Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort

Yoji Takeuchi, Hiroyasu Iishi, Shinji Tanaka, Yutaka Saito, Hiroaki Ikematsu, Shin ei Kudo, Yasushi Sano, Takashi Hisabe, Naohisa Yahagi, Yusuke Saitoh, Masahiro Igarashi, Kiyonori Kobayashi, Hiroo Yamano, Seiji Shimizu, Osamu Tsuruta, Yuji Inoue, Toshiaki Watanabe, Hisashi Nakamura, Takahiro Fujii, Noriya UedoToshio Shimokawa, Hideki Ishikawa, Kenichi Sugihara

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Abstract

Background: Colorectal endoscopic submucosal dissection (C-ESD) is a promising but challenging procedure. We aimed to evaluate the factors associated with technical difficulties (failure of en bloc resection and procedure time, ≥2 h) and adverse events (perforation and bleeding) of C-ESD. Methods: We conducted a retrospective exploratory factor analysis of a prospectively collected cohort in 15 institutions. Eight-hundred sixteen colorectal neoplasms larger than 20 mm from patients who underwent C-ESD were included. We assessed the outcomes of C-ESD and risk factors for technical difficulties and adverse events. Results: Of the 816 lesions, 767 (94 %) were resected en bloc, with a median procedure time of 78 min. Perforation occurred in 2.1 % and bleeding in 2.2 %. Independent factors associated with failure of en bloc resection were low-volume center (<30 neoplasms), snare use, and poor lifting after submucosal injection. Factors significantly associated with long procedure time (≥2 h) were large tumor size (≥4 cm), low-volume center, less-experienced endoscopist, CO2 insufflation, and use of two or more endoknives. Poor lifting was the only factor significantly associated with perforation, whereas rectal lesion and lack of a thin-type endoscope were factors significantly associated with bleeding. Poor lifting after submucosal injection occurred more frequently for nongranular-type laterally spreading tumors (LST) and for protruding and recurrent lesions than for granular-type LST (LST-G). Conclusions: Poor lifting after submucosal injection was the risk factor most frequently associated with technical difficulties and adverse events on C-ESD. Less experienced endoscopists should start by performing C-ESDs on LST-G lesions.

Original languageEnglish
Pages (from-to)1275-1284
Number of pages10
JournalInternational journal of colorectal disease
Volume29
Issue number10
DOIs
Publication statusPublished - 2014 Jan 1
Externally publishedYes

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Keywords

  • Colonoscopy
  • Colorectal neoplasm
  • Endoscopic gastrointestinal surgery
  • Endoscopic submucosal dissection

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Takeuchi, Y., Iishi, H., Tanaka, S., Saito, Y., Ikematsu, H., Kudo, S. E., Sano, Y., Hisabe, T., Yahagi, N., Saitoh, Y., Igarashi, M., Kobayashi, K., Yamano, H., Shimizu, S., Tsuruta, O., Inoue, Y., Watanabe, T., Nakamura, H., Fujii, T., ... Sugihara, K. (2014). Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. International journal of colorectal disease, 29(10), 1275-1284. https://doi.org/10.1007/s00384-014-1947-2