Risk factors for prolonged procedure time of endoscopic submucosal dissection for colorectal laterally spreading tumors / 中华消化内镜杂志

ABSTRACT

Objective:To investigate the risk factors for prolonged procedure time of endoscopic submucosal dissection (ESD) for colorectal laterally spreading tumors (LSTs).Methods:Consecutive patients who underwent ESD for colorectal LSTs at Beijing Digestive Disease Center from June 2013 to March 2019 were retrospectively analyzed. Univariate analysis was used to identify factors associated with prolonged procedure time (≥60 min). Factors with significant difference in univariate analysis were included in multivariate logistic regression to determine the independent risk factors.Results:A total of 201 patients (age 65.05±10.44 years old, 53.73% were males) with 213 LSTs (diameter 2.52±1.67 cm) were included. En bloc resection rate, complete resection rate and curative resection rate were 93.90%, 84.04% and 79.81%, respectively. Intraoperative perforation rate, delayed perforation rate and delayed bleeding rate were 1.88%, 0.94% and 1.41%, respectively. Diameter ≥3 cm ( OR=13.48, P<0.001), granular nodular mixed (G-NM) subtype ( OR=25.28, P=0.002), granular homogenous subtype ( OR=9.00, P=0.045), location of rectosigmoid ( OR=3.08, P=0.002) and positive non-lifting sign ( OR=3.40, P=0.012) were associated with longer procedure time in univariate analysis. In multivariate logistic regression, diameter ≥3 cm ( OR=9.29, P<0.001), G-NM subtype ( OR=8.80, P=0.043) and positive non-lifting sign ( OR=3.43, P=0.043) were independent risk factors for prolonged procedure time. Longer procedure time was associated with lower rates of complete resection (69.56% VS 88.55%, P=0.003) and curative resection (63.64% VS 85.50%, P=0.002), and increased rate of carcinoma (86.96% VS 51.91%, P<0.001). Conclusion:LSTs of size over 3 cm, G-NM subtype or positive non-lifting sign predict prolonged procedure time, which is associated with reduced efficacy of ESD and higher risk of carcinoma.