Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD
Background and study aim Endoscopic submucosal dissection (ESD) is a widely accepted treatment for superficial gastric neoplasms. Difficult ESD can lead to complications, such as bleeding and perforation. To predict difficult ESD procedures, we analyzed the factors associated with difficult ESD. Pat...
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| Veröffentlicht in: | Surgical endoscopy 2017-04, Vol.31 (4), p.1617-1626 |
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| creator | Kim, Ji Ha Nam, Hyeong Seok Choi, Cheol Woong Kang, Dae Hwan Kim, Hyung Wook Park, Su Bum Kim, Su Jin Hwang, Sun Hwi Lee, Si Hak |
| description | Background and study aim
Endoscopic submucosal dissection (ESD) is a widely accepted treatment for superficial gastric neoplasms. Difficult ESD can lead to complications, such as bleeding and perforation. To predict difficult ESD procedures, we analyzed the factors associated with difficult ESD.
Patients and methods
The medical records of 1052 ESD procedures were retrospectively reviewed. Difficult ESD was defined by any one of three end points: longer procedure time (≥60 min), piecemeal resection, incomplete (R1) resection, or gastric wall perforation. To determine the factors associated with difficult ESD, clinical and pathologic features and endoscopic findings were analyzed.
Results
The rates of en bloc resection and curative (R0) resection were 93.3 and 92.4 %, respectively. The mean procedure time was 27.7 ± 16.7 min. After multivariate analysis, larger tumor size (≥20 mm) was an independent risk factor for longer procedure time (OR 4.1,
P
|
| doi_str_mv | 10.1007/s00464-016-5149-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1859714067</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1859714067</sourcerecordid><originalsourceid>FETCH-LOGICAL-c442t-b01090f2f7551d23620c918c8488542e1dfd44f2f41d9e40a8b669496bc1295c3</originalsourceid><addsrcrecordid>eNp1kV9rFTEQxYMo9rb1A_RFFnzxZetMdja78U36HwqC1ueQm2RvU_durpldxG9vyq1SBJ8yML9zMpwjxAnCKQJ0HxiAFNWAqm6RdK1eiBVSI2spsX8pVqAbqGWn6UAcMj9AwTW2r8WB7Ei3DTUrEb9E_l4N1s0pc2WZk4t2Dr76Gef7ysdhiG4Z52pjec7RVWHyiV3alZGX9XZxie1YOObg5pimj9UuBx_LPG2eyS--nh-LV4MdObx5eo_Et8uLu7Pr-vbz1c3Zp9vaEcm5XgOChkEOXduil42S4DT2rqe-b0kG9IMnKntCrwOB7ddKadJq7VDq1jVH4v3ed5fTjyXwbLaRXRhHO4W0sMG-1R0SqK6g7_5BH9KSp3JdoToFJSGCQuGecjkx5zCYXY5bm38ZBPPYg9n3YEoP5rEHo4rm7ZNzCSn4v4o_wRdA7gEuq2kT8rOv_-v6G2bwks8</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1876034340</pqid></control><display><type>article</type><title>Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Kim, Ji Ha ; Nam, Hyeong Seok ; Choi, Cheol Woong ; Kang, Dae Hwan ; Kim, Hyung Wook ; Park, Su Bum ; Kim, Su Jin ; Hwang, Sun Hwi ; Lee, Si Hak</creator><creatorcontrib>Kim, Ji Ha ; Nam, Hyeong Seok ; Choi, Cheol Woong ; Kang, Dae Hwan ; Kim, Hyung Wook ; Park, Su Bum ; Kim, Su Jin ; Hwang, Sun Hwi ; Lee, Si Hak</creatorcontrib><description><![CDATA[Background and study aim
Endoscopic submucosal dissection (ESD) is a widely accepted treatment for superficial gastric neoplasms. Difficult ESD can lead to complications, such as bleeding and perforation. To predict difficult ESD procedures, we analyzed the factors associated with difficult ESD.
Patients and methods
The medical records of 1052 ESD procedures were retrospectively reviewed. Difficult ESD was defined by any one of three end points: longer procedure time (≥60 min), piecemeal resection, incomplete (R1) resection, or gastric wall perforation. To determine the factors associated with difficult ESD, clinical and pathologic features and endoscopic findings were analyzed.
Results
The rates of en bloc resection and curative (R0) resection were 93.3 and 92.4 %, respectively. The mean procedure time was 27.7 ± 16.7 min. After multivariate analysis, larger tumor size (≥20 mm) was an independent risk factor for longer procedure time (OR 4.1,
P
< 0.001), for piecemeal resection (OR 2.3,
P
= 0.003) and incomplete (R1) resection (OR 2.1,
P
= 0.005). Location of the lesion (upper third) was an independent risk factor for longer procedure time (OR 5.8,
P
< 0.001), for piecemeal resection (OR 4.1,
P
< 0.001) and incomplete (R1) resection (OR 4.5,
P
< 0.001). Submucosal fibrosis was an independent risk factor for longer procedure time (OR 9.7,
P
< 0.001), for piecemeal resection (OR 2.4,
P
< 0.001) and incomplete (R1) resection (OR 2.6,
P
< 0.001). Finally, submucosal invasive gastric cancer was an independent risk factor for piecemeal resection (OR 2.6,
P
= 0.008), for perforation (OR 19.3,
P
= 0.001) and for incomplete (R1) resection (OR 2.7,
P
= 0.001).
Conclusions
Difficult ESD procedures are a function of the lesion size and location, submucosal fibrosis, and submucosal invasive cancer. When a difficult ESD procedure is expected, appropriate preparations should be considered, including consultation with more experienced endoscopists.]]></description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-016-5149-6</identifier><identifier>PMID: 27495343</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Anticoagulants ; Biopsy ; Cancer therapies ; Clinical Competence - standards ; Dissection ; Dissection - methods ; Endoscopic Mucosal Resection - adverse effects ; Endoscopic Mucosal Resection - standards ; Endoscopy ; Female ; Gastric cancer ; Gastric Mucosa - pathology ; Gastric Mucosa - surgery ; Gastroenterology ; Gynecology ; Hepatology ; Hospitals ; Humans ; Lymphatic system ; Male ; Medical records ; Medical screening ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Proctology ; Research centers ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms - pathology ; Stomach Neoplasms - surgery ; Surgery ; Treatment Outcome ; Ulcers</subject><ispartof>Surgical endoscopy, 2017-04, Vol.31 (4), p.1617-1626</ispartof><rights>Springer Science+Business Media New York 2016</rights><rights>Surgical Endoscopy is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c442t-b01090f2f7551d23620c918c8488542e1dfd44f2f41d9e40a8b669496bc1295c3</citedby><cites>FETCH-LOGICAL-c442t-b01090f2f7551d23620c918c8488542e1dfd44f2f41d9e40a8b669496bc1295c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-016-5149-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-016-5149-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27495343$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Ji Ha</creatorcontrib><creatorcontrib>Nam, Hyeong Seok</creatorcontrib><creatorcontrib>Choi, Cheol Woong</creatorcontrib><creatorcontrib>Kang, Dae Hwan</creatorcontrib><creatorcontrib>Kim, Hyung Wook</creatorcontrib><creatorcontrib>Park, Su Bum</creatorcontrib><creatorcontrib>Kim, Su Jin</creatorcontrib><creatorcontrib>Hwang, Sun Hwi</creatorcontrib><creatorcontrib>Lee, Si Hak</creatorcontrib><title>Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description><![CDATA[Background and study aim
Endoscopic submucosal dissection (ESD) is a widely accepted treatment for superficial gastric neoplasms. Difficult ESD can lead to complications, such as bleeding and perforation. To predict difficult ESD procedures, we analyzed the factors associated with difficult ESD.
Patients and methods
The medical records of 1052 ESD procedures were retrospectively reviewed. Difficult ESD was defined by any one of three end points: longer procedure time (≥60 min), piecemeal resection, incomplete (R1) resection, or gastric wall perforation. To determine the factors associated with difficult ESD, clinical and pathologic features and endoscopic findings were analyzed.
Results
The rates of en bloc resection and curative (R0) resection were 93.3 and 92.4 %, respectively. The mean procedure time was 27.7 ± 16.7 min. After multivariate analysis, larger tumor size (≥20 mm) was an independent risk factor for longer procedure time (OR 4.1,
P
< 0.001), for piecemeal resection (OR 2.3,
P
= 0.003) and incomplete (R1) resection (OR 2.1,
P
= 0.005). Location of the lesion (upper third) was an independent risk factor for longer procedure time (OR 5.8,
P
< 0.001), for piecemeal resection (OR 4.1,
P
< 0.001) and incomplete (R1) resection (OR 4.5,
P
< 0.001). Submucosal fibrosis was an independent risk factor for longer procedure time (OR 9.7,
P
< 0.001), for piecemeal resection (OR 2.4,
P
< 0.001) and incomplete (R1) resection (OR 2.6,
P
< 0.001). Finally, submucosal invasive gastric cancer was an independent risk factor for piecemeal resection (OR 2.6,
P
= 0.008), for perforation (OR 19.3,
P
= 0.001) and for incomplete (R1) resection (OR 2.7,
P
= 0.001).
Conclusions
Difficult ESD procedures are a function of the lesion size and location, submucosal fibrosis, and submucosal invasive cancer. When a difficult ESD procedure is expected, appropriate preparations should be considered, including consultation with more experienced endoscopists.]]></description><subject>Abdominal Surgery</subject><subject>Anticoagulants</subject><subject>Biopsy</subject><subject>Cancer therapies</subject><subject>Clinical Competence - standards</subject><subject>Dissection</subject><subject>Dissection - methods</subject><subject>Endoscopic Mucosal Resection - adverse effects</subject><subject>Endoscopic Mucosal Resection - standards</subject><subject>Endoscopy</subject><subject>Female</subject><subject>Gastric cancer</subject><subject>Gastric Mucosa - pathology</subject><subject>Gastric Mucosa - surgery</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Lymphatic system</subject><subject>Male</subject><subject>Medical records</subject><subject>Medical screening</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Proctology</subject><subject>Research centers</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><subject>Ulcers</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kV9rFTEQxYMo9rb1A_RFFnzxZetMdja78U36HwqC1ueQm2RvU_durpldxG9vyq1SBJ8yML9zMpwjxAnCKQJ0HxiAFNWAqm6RdK1eiBVSI2spsX8pVqAbqGWn6UAcMj9AwTW2r8WB7Ei3DTUrEb9E_l4N1s0pc2WZk4t2Dr76Gef7ysdhiG4Z52pjec7RVWHyiV3alZGX9XZxie1YOObg5pimj9UuBx_LPG2eyS--nh-LV4MdObx5eo_Et8uLu7Pr-vbz1c3Zp9vaEcm5XgOChkEOXduil42S4DT2rqe-b0kG9IMnKntCrwOB7ddKadJq7VDq1jVH4v3ed5fTjyXwbLaRXRhHO4W0sMG-1R0SqK6g7_5BH9KSp3JdoToFJSGCQuGecjkx5zCYXY5bm38ZBPPYg9n3YEoP5rEHo4rm7ZNzCSn4v4o_wRdA7gEuq2kT8rOv_-v6G2bwks8</recordid><startdate>20170401</startdate><enddate>20170401</enddate><creator>Kim, Ji Ha</creator><creator>Nam, Hyeong Seok</creator><creator>Choi, Cheol Woong</creator><creator>Kang, Dae Hwan</creator><creator>Kim, Hyung Wook</creator><creator>Park, Su Bum</creator><creator>Kim, Su Jin</creator><creator>Hwang, Sun Hwi</creator><creator>Lee, Si Hak</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20170401</creationdate><title>Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD</title><author>Kim, Ji Ha ; Nam, Hyeong Seok ; Choi, Cheol Woong ; Kang, Dae Hwan ; Kim, Hyung Wook ; Park, Su Bum ; Kim, Su Jin ; Hwang, Sun Hwi ; Lee, Si Hak</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c442t-b01090f2f7551d23620c918c8488542e1dfd44f2f41d9e40a8b669496bc1295c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abdominal Surgery</topic><topic>Anticoagulants</topic><topic>Biopsy</topic><topic>Cancer therapies</topic><topic>Clinical Competence - standards</topic><topic>Dissection</topic><topic>Dissection - methods</topic><topic>Endoscopic Mucosal Resection - adverse effects</topic><topic>Endoscopic Mucosal Resection - standards</topic><topic>Endoscopy</topic><topic>Female</topic><topic>Gastric cancer</topic><topic>Gastric Mucosa - pathology</topic><topic>Gastric Mucosa - surgery</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Lymphatic system</topic><topic>Male</topic><topic>Medical records</topic><topic>Medical screening</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Proctology</topic><topic>Research centers</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - surgery</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><topic>Ulcers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Ji Ha</creatorcontrib><creatorcontrib>Nam, Hyeong Seok</creatorcontrib><creatorcontrib>Choi, Cheol Woong</creatorcontrib><creatorcontrib>Kang, Dae Hwan</creatorcontrib><creatorcontrib>Kim, Hyung Wook</creatorcontrib><creatorcontrib>Park, Su Bum</creatorcontrib><creatorcontrib>Kim, Su Jin</creatorcontrib><creatorcontrib>Hwang, Sun Hwi</creatorcontrib><creatorcontrib>Lee, Si Hak</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Ji Ha</au><au>Nam, Hyeong Seok</au><au>Choi, Cheol Woong</au><au>Kang, Dae Hwan</au><au>Kim, Hyung Wook</au><au>Park, Su Bum</au><au>Kim, Su Jin</au><au>Hwang, Sun Hwi</au><au>Lee, Si Hak</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2017-04-01</date><risdate>2017</risdate><volume>31</volume><issue>4</issue><spage>1617</spage><epage>1626</epage><pages>1617-1626</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract><![CDATA[Background and study aim
Endoscopic submucosal dissection (ESD) is a widely accepted treatment for superficial gastric neoplasms. Difficult ESD can lead to complications, such as bleeding and perforation. To predict difficult ESD procedures, we analyzed the factors associated with difficult ESD.
Patients and methods
The medical records of 1052 ESD procedures were retrospectively reviewed. Difficult ESD was defined by any one of three end points: longer procedure time (≥60 min), piecemeal resection, incomplete (R1) resection, or gastric wall perforation. To determine the factors associated with difficult ESD, clinical and pathologic features and endoscopic findings were analyzed.
Results
The rates of en bloc resection and curative (R0) resection were 93.3 and 92.4 %, respectively. The mean procedure time was 27.7 ± 16.7 min. After multivariate analysis, larger tumor size (≥20 mm) was an independent risk factor for longer procedure time (OR 4.1,
P
< 0.001), for piecemeal resection (OR 2.3,
P
= 0.003) and incomplete (R1) resection (OR 2.1,
P
= 0.005). Location of the lesion (upper third) was an independent risk factor for longer procedure time (OR 5.8,
P
< 0.001), for piecemeal resection (OR 4.1,
P
< 0.001) and incomplete (R1) resection (OR 4.5,
P
< 0.001). Submucosal fibrosis was an independent risk factor for longer procedure time (OR 9.7,
P
< 0.001), for piecemeal resection (OR 2.4,
P
< 0.001) and incomplete (R1) resection (OR 2.6,
P
< 0.001). Finally, submucosal invasive gastric cancer was an independent risk factor for piecemeal resection (OR 2.6,
P
= 0.008), for perforation (OR 19.3,
P
= 0.001) and for incomplete (R1) resection (OR 2.7,
P
= 0.001).
Conclusions
Difficult ESD procedures are a function of the lesion size and location, submucosal fibrosis, and submucosal invasive cancer. When a difficult ESD procedure is expected, appropriate preparations should be considered, including consultation with more experienced endoscopists.]]></abstract><cop>New York</cop><pub>Springer US</pub><pmid>27495343</pmid><doi>10.1007/s00464-016-5149-6</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Surgical endoscopy, 2017-04, Vol.31 (4), p.1617-1626 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Abdominal Surgery Anticoagulants Biopsy Cancer therapies Clinical Competence - standards Dissection Dissection - methods Endoscopic Mucosal Resection - adverse effects Endoscopic Mucosal Resection - standards Endoscopy Female Gastric cancer Gastric Mucosa - pathology Gastric Mucosa - surgery Gastroenterology Gynecology Hepatology Hospitals Humans Lymphatic system Male Medical records Medical screening Medicine Medicine & Public Health Middle Aged Multivariate Analysis Proctology Research centers Retrospective Studies Risk Factors Stomach Neoplasms - pathology Stomach Neoplasms - surgery Surgery Treatment Outcome Ulcers |
| title | Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD |
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