenterology and Hepatology ; Humans ; Intestinal Mucosa - surgery ; Intestinal Perforation - etiology ; Male ; Middle Aged ; Preoperative Period ; Rectal Neoplasms - pathology ; Rectal Neoplasms - surgery ; Rectum - pathology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Treatment Failure</subject><ispartof>Gastrointestinal endoscopy, 2016-05, Vol.83 (5), p.954-962</ispartof><rights>American Society for Gastrointestinal Endoscopy</rights><rights>2016 American Society for Gastrointestinal Endoscopy</rights><rights>Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-b540c9eba5f4784e95bb3fd8d38c7d96c65f7d9a7c0f379f0865a443e8ffcd0d3</citedby><cites>FETCH-LOGICAL-c474t-b540c9eba5f4784e95bb3fd8d38c7d96c65f7d9a7c0f379f0865a443e8ffcd0d3</cites><orcidid>0000-0002-9257-5842</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26297870$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Imai, Kenichiro, MD</creatorcontrib><creatorcontrib>Hotta, Kinichi, MD</creatorcontrib><creatorcontrib>Yamaguchi, Yuichiro, MD</creatorcontrib><creatorcontrib>Kakushima, Naomi, MD, PhD</creatorcontrib><creatorcontrib>Tanaka, Masaki, MD</creatorcontrib><creatorcontrib>Takizawa, Kohei, MD</creatorcontrib><creatorcontrib>Kawata, Noboru, MD</creatorcontrib><creatorcontrib>Matsubayashi, Hiroyuki, MD, PhD</creatorcontrib><creatorcontrib>Shimoda, Tadakazu, MD</creatorcontrib><creatorcontrib>Mori, Keita, PhD</creatorcontrib><creatorcontrib>Ono, Hiroyuki, MD, PhD</creatorcontrib><title>Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training</title><title>Gastrointestinal endoscopy</title><addtitle>Gastrointest Endosc</addtitle><description>Background and Aims The technical difficulties inherent in endoscopic submucosal dissection (ESD) for colorectal neoplasms may result in the failure of en bloc resection or perforation. The aim of this retrospective study was to assess the predictors of en bloc resection failure or perforation by using preoperatively available factors. Methods Between September 2002 and March 2013, 716 colorectal ESDs in 673 consecutive patients were performed at a tertiary cancer center. Patient characteristics, tumor location, tumor type, colonoscopy-related factors, and endoscopist experience were assessed based on a prospectively recorded institutional ESD database. Logistic regression analysis was performed to identify predictors of failure of en bloc resection or perforations, with subgroup analyses of ESDs performed by endoscopists less experienced in colorectal ESD (&lt;40 cases) and for colonic lesions only. Results On multivariate analysis, independent predictors of failure of en bloc resection or perforations were the presence of fold convergence (odds ratio [OR] 4.4; 95% confidence interval [95% CI], 1.9-9.9), protruding type (OR 3.6; 95% CI, 1.8-7.1), poor endoscope operability (OR 3.5; 95% CI, 1.8-6.9), right-sided colonic lesions (OR 3.0; 95% CI, 1.5-6.3 vs rectal lesions), left-sided colonic lesions (OR 3.2; 95% CI, 1.7-6.3, vs rectal lesions), the presence of an underlying semilunar fold (OR 2.1; 95% CI, 1.3-3.6), and a less-experienced endoscopist (OR 2.1; 95% CI, 1.3-3.6). Among less-experienced endoscopists, colonic lesions were independent predictors (right-sided colonic lesions 8.1; 95% CI, 2.9-25.1; left-sided colonic lesions 8.1; 95% CI, 2.5-28.3 vs rectal lesions). For colonic lesions, the presence of fold convergence (OR 3.7; 95% CI, 1.6-8.6), poor endoscope operability (OR 3.6; 95% CI, 1.8-7.2), a less-experienced endoscopist (OR 3.0; 95% CI, 1.7-1.8), and the presence of an underlying semilunar fold (OR 2.7; 95% CI, 1.5-4.7) were identified predictors. Conclusion This study successfully identified predictors of en bloc resection failure or perforation. 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Hotta, Kinichi, MD ; Yamaguchi, Yuichiro, MD ; Kakushima, Naomi, MD, PhD ; Tanaka, Masaki, MD ; Takizawa, Kohei, MD ; Kawata, Noboru, MD ; Matsubayashi, Hiroyuki, MD, PhD ; Shimoda, Tadakazu, MD ; Mori, Keita, PhD ; Ono, Hiroyuki, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-b540c9eba5f4784e95bb3fd8d38c7d96c65f7d9a7c0f379f0865a443e8ffcd0d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Clinical Competence</topic><topic>Colon - pathology</topic><topic>Colonic Neoplasms - pathology</topic><topic>Colonic Neoplasms - surgery</topic><topic>Dissection - adverse effects</topic><topic>Dissection - education</topic><topic>Endoscopy, Gastrointestinal - adverse effects</topic><topic>Endoscopy, Gastrointestinal - education</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Intestinal Mucosa - surgery</topic><topic>Intestinal Perforation - etiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Preoperative Period</topic><topic>Rectal Neoplasms - pathology</topic><topic>Rectal Neoplasms - surgery</topic><topic>Rectum - pathology</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Imai, Kenichiro, MD</creatorcontrib><creatorcontrib>Hotta, Kinichi, MD</creatorcontrib><creatorcontrib>Yamaguchi, Yuichiro, MD</creatorcontrib><creatorcontrib>Kakushima, Naomi, MD, PhD</creatorcontrib><creatorcontrib>Tanaka, Masaki, MD</creatorcontrib><creatorcontrib>Takizawa, Kohei, MD</creatorcontrib><creatorcontrib>Kawata, Noboru, MD</creatorcontrib><creatorcontrib>Matsubayashi, Hiroyuki, MD, PhD</creatorcontrib><creatorcontrib>Shimoda, Tadakazu, MD</creatorcontrib><creatorcontrib>Mori, Keita, PhD</creatorcontrib><creatorcontrib>Ono, Hiroyuki, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastrointestinal endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Imai, Kenichiro, MD</au><au>Hotta, Kinichi, MD</au><au>Yamaguchi, Yuichiro, MD</au><au>Kakushima, Naomi, MD, PhD</au><au>Tanaka, Masaki, MD</au><au>Takizawa, Kohei, MD</au><au>Kawata, Noboru, MD</au><au>Matsubayashi, Hiroyuki, MD, PhD</au><au>Shimoda, Tadakazu, MD</au><au>Mori, Keita, PhD</au><au>Ono, Hiroyuki, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training</atitle><jtitle>Gastrointestinal endoscopy</jtitle><addtitle>Gastrointest Endosc</addtitle><date>2016-05-01</date><risdate>2016</risdate><volume>83</volume><issue>5</issue><spage>954</spage><epage>962</epage><pages>954-962</pages><issn>0016-5107</issn><eissn>1097-6779</eissn><abstract>Background and Aims The technical difficulties inherent in endoscopic submucosal dissection (ESD) for colorectal neoplasms may result in the failure of en bloc resection or perforation. The aim of this retrospective study was to assess the predictors of en bloc resection failure or perforation by using preoperatively available factors. Methods Between September 2002 and March 2013, 716 colorectal ESDs in 673 consecutive patients were performed at a tertiary cancer center. Patient characteristics, tumor location, tumor type, colonoscopy-related factors, and endoscopist experience were assessed based on a prospectively recorded institutional ESD database. Logistic regression analysis was performed to identify predictors of failure of en bloc resection or perforations, with subgroup analyses of ESDs performed by endoscopists less experienced in colorectal ESD (&lt;40 cases) and for colonic lesions only. Results On multivariate analysis, independent predictors of failure of en bloc resection or perforations were the presence of fold convergence (odds ratio [OR] 4.4; 95% confidence interval [95% CI], 1.9-9.9), protruding type (OR 3.6; 95% CI, 1.8-7.1), poor endoscope operability (OR 3.5; 95% CI, 1.8-6.9), right-sided colonic lesions (OR 3.0; 95% CI, 1.5-6.3 vs rectal lesions), left-sided colonic lesions (OR 3.2; 95% CI, 1.7-6.3, vs rectal lesions), the presence of an underlying semilunar fold (OR 2.1; 95% CI, 1.3-3.6), and a less-experienced endoscopist (OR 2.1; 95% CI, 1.3-3.6). Among less-experienced endoscopists, colonic lesions were independent predictors (right-sided colonic lesions 8.1; 95% CI, 2.9-25.1; left-sided colonic lesions 8.1; 95% CI, 2.5-28.3 vs rectal lesions). For colonic lesions, the presence of fold convergence (OR 3.7; 95% CI, 1.6-8.6), poor endoscope operability (OR 3.6; 95% CI, 1.8-7.2), a less-experienced endoscopist (OR 3.0; 95% CI, 1.7-1.8), and the presence of an underlying semilunar fold (OR 2.7; 95% CI, 1.5-4.7) were identified predictors. Conclusion This study successfully identified predictors of en bloc resection failure or perforation. Understanding these indicators could help to accurately stratify lesions according to technical difficulty and to appropriately select endoscopists.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26297870</pmid><doi>10.1016/j.gie.2015.08.024</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-9257-5842</orcidid></addata></record>
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subjects Adult
Aged
Aged, 80 and over
Clinical Competence
Colon - pathology
Colonic Neoplasms - pathology
Colonic Neoplasms - surgery
Dissection - adverse effects
Dissection - education
Endoscopy, Gastrointestinal - adverse effects
Endoscopy, Gastrointestinal - education
Female
Gastroenterology and Hepatology
Humans
Intestinal Mucosa - surgery
Intestinal Perforation - etiology
Male
Middle Aged
Preoperative Period
Rectal Neoplasms - pathology
Rectal Neoplasms - surgery
Rectum - pathology
Retrospective Studies
Risk Assessment
Risk Factors
Treatment Failure
title Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training
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