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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(09): E1075-E1084
DOI: 10.1055/a-2387-1754
Original article

Endoscopic ultrasound classification for prediction of endoscopic submucosal dissection resectability: PREDICT classification

Noriko Matsuura 
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Motohiko Kato 
2   Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Kentaro Iwata
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
3   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Kurato Miyazaki
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
3   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Teppei Masunaga 
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Yoko Kubosawa
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
3   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Mari Mizutani
2   Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Yukie Hayashi
3   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Kaoru Takabayashi
2   Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Yusaku Takatori
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Atsushi Nakayama
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
,
Koji Okabayashi
4   Department of Surgery, Keio University School of Medicine Graduate School of Medicine Department of Surgery, Shinjuku-ku, Japan (Ringgold ID: RIN215684)
,
Hirofumi Kawakubo
4   Department of Surgery, Keio University School of Medicine Graduate School of Medicine Department of Surgery, Shinjuku-ku, Japan (Ringgold ID: RIN215684)
,
Yuko Kitagawa
4   Department of Surgery, Keio University School of Medicine Graduate School of Medicine Department of Surgery, Shinjuku-ku, Japan (Ringgold ID: RIN215684)
,
Naohisa Yahagi
1   Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University School of Medicine, Shinjuku-ku, Japan (Ringgold ID: RIN38084)
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Abstract

Background and study aims The safety of endoscopic submucosal dissection (ESD) has been reported, and the risk of lymph node metastasis is low for colorectal cancer if depth of invasion is the only non-curative factor on histological evaluation. ESD is increasingly performed even if submucosal (SM) invasion is suspected. However, reports about endoscopic findings for the criteria to predict ESD resectability remain limited. Endoscopic ultrasound (EUS) can directly visualize the tomographic image of the gastrointestinal wall and may help predict ESD resectability. Therefore, we investigated the possibility of predicting ESD resectability using EUS.

Patients and methods We compared the association between EUS findings and pathological results for gastric or colorectal lesions with suspected SM invasion using white light endoscopy between June 2020 and January 2023. EUS findings were grouped based on the status of the underlying the tumor, as follows: Type I, submucosal layer was observed with reproducibility; Type II, submucosal layer not fully visible; and Type III, submucosal layer disrupted and muscularis propria (MP) layer thickened.

Results Forty-one gastric cancer and 22 colorectal cancer cases were analyzed. The proportions of pathological VM0 (no tumor exposed on any vertical margin) for ESD-resected specimens were 89% and 33% for Type I and II, respectively, (P ≤ 0.01). The proportions of cancer involving MP or deeper were significantly higher for Type II/III than for Type I (41% vs 0%, P ≤ 0.01).

Conclusions EUS may have an important role in predicting ESD resectability of gastric and colorectal cancers suspected of having SM invasion.

Keywords

Endoscopy Lower GI Tract - Diagnosis and imaging (inc chromoendoscopy, NBI, iSCAN, FICE, CLE...) - Endoscopic resection (polypectomy, ESD, EMRc, ...) - Endoscopic ultrasonography - Gastric cancer - Rectal cancer - Endoscopy Upper GI Tract - Endoscopic resection (ESD, EMRc, ...)

Supplementary Material



Publication History

Received: 13 December 2023

Accepted after revision: 01 August 2024

Article published online:
16 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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