Effectiveness and Safety of Endoscopic Submucosal Dissection for Gastrointestinal Lesions With Significant Submucosal Fibrosis: A Western Prospective Cohort Study

Aims During ESD, submucosal fibrosis can be an additional and often unexpected obstacle to technical success. This study aimed to assess the outcomes and the safety of ESD when submucosal fibrosis is detected.

Methods All consecutive patients undergoing ESD at our center as first treatment for gastrointestinal lesions were prospectively enrolled from March 2018 to March 2020.Collected data included patient demographics, procedural outcomes and complication rate. Fibrosis was classified as F0 (no fibrosis), F1 (mild fibrosis in the blue submucosal layer), F2 (whitish submucosa or severe fibrosis). According to fibrosis grade, two groups of lesions were defined: no/mild fibrosis (F0-F1) and severe fibrosis (F2).

Results 111 patients (65.8 % males, median age 70.9 years) with 111 lesions undergoing ESD were enrolled. 78/111 (70.3 %) were colorectal lesions, while 33/111 (29.7 %) were located in the upper GI tract. Mean lesion size was 36.7 mm (range15-82 mm). Technical success rate was 110/111 (99.1 %). En bloc resection was not achieved for one lesion with severe fibrosis (F2). In the colon, R0-resection rate was 85.5 % for lesions with no/mild fibrosis (F0-F1) and 71.4 % for lesions with severe fibrosis (F2) (p = 0.16). Curative resection rate was significantly higher for F0-F1 lesions compared to F2 lesions (90.9 % vs 73.9 %, p = 0.049). No difference in complication rate between the two groups was highlighted. In the upper GI, R0 resection rate was similar between F0-F1 group and F2 group: 84.6 % vs 85.7 %, respectively. Curative resection rate was higher in the F0-F1 group (88.5 % vs 71.4 %), without statistical difference (p = 0.26). Bleeding rate was significantly higher in the F2 group (28.6 % vs. 3.8 %, p = 0.043). Mean procedure time was higher for F2 lesions (130 vs 92.5 minutes), with no statistical difference (p = 0.12).

Conclusions Detection of severe fibrosis during ESD could affect procedural outcomes and increase complication rates, therefore it should always be expected and overcame with the correct strategies.

Citation: sferrazza s, Vieceli F, Maida M et al. eP12 EFFECTIVENESS AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR GASTROINTESTINAL LESIONS WITH SIGNIFICANT SUBMUCOSAL FIBROSIS: A WESTERN PROSPECTIVE COHORT STUDY. Endoscopy 2021; 53: S100.

Publication History

Article published online:
19 March 2021