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

• DOI: 10.1007/s00384-014-1947-2
• Publication Date: 2014-07-02T08:33:20Z
• Authors: 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 Uedo; Toshio Shimokawa; Hideki Ishikawa; Kenichi Sugihara
• Keywords: Male; Colonoscopes; Dissection; Operative Time; Insufflation; Colonoscopy; Carbon Dioxide; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Intestinal Perforation; Risk Factors; Humans; Female; Clinical Competence; Intestinal Mucosa; Colorectal Neoplasms; Factor Analysis, Statistical; Gastrointestinal Hemorrhage; Aged; Retrospective Studies

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.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.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).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.