THE SIZE, MANOEUVRABILITY, SITE, HISTORY SCORE (SMSH)—A NEW TOOL FOR PREDICTING THE OUTCOMES OF COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Aims Despite its undeniable carcinologic advantages, endoscopic submucosal dissection (ESD) has not replaced piecemeal endoscopic mucosal resection in Western countries because of the technical difficulty, long procedure duration, high complication rate, and steep learning curve. Differentiation of easy and difficult lesions would promote use of ESD. The objective of this study was to try to create a score that predict outcomes after colorectal ESD for large superficial lesions.

Methods We considered R0 resection without perforation (ESD success) as the primary endpoint.

Independent risk factors identified in a multivariate analysis of a large prospective monocentric derivation cohort were used to create the SMSH score, which was validated in an independent prospective French multicentre validation set.

Results The derivation and validation sets comprised 738 and 1,042 lesions, respectively. The SMSH score comprised four preprocedural risk factors: tumour size, manoeuvrability, tumour location, and lesion history. The probability of ESD success in the easy (SMSH1; total score<4 points), average (SMSH2; 4–7 points), difficult (SMSH3; 8–12 points), and very difficult (SMSH4;>12 points) categories was 89%, 85%, 77%, and 65% in the derivation set (p<0.001), and 89%, 87%, 76%, and 53% in the external validation set (p<0.001), respectively.

Conclusions The SMSH score, based on pre-procedural data, predicts ESD success for colorectal lesions and identifies easy lesions suitable for trainees and difficult lesions that should be reserved for expert centres.

Publication History

Article published online:
14 April 2022