OUTCOMES AND PREDICTIVE FACTORS OF SUBMUCOSAL FIBROSIS IN COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION: A PROSPECTIVE INTERNATIONAL STUDY

Aims Endoscopic submucosal dissection (ESD) enables en-bloc resection of large colorectal lesions. Submucosal fibrosis is a major feature for technical difficulty and poor outcomes. The aims of our study were: (1) to assess ESD outcomes according to the degree of fibrosis, and (2) to identify the predictive factors of fibrosis in colorectal lesions undergoing ESD.

Methods We prospectively enrolled all consecutive patients undergoing colorectal ESD between 2019 and 2021 in three Asian and Western tertiary referral centers. The degree of submucosal fibrosis was classified as absent (F0), mild (F1), and severe (F2). Logistic regression analysis was used to assess both ESD outcomes and predictive factors of fibrosis.

Results 309 patients were included. The incidence of fibrosis was 36.5% (F1: 23%; F2: 14%). The duration of ESD and the rate of R0 resection were significantly associated with the degree of fibrosis (p<0.001; p<0.001). The rate of complications was more frequent among F1-F2 lesions, though the result was not significant (p=0.164). Lesion size≥40 mm (OR 2.35, CI 1.39-3.98), morphology (OR 3.54, CI 1.28-9.77 for 0-Is vs. LST-G) and site (OR 2.47, CI 1.25-4.86 for rectum vs. proximal colon) were associated with increasing degree of submucosal fibrosis.

Conclusions Lesions size, morphology and location are predictive factors for the increasing degree of submucosal fibrosis, which is associated with non-curative resection and long procedural time. Such results may pave the way to a more rational resource allocation for ESD.

Publication History

Article published online:
14 April 2022