Endoscopy 2020; 52(S 01): S286
DOI: 10.1055/s-0040-1704904
ESGE Days 2020 ePoster presentations
Colon and rectum 09:00–17:00 Thursday, April 23, 2020 ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

OUTCOMES AND SAFETY OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR LESIONS WITH SIGNIFICANT SUBMUCOSAL FIBROSIS: A CASE SERIES

S Sferrazza
1   Santa Chiara Hospital, Gastroenterology, Trento, Italy
,
M Maida
2    S Elia – Raimondi Hospital, Gastroenterology, Caltanissetta, Italy
,
F Vieceli
1   Santa Chiara Hospital, Gastroenterology, Trento, Italy
,
G de Pretis
1   Santa Chiara Hospital, Gastroenterology, Trento, Italy
,
R Maselli
3   Humanitas Research Hospital, Gastroenterology, Milan, Italy
,
A Repici
3   Humanitas Research Hospital, Gastroenterology, Milan, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims During endoscopic submucosal dissection (ESD), submucosal fibrosis can be an additional and unexpected obstacle to technical success. This study aimed to assess the outcomes and the safety of ESD as treatment for gastrointestinal lesions with submucosal fibrosis detected during the procedure.

    Methods All consecutive patients undergoing ESD at our center as first treatment for gastrointestinal lesions, with detection of fibrosis during the procedure, were retrospectively reviewed.

    Fibrosis was classified as F0 (no fibrosis), F1 (mild fibrosis in the blue submucosal layer), F2 (whitish submucosa or severe fibrosis). Complete resection was defined as a single piece (en-bloc) resection of the targeted lesion plus histological confirmation of horizontal and vertical free margins.

    Results Overall, 12 ESD of lesions with significant fibrosis met the inclusion criteria. Of these 4 (33.3%) were located in the colon, 3 (25.0%) in the rectum, 4 (33.3%) in the stomach and 1 (8.3%) in the esophagus. The size of the lesions ranged from 25 to 80 mm. A mild (F1) fibrosis was found in 5/12 (41.7%) lesions and a severe (F2) fibrosis in the remaining 7/12 (58.3%) lesions. Technical success of ESD with en-bloc resection was achieved in 11/12 (91.7%) of cases and, only for one rectal lesion, the procedure was converted to piecemeal EMR. A R0 resection was achieved in 10/12 (83.3%) of patients. In one case, an invasion of resection margins was present, in the other one the histological examination revealed an adenocarcinoma with deep invasion of the submucosal, subsequently referred for surgery. One perforation of the right colon, successfully treated with endoclip closure, and one mayor intraprocedural bleeding treated with hemostatic forceps occurred. No case of recurrence after a mean follow-up of 9 months were registered.

    Conclusions Based on our experience, ESD is feasible and safe even when fibrosis is detected during the procedure.


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