Año 2018 / Volumen 110 / Número 11
Original
Switching from endoscopic submucosal dissection to salvage piecemeal knife-assisted snare resection to remove a lesion: a preoperative risk score from the beginning

699-705

DOI: 10.17235/reed.2018.5608/2018

José C. Marín-Gabriel, David Lora Pablos, José Díaz-Tasende, Pilar Cancelas-Navia, Sarbelio Rodríguez Muñoz, Andrés J. del Pozo-García, Marina Alonso-Riaño, Yolanda Rodríguez-Gil, Carolina Ibarrola-Andrés, Gregorio Castellano Tortajada,

Resumen
Background and aims: endoscopic submucosal dissection (ESD) in the Western setting remains a challenge. Therefore, other simplified techniques such as knife-assisted snare resection (KAR) have been reported to overcome this issue. Methods: patients who underwent an ESD for the treatment of gastrointestinal neoplasms were included in a retrospective cross-sectional observational study. Factors associated with the end of ESD as a salvage p-KAR were identified and a logistic regression model was developed. Results: a total of 136 lesions in 133 patients were analyzed. Operator experience of under 50 cases and the combination of lesion size > 30 mm and colorectal location were independent predictive factors for switching to a salvage p-KAR according to the multivariate logistic regression analysis. We developed a risk scoring system based on these four variables (experience, size, location and the combination of size and location) with a receiver operating characteristic curve of 0.81 (95% CI: 0.74-0.89). The diagnostic accuracy of the score for a cut-off point ≥ 5 had a sensitivity of 0.79 (95% CI: 0.66-0.93) and a specificity of 0.71 (95% CI: 0.61-0.80). Conclusion: a simple predictive score system that includes four preoperative factors accurately predicts ESD to finish as a p-KAR. A careful selection of cases considering these variables could be useful to achieve better outcomes in the Western setting.
Share Button
Nuevo comentario
Comentarios
No hay comentarios para este artículo.
Bibliografía
1. Tanaka S, Kashida H, Saito Y, et al. JGES guidelines for colorectal endoscopic submucosal dissection/endoscopic mucosal resection. Dig Endosc. 2015;27(4):417-34.
2. Saito Y, Uraoka T, Yamaguchi Y, et al. A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc. 2010;72(6):1217-25.
3. Goto O, Fujishiro M, Kodashima S, et al. Outcomes of endoscopic submucosal dissection for early gastric cancer with special reference to validation for curability criteria. Endoscopy. 2009;41(2):118-22.
4. Farhat S, Chaussade S, Ponchon T, et al. Endoscopic submucosal dissection in a European setting. A multi-institutional report of a technique in development. Endoscopy. 2011;43(8):664-70.
5. Probst A, Pommer B, Golger D, et al. Endoscopic submucosal dissection in gastric neoplasia - experience from a European center. Endoscopy. 2010;42(12):1037-44.
6. Bhattacharyya R, Chedgy FJ, Kandiah K, et al. Knife-assisted snare resection (KAR) of large and refractory colonic polyps at a Western centre: Feasibility, safety and efficacy study to guide future practice. United European Gastroenterol J. 2016;4(3):466-73.
7. Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer. 2007;10(1):1-11.
8. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58(6 Suppl):S3-43.
9. Kudo S, Lambert R, Allen JI, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc. 2008;68(4 Suppl):S3-47.
10. Schlemper RJ, Riddell RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47(2):251-5.
11. Neuhaus H. ESD around the world: Europe. Gastrointest Endosc Clin N Am. 2014;24(2):295-311.
12. Ono H, Yao K, Fujishiro M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Digestive Endoscopy. 2016;28(1):3-15.
13. Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(9):829-54.
14. Uraoka T, Parra-Blanco A, Yahagi N. Colorectal endoscopic submucosal dissection: is it suitable in western countries? J Gastroenterol Hepatol. 2013;28(3):406-14.
15. Mehta HB, Mehta V, Girman CJ, et al. Regression coefficient-based scoring system should be used to assign weights to the risk index. J Clin Epidemiol. 2016;79:22-8.
16. Hulagu S, Senturk O, Aygun C, et al. Endoscopic submucosal dissection for premalignant lesions and noninvasive early gastrointestinal cancers. World J Gastroenterol. 2011;17(13):1701-9.
17. Uraoka T, Kawahara Y, Kato J, et al. Endoscopic submucosal dissection in the colorectum: present status and future prospects. Dig Endosc. 2009;21 Suppl 1:S13-6.
18. Hotta K, Oyama T, Shinohara T, et al. Learning curve for endoscopic submucosal dissection of large colorectal tumors. Dig Endosc. 2010;22(4):302-6.
19. Isomoto H, Nishiyama H, Yamaguchi N, et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy. 2009;41(8):679-83.
20. Takeuchi Y, Iishi H, Tanaka S, et al. Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis. 2014;29(10):1275-84.
21. Hayashi N, Tanaka S, Nishiyama S, et al. Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors. Gastrointest Endosc. 2014;79(3):427-35.
22. Hori K, Uraoka T, Harada K, et al. Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum. Endoscopy. 2014;46(10):862-70.
23. Imai K, Hotta K, Yamaguchi Y, et al. Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: implications for lesion stratification by technical difficulties during stepwise training. Gastrointest Endosc. 2016;83(5):954-62.
Artículos relacionados

Imagen en Patología Digestiva

Sustained silence of a small signet ring cell carcinoma

DOI: 10.17235/reed.2023.9891/2023

Carta

Pseudo-submucosal tumor in the colon: seeing is believing

DOI: 10.17235/reed.2023.9773/2023

Carta

Successful endoscopic removal of a giant duodenal bulb mass

DOI: 10.17235/reed.2022.8595/2022

Imagen en Patología Digestiva

Anemia induced by hemangioma at the duodenal papilla, resected by endoscopic mucosal resection

DOI: 10.17235/reed.2022.8439/2021

Imagen en Patología Digestiva

A rare mass in the duodenal bulb: Brunner’s glands cystadenoma

DOI: 10.17235/reed.2018.5344/2017

Carta al Editor

Gastric neuroendocrine tumor presenting with gastrointestinal bleeding

DOI: 10.17235/reed.2015.3998/2015

Carta al Editor

Endoscopic submucosal dissection for a gastric fibrolipoma

DOI: 10.17235/reed.2015.3982/2015

Instrucciones para citar
Marín-Gabriel J, Lora Pablos D, Díaz-Tasende J, Cancelas-Navia P, Rodríguez Muñoz S, del Pozo-García A, et all. Switching from endoscopic submucosal dissection to salvage piecemeal knife-assisted snare resection to remove a lesion: a preoperative risk score from the beginning. 5608/2018


Descargar en un gestor de citas

Descargue la cita de este artículo haciendo clic en uno de los siguientes gestores de citas:

Métrica
Este artículo ha sido visitado 708 veces.
Este artículo ha sido descargado 142 veces.

Estadísticas de Dimensions


Estadísticas de Plum Analytics

Ficha Técnica

Recibido: 18/03/2018

Aceptado: 21/05/2018

Prepublicado: 17/09/2018

Publicado: 30/10/2018

Tiempo de revisión del artículo: 62 días

Tiempo de prepublicación: 183 días

Tiempo de edición del artículo: 226 días


Compartir
Este artículo aun no tiene valoraciones.
Valoración del lector:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
La REED es el órgano oficial de la Sociedad Española de Patología Digestiva, la SociedadEspañola de Endoscopia Digestiva y la Asociación Española de Ecografía Digestiva
Política de cookies Política de Privacidad Aviso Legal © Copyright 2023 y Creative Commons. Revista Española de Enfermedades Digestivas