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Factors Predictive of Complete Excision of Large Colorectal Neoplasia Using Hybrid Endoscopic Submucosal Dissection: A KASID Multicenter Study

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A Correction to this article was published on 17 July 2018

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Abstract

Background

Endoscopic submucosal dissection (ESD) with snaring (hybrid ESD) bridges the gap between ESD and endoscopic mucosal resection. We evaluated factors predictive of en bloc and complete resection of large colorectal neoplasms using hybrid ESD.

Methods

This was a prospective clinical study of 78 patients who underwent hybrid ESD for excision of colorectal neoplasms (≥ 2 cm) between May 2015 and September 2016 at six university hospitals. We evaluated lesion and patient characteristics, endoscopist experience level (< 50 or ≥ 50 cases with colorectal ESD), and technical factors such as concurrent fibrosis, completion of a circumferential incision, degree of submucosal dissection (< 50 or ≥ 50%), and visualization during snaring (< 50 or ≥ 50%).

Results

Multivariate analyses showed that the en bloc resection rate was significantly related to the degree of visualization during snaring (odds ratio (OR) 7.811, 95% confidence interval [CI] 1.722–35.426; p = 0.008) and the presence of fibrosis (OR 0.258, 95% CI 0.68–0.993; p = 0.049). The complete resection rate was significantly related to the colorectal ESD endoscopist skill level (OR 5.626, 95% CI 1.485–21.313; p = 0.011) and gross lesion type (OR 0.145, 95% CI 0.022–0.936; p = 0.042). When all three technical factors, i.e., completion of circumferential incision, ≥ 50% submucosal dissection, and ≥ 50% visualization during snaring, were satisfied performing hybrid ESD, the en bloc resection rate (87.5%) was similar to that of ESD.

Conclusions

Visualization during snaring, presence of fibrosis, gross lesion type, and endoscopist colorectal ESD experience level affect en bloc or complete resection of large colorectal neoplasia using hybrid ESD.

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Change history

  • 17 July 2018

    The original version of the article unfortunately contained errors in author affiliation. Affiliation of third and ninth author was incorrectly assigned.

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Acknowledgments

This work was supported by a Soonchunhyang University Research Fund.

Author information

Author notes

  1. Yunho Jung and Jong Wook Kim contributed equally to this work.

Authors and Affiliations

  1. Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Cheonan, Korea

    Yunho Jung

  2. Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea

    Jong Wook Kim

  3. Department of Internal Medicine, Division of Gastroenterology, Soonchunhyang University College of Medicine, Seoul, Korea

    Jeong-Sik Byeon & Hyun Gun Kim

  4. Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea

    Hoon Sup Koo

  5. Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea

    Sun-Jin Boo

  6. Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Korea

    Jun Lee

  7. Department of Preventive Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea

    Young Hwangbo

  8. Department of Pathology, Soonchunhyang University College of Medicine, Seoul, Korea

    Yoon Mi Jeen

  9. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Hyun Gun Kim

Authors
  1. Yunho Jung
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  2. Jong Wook Kim
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  3. Jeong-Sik Byeon
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  7. Young Hwangbo
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  8. Yoon Mi Jeen
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Corresponding author

Correspondence to Hyun Gun Kim.

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Jung, Y., Kim, J.W., Byeon, JS. et al. Factors Predictive of Complete Excision of Large Colorectal Neoplasia Using Hybrid Endoscopic Submucosal Dissection: A KASID Multicenter Study. Dig Dis Sci 63, 2773–2779 (2018). https://doi.org/10.1007/s10620-018-5140-2

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  • DOI: https://doi.org/10.1007/s10620-018-5140-2

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