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DOI: 10.1055/s-0039-1681202
SMSA SCORE FOR COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION (CR-ESD): IS IT USEFUL FOR PLANNING RESOURCES OR PREDICTING PROCEDURAL OUTCOMES? A MULTICENTER SPANISH PROSPECTIVE STUDY
Publication History
Publication Date:
18 March 2019 (online)
Aims:
To assess the ability of SMSA to predict clinical outcomes of CR-ESD: length of the procedure and percentages of piecemeal resections, aborted procedures and complications.
Methods:
Consecutive patients were enrolled in a prospective multicenter Spanish CR-ESD registry since January 2016 to October 2018. We analyzed 585 cases in 19 hospitals.
Results:
The duration of the procedure was > 240 min in 36 ESDs (6.2%). There were 13 aborted procedures (2.2%), 92 piecemeal resections (16.1%), 86 intraprocedural perforations (14.7%), 19 delayed perforations (3.4%) and 37 delayed bleedings (6.6%). There were 40 SMSA2 (6.8%), 189 SMSA3 (32.3%) and 356 SMSA4 (60.8%) lesions. The median procedure duration was 74.5 min for SMSA2, 80 min for SMSA3 and 120 min for SMSA4. A statistically significant association was observed for SMSA4 and duration of the procedure > 240 min (8.4% vs. 2.6%; OR = 3.4; CI95%: 1.4 – 8.3; p = 0.004). The percentage of piecemeal resections was as follows SMSA2: 27.5% vs. SMSA3: 11.4% vs. SMSA4: 17.2%; p = 0.03. SMSA2 lesions were significantly associated with piecemeal resections (SMSA2 vs. SMSA3/4: 27.5% vs. 14.8%; OR = 2.1; CI95%: 1.01 – 4.4; p = 0.04). No significant differences were noted for aborted ESDs: SMSA2: 0% vs. SMSA3: 2.6% vs. SMSA4: 2.2%; p = 0.59. Statistically significant differences were observed between intraprocedural perforations and SMSA3/4 lesions (SMSA2 vs. SMSA3/4: 2.5% vs. 15.6%; OR = 7.2; IC95%: 1.01 – 53.1; p = 0.02). The delayed perforation rate was: 0%/2.7%/4.2%; p = 0.3 and the delayed bleeding rate: 8.1%/5.9%/6.8%; p = 0.8, respectively.
Conclusions:
The SMSA score may be useful for planning endoscopy lists since it significantly correlates with the length of the procedure. Higher scores were also associated with intraprocedural perforations. However, we did not find a direct proportional link when considering other procedural outcomes (piecemeal resections, aborted procedures and delayed perforation or bleeding).