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. 2018 Jul;29(4):473-480.
doi: 10.5152/tjg.2018.17400.

Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection

Myeongsook Seo  1 , Dong-Hoon Yang  1 , Jihun Kim  2 , Eun Mi Song  1 , Gwang Un Kim  1 , Sung Wook Hwang  1 , Sang Hyoung Park  1 , Kyung-Jo Kim  1 , Byong Duk Ye  1 , Jeong-Sik Byeon  1 , Seung-Jae Myung  1 , Suk-Kyun Yang  1
Affiliations

Clinical outcomes of colorectal endoscopic submucosal dissection and risk factors associated with piecemeal resection

Myeongsook Seo et al. Turk J Gastroenterol. 2018 Jul.

Abstract

Background/aims: We aimed to investigate the factors associated with piecemeal resection of colorectal neoplasia (CRN), in spite of endoscopic submucosal dissection (ESD).

Materials and methods: We analyzed the retrospective data for colorectal ESD cases from January 2005 to April 2014. We also reviewed the piecemeal endoscopic mucosal resection (EMR) for CRNs ≥20 mm, performed over the same period.

Results: En bloc resection was possible in 648 (85.7%) of 756 lesions in 740 patients. Multivariate analysis showed that hybrid ESD (odds ratio (OR), 29.07; 95% confidence interval (CI), 15.46-54.65; p<0.01) and mild or severe submucosal fibrosis (OR, 3.62; 95% CI, 1.94-6.76; p<0.01) were independently associated with piecemeal ESD. The en bloc ESD group showed higher histologic complete resection rate than the piecemeal ESD group (80.4% vs. 56.5%; p<0.01), and the piecemeal ESD group showed higher recurrence rate than in the en bloc ESD group (5.6% [4/72] vs. 0.7% [3/450]; p<0.01). Overall recurrence rate was 1.3% (7/522).

Conclusion: Hybrid ESD and submucosal fibrosis are independently associated with piecemeal ESD. Piecemeal ESD cases recurred more frequently than en bloc ESD cases.

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Conflict of interest statement

Conflict of Interest: The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram showing the categorization of lesions into the two treatment groups ESD: endoscopic submucosal dissection; GIST: gastrointestinal stromal tumor
Figure 2
Figure 2
Kaplan-Meier plots in follow-up patients. Comparison of cumulative recurrence rates between en bloc ESD and piecemeal ESD groups (log rank test, p<0.001) ESD: endoscopic submucosal dissection
See this image and copyright information in PMC

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