Nana Hayashi, MD from Hiroshima University Hospital in Hiroshima, Japan discusses her Original Article “Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors.”
Predictors of incomplete resection and perforation can include lesion size, growth type, pathological diagnosis, use of hemostatic forceps, degree of fibrosis, history of biopsy, history of local endoscopic treatment, and endoscopic operability.
Until now, there have been no reports regarding the relationship between poor endoscopic operability and outcome of colorectal endoscopic submucosal dissection (ESD).
Figure 1. Degree of fibrosis of the submucosal layers in colorectal tumors. Degree of fibrosis of the submucosal layers was classified into the following 3 grades according to the appearance of the layers during the submucosal injection of a mixture of sodium hyaluronate and indigo carmine: F0, no fibrosis, which manifested as a blue transparent layer; F1, mild fibrosis, which appears as a white weblike structure in the blue submucosal layers; and F2, severe fibrosis, which appears as a white muscular structure without blue transparent layer in the submucosal layers.
The incomplete resection rate was 4.1% and the perforation rate was 5.6%. Poor endoscopic operability and submucosal deep invasion were independent significant predictors of incomplete resections. Also, fibrosis based on previous endoscopic treatment was significantly associated with perforation. Poor endoscopic operability and severe fibrosis were independent significant predictors of perforation.
Our study had the limitation of being a single-center study examining results from a single colonoscopist.
Read the abstract here.
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