Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum.
Endoscopy
; 46(10): 862-70, 2014 Oct.
Article
em En
| MEDLINE
| ID: mdl-25208032
ABSTRACT
BACKGROUND AND STUDY AIMS:
Because of technical difficulty, colorectal endoscopic submucosal dissection (CR-ESD) is not widely performed. We aimed to determine risk factors for such technical difficulty as defined by long procedure duration (≥ â150âmin), perforation, and piecemeal resection. PATIENTS ANDMETHODS:
Patients with consecutive colorectal tumors treated with ESD between April 2006 and December 2010 were enrolled in a prospective cohort study. For prediction of technical difficulty, three types of factor were investigated tumor location, tumor type, and colonoscopy-related. Cases were subsequently categorized into earlier and later periods (April 2006â-âAugust 2008, 123 lesions; September 2008â-âDecember 2010, 124 lesions). Variables were analyzed using multiple logistic regression, with subgroup analyses for each period.RESULTS:
247 lesions were analyzed. Flexure location was an independent risk factor for technical difficulty as measured by longer procedure duration (odds ratio [OR] 4.1, 95â% confidence interval [95â%CI] 1.1â-â14.9), piecemeal resection (4.7, 1.1â-â17.2), or perforation (8.8, 1.1â-â56.8). Tumor with scarring or locally recurrent was a risk factor for longer procedure duration (4.7, 1.7â-â13.7), and for piecemeal resection (7.8, 2.4â-â25.0). Tumor of size â≥â 50âmm or spreading across ≥ â2 folds was the strongest independent risk factor for longer duration (6.3, 2.8â-â15.4), and was an independent risk factor for longer duration in both time periods (earlier, 3.3, 1.1â-â10.4; later, 27.4, 7.4â-â138.0). Flexure location was an independent risk factor for perforation (13.9, 1.5â-â129.1) and for piecemeal resection (5.1, 0.9â-â25.2) in the earlier but not the later period.CONCLUSIONS:
Factors predicting technical difficulty of CR-ESDs were clarified. Their importance was influenced by the increasing experience of the endoscopist.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Colorretais
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Colonoscopia
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Dissecação
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Duração da Cirurgia
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Mucosa Intestinal
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Perfuração Intestinal
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Recidiva Local de Neoplasia
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article