SMSH SCORE (SIZE, MANEUVERABILITY, SITE, HISTORY) A NEW SCORE TO PREDICT EFFICACY AND COMPLICATIONS OF COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION (ESD)

Aims ESD is the gold standard for the treatment of large colorectal superficial lesions.The objective of this study was to identify pre-procedural predictive factors of R0 resection and perforation and try to design a predictive score.

Methods Prospective cohort study including all cases of ESD from a French referent center between 12/2012 and 09/2019. Primary endpoint was to identify predictive factors of R0 Resection, secondary endpoints was validation of a new score that could predict R0 and non R0 resection.

Results 466 lesions were included, 198 (42.4%) rectal lesions and 268 (57.6%) colonic.

The en bloc, R0 and curative resection rates were 94.8%, 80.2% and 75.7%, respectively.

In multivariate analysis: size of more than 8 cm (OR: 0.335,p = 0.034), poor endoscopic maneuverability (OR: 0.285,p = 0.001), localization anal verge, sigmoid or right angle (OR 0.386: p = 0.001), were significant pre-procedure risk factors for non-R0 resection.

A new score called SMSH (Size-Maneuverability-Site-History) was created to predict through pre-procedure criteria the effectiveness of colorectal ESD.

This score is divided into 3 groups 1 (< 4 points); 2 (> = 4 and < 8 points); 3 (> = 8 points) of increasing difficulty.

Applied to our prospective cohort 72 (15.9%) patients were classified as SMSH 1, 196 SMSH 2 (43.3%) and 185 SMSH 3 (40.8%).

There was a significant difference between the 3 groups:

- R0 resection rate: SMSH 1: 90.3%; SMSH 2: 84.6%; SMSH 3: 74.6% p = 0.0057

- Perforation rate: SMSH 1: 4,1%; SMSH 2: 5,6%; SMSH 3: 12,4% p=0,02

Conclusions SMSH score is able to predict results of colorectal ESD based on pre-procedural data. This new score should to help physicians to target their lesions according to their expertise. Independent validation cohort is needed.