Background

Endoscopic submucosal dissection (ESD) has gained increasing popularity in the management of complicated colorectal polyps. However, clinical outcomes for ESD have remained highly inconsistent worldwide. This study investigated and analysed factors that significantly affect ESD outcomes.

Methods

We conducted a single-centred retrospective study on 220 colorectal polyps removed by ESD from 1st January 2016 to 31st December 2020. Data were collected and retrieved from clinical records. Variables studied included patient demographics, ESD technicalities and polyp characteristics. The primary outcome was completeness of resection based on en bloc and R0 resection rates. The secondary outcomes were recurrence, complications and hospital stay. Further analysis was performed for significant outcome determining factors.

Results

The en bloc resection and R0 resection rates were 97.3% and 65% respectively. Intraprocedural and delayed perforation rates were 3.2% and 0.5% respectively. Intraprocedural and delayed bleeding rates were both 1.8%. Post-polypectomy syndrome rate was 2.7%. The median hospital stay was 4 days. Submucosal fibrosis was a significant determining factor for lower en bloc resection (p = 0.004), lower R0 resection (p = 0.002), intraprocedural perforation (p = 0.001), intraprocedural bleeding (p = 0.025) and post-polypectomy syndrome (p = 0.039). Hybrid snaring was associated with lower en bloc resection (p < 0.001), while longer ESD time was associated with lower R0 resection (p = 0.003) and post-polypectomy syndrome (p = 0.025). Other significant factors for post-polypectomy syndrome included young age (p = 0.021) and large polyp size (p = 0.018). Secondary analysis showed that submucosal fibrosis was significantly associated with non-granular lesions (p < 0.001) and prior biopsy (p = 0.003).

Conclusion

Submucosal fibrosis, hybrid snaring, ESD time, age and polyp size were significant outcome determining factors for ESD. By identifying these factors, strategies may be formulated to improve ESD outcomes.

中文翻译：

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结直肠息肉的内镜粘膜下剥离术：结果决定因素

背景

内镜粘膜下剥离术 (ESD) 在复杂性结直肠息肉的治疗中越来越受欢迎。然而，ESD 的临床结果在世界范围内仍然高度不一致。本研究调查并分析了显着影响 ESD 结果的因素。

方法

我们对 2016 年 1 月 1 日至 2020 年 12 月 31 日期间通过 ESD 切除的 220 例结直肠息肉进行了单中心回顾性研究。数据是从临床记录中收集和检索的。研究的变量包括患者人口统计学、ESD 技术细节和息肉特征。主要结果是基于整块和 R0 切除率的切除完整性。次要结果是复发、并发症和住院时间。对重要的结果决定因素进行了进一步分析。

结果

整块切除率和R0切除率分别为97.3%和65%。术中和延迟穿孔率分别为 3.2% 和 0.5%。术中和延迟出血率均为 1.8%。息肉切除术后综合征发生率为 2.7%。中位住院时间为 4 天。粘膜下纤维化是下位整块切除 ( p  = 0.004)、下位 R0 切除 ( p  = 0.002)、术中穿孔 ( p  = 0.001)、术中出血 ( p  = 0.025) 和息肉切除术后综合征 ( p  = 0.039）。混合圈套与较低的整块切除相关（p  < 0.001），而较长的 ESD 时间与较低的 R0 切除相关（p  = 0.003) 和息肉切除术后综合征 ( p  = 0.025)。息肉切除术后综合征的其他重要因素包括年轻 ( p  = 0.021) 和大息肉大小 ( p  = 0.018)。二次分析表明，粘膜下纤维化与非颗粒性病变 ( p  < 0.001) 和既往活检 ( p  = 0.003)显着相关。

结论

粘膜下纤维化、杂交圈套、ESD 时间、年龄和息肉大小是 ESD 的重要结果决定因素。通过识别这些因素，可以制定策略来改善 ESD 结果。