Skip to main content

Advertisement

Log in

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

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Soetikno RM, Gotoda T, Nakanishi Y et al (2003) Endoscopic mucosal resection. Gastrointest Endosc 57:567–579

    Article  PubMed  Google Scholar 

  2. Japanese Society for Cancer of the Colon and Rectum (2009) Japanese classification of colorectal carcinoma. Second English Edition. Tokyo: Kanehara & Co Ltd

  3. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc 2003; 58:S3–S43

  4. Iishi H, Tatsuta M, Iseki K et al (2000) Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc 51:697–700

    Article  PubMed  CAS  Google Scholar 

  5. Moss A, Bourke MJ, Williams SJ et al (2011) Endoscopic mucosal resection outcomes and prediction of submucosal cancer from advanced colonic mucosal neoplasia. Gastroenterology 140:1909–1918

    Article  PubMed  Google Scholar 

  6. Terasaki M, Tanaka S, Oka S et al (2012) Clinical outcomes of endoscopic submucosal dissection and endoscopic mucosal resection for laterally spreading tumors larger than 20 mm. J Gastroenterol Hepatol 27:734–740

    Article  PubMed  Google Scholar 

  7. Hotta K, Fujii T, Saito Y et al (2009) Local recurrence after endoscopic resection of colorectal tumors. Int J Colorectal Dis 24:225–230

    Article  PubMed  Google Scholar 

  8. Saito Y, Kawano H, Takeuchi Y et al (2012) Current status of colorectal endoscopic submucosal dissection in Japan and other Asian countries: progressing towards technical standardization. Dig Endosc 24(Suppl 1):67–72

    Article  PubMed  Google Scholar 

  9. Uraoka T, Parra-Blanco A, Yahagi N (2012) Colorectal endoscopic submucosal dissection in Japan and Western countries. Dig Endosc 24:80–83

    Article  PubMed  Google Scholar 

  10. Fujishiro M, Yahagi N, Kakushima N et al (2007) Outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms in 200 consecutive cases. Clin Gastroenterol Hepatol 5:678–683

    Article  PubMed  Google Scholar 

  11. Lee EJ, Lee JB, Lee SH et al (2013) Endoscopic submucosal dissection for colorectal tumors–1,000 colorectal ESD cases: one specialized institute’s experiences. Surg Endosc 27:31–39

    Article  PubMed  Google Scholar 

  12. Saito Y, Uraoka T, Yamaguchi Y et al (2010) A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72:1217–1225

    Article  PubMed  Google Scholar 

  13. Nakajima T, Saito Y, Tanaka S et al (2013) Current status of endoscopic resection strategy for large, early colorectal neoplasia in Japan. Surg Endosc 27:3262–3270

    Article  PubMed  Google Scholar 

  14. Oka S, Tanaka S, Saito Y et al. Multicenter prospective study on local recurrence after endoscopic resection of large colorectal neoplasia conducted by the colorectal endoscopic resection standardization implementation working group of Japanese society for cancer of the colon and rectum. Endoscopy 2012;44:A70 [abstract]

  15. von Elm E, Altman DG, Egger M et al (2007) STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457

    Article  Google Scholar 

  16. Tanaka S, Oka S, Chayama K (2008) Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol 43:641–651

    Article  PubMed  Google Scholar 

  17. Tanaka S, Terasaki M, Kanao H et al (2012) Current status and future perspectives of endoscopic submucosal dissection for colorectal tumors. Dig Endosc 24(Suppl 1):73–79

    Article  PubMed  Google Scholar 

  18. Moss A, Bourke MJ, Tran K et al (2010) Lesion isolation by circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) substantially improves en bloc resection rates for 40-mm colonic lesions. Endoscopy 42:400–404

    Article  PubMed  CAS  Google Scholar 

  19. Kudo S, Lambert R, Allen JI et al (2008) Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 68:S3–S47

    Article  PubMed  Google Scholar 

  20. Matsumoto A, Tanaka S, Oba S et al (2010) Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis. Scand J Gastroenterol 45:1329–1337

    Article  PubMed  Google Scholar 

  21. Schlemper RJ, Riddell RH, Kato Y et al (2000) The Vienna classification of gastrointestinal epithelial neoplasia. Gut 47:251–255

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  22. Cotton PB, Eisen GM, Aabakken L et al (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454

    Article  PubMed  Google Scholar 

  23. Probst A, Golger D, Anthuber M et al (2012) Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European center. Endoscopy 44:660–667

    Article  PubMed  CAS  Google Scholar 

  24. Kim ES, Cho KB, Park KS et al (2011) Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors. Endoscopy 43:573–578

    Article  PubMed  CAS  Google Scholar 

  25. Lee EJ, Lee JB, Choi YS et al (2012) Clinical risk factors for perforation during endoscopic submucosal dissection (ESD) for large-sized, nonpedunculated colorectal tumors. Surg Endosc 26:1587–1594

    Article  PubMed  Google Scholar 

  26. Metz AJ, Bourke MJ, Moss A et al (2011) Factors that predict bleeding following endoscopic mucosal resection of large colonic lesions. Endoscopy 43:506–511

    Article  PubMed  CAS  Google Scholar 

  27. Takizawa K, Oda I, Gotoda T et al (2008) Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection—an analysis of risk factors. Endoscopy 40:179–183

    Article  PubMed  CAS  Google Scholar 

  28. Saito Y, Uraoka T, Matsuda T et al (2007) A pilot study to assess the safety and efficacy of carbon dioxide insufflation during colorectal endoscopic submucosal dissection with the patient under conscious sedation. Gastrointest Endosc 65:537–542

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank the members of the Colorectal Endoscopic Resection Standardization Implementation Working Group of the Japanese Society for Cancer of the Colon and Rectum (JSCCR) for valuable discussions. This study was financially supported by a grant-in-aid from JSCCR.

Conflict of interests

None of the authors has any financial relationships to disclose relevant to this publication.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoji Takeuchi.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takeuchi, Y., Iishi, H., Tanaka, S. et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis 29, 1275–1284 (2014). https://doi.org/10.1007/s00384-014-1947-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-014-1947-2

Keywords

Navigation