Risk factors associated with difficult gastric endoscopic submucosal dissection: predicting difficult ESD

Area of Science:

• Gastroenterology
• Endoscopic Surgery
• Oncology

Background:

• Endoscopic submucosal dissection (ESD) is a standard treatment for superficial gastric neoplasms.
• Difficult ESD cases can lead to complications like bleeding and perforation.
• Predicting and managing difficult ESD is essential for improving patient outcomes.

Purpose of the Study:

• To identify clinical, pathological, and endoscopic factors predicting difficult endoscopic submucosal dissection (ESD) procedures.
• To analyze the association between specific lesion characteristics and increased ESD complexity.

Main Methods:

• Retrospective review of 1052 endoscopic submucosal dissection (ESD) procedures.
• Difficult ESD defined by prolonged procedure time (≥60 min), piecemeal resection, incomplete resection (R1), or perforation.
• Multivariate analysis of clinical, pathological, and endoscopic findings.

Main Results:

• Larger tumor size (≥20 mm), upper third lesion location, submucosal fibrosis, and submucosal invasive cancer were independent risk factors for difficult ESD.
• These factors were associated with longer procedure times, piecemeal resections, incomplete resections, and perforation.
• En bloc and curative resection rates were high (93.3% and 92.4%, respectively).

Conclusions:

• Difficult ESD is significantly influenced by lesion size, location, submucosal fibrosis, and submucosal invasive cancer.
• Anticipating difficult ESD procedures allows for better preparation and consultation with experienced endoscopists.
• Proactive management of these factors can minimize complications and improve ESD success rates.