Endoscopy 2019; 51(04): S11
DOI: 10.1055/s-0039-1681202
ESGE Days 2019 oral presentations
Friday, April 5, 2019 08:30 – 10:30: Colon ESD South Hall 2B
Georg Thieme Verlag KG Stuttgart · New York

SMSA SCORE FOR COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION (CR-ESD): IS IT USEFUL FOR PLANNING RESOURCES OR PREDICTING PROCEDURAL OUTCOMES? A MULTICENTER SPANISH PROSPECTIVE STUDY

, , ESD Interest Group – GSEED Endoscopic Resection Working Group
JC Marín-Gabriel
1   Gastroenterology, Endoscopy Unit, '12 de Octubre' University Hospital, Madrid, Spain
2   Gastroenterology, Endoscopy Unit, HM Sanchinarro University Hospital, Madrid, Spain
,
A Herreros de Tejada Echanojauregui
3   Gastroenterology, Endoscopy Unit, Puerta de Hierro – Majadahonda University Hospital, Majadahonda, Spain
4   Gastroenterology, Endoscopy Unit, MD Anderson Cancer Centre Madrid, Madrid, Spain
,
F Múgica-Aguinaga
5   Gastroenterology, Endoscopy Unit, Donostia University Hospital, San Sebastián, Spain
,
F Ramos-Zabala
6   Gastroenterology, Endoscopy Unit, HM Montepríncipe University Hospital, Boadilla del Monte, Spain
,
E Albéniz-Arbizu
7   Gastroenterology, Endoscopy Unit, Navarra University Hospital, Pamplona, Spain
,
PJ Rosón-Rodríguez
8   Gastroenterology, Endoscopy Unit, Quirón Málaga Hospital, Málaga, Spain
,
J de la Peña-García
9   Gastroenterology, Endoscopy Unit, 'Marqués de Valdecilla' University Hospital, Santander, Spain
,
Á Terán-Lantarón
10   Gastroenterology, Endoscopy Unit, 'Marques de Valdecilla' University Hospital, Santander, Spain
,
J Rodríguez-Sánchez
11   Gastroenterology, Endoscopy Unit, 'Ciudad Real' General University Hospital, Ciudad Real, Spain
,
D García-Romero
12   Gastroenterology, Endoscopy Unit, 'Nuestra Sra. de la Candelaria' University Hospital, Santa Cruz de Tenerife, Spain
,
A Amorós-Tenorio
12   Gastroenterology, Endoscopy Unit, 'Nuestra Sra. de la Candelaria' University Hospital, Santa Cruz de Tenerife, Spain
,
A Sánchez-Yagüe
13   Gastroenterology, Endoscopy Unit, 'Costa del Sol' Health Agency, Marbella, Spain
,
H Uchima
14   Gastroenterology, Endoscopy Unit, 'Doctor Josep Trueta' University Hospital, Girona, Spain
,
AJ del Pozo-García
1   Gastroenterology, Endoscopy Unit, '12 de Octubre' University Hospital, Madrid, Spain
,
C Dolz-Abadía
15   Gastroenterology, Endoscopy Unit, 'Son Llatzer' University Hospital, Palma de Mallorca, Spain
,
MG Fernández-Esparrach
16   Gastroenterology, Endoscopy Unit, 'Clínic' University Hospital, Barcelona, Spain
,
J Santiago-García
3   Gastroenterology, Endoscopy Unit, Puerta de Hierro – Majadahonda University Hospital, Majadahonda, Spain
,
Ó Nogales-Rincón
17   Gastroenterology, Endoscopy Unit, 'Gregorio Marañón' General University Hospital, Madrid, Spain
,
A Álvarez-Delgado
18   Gastroenterology, Endoscopy Unit, 'Salamanca' University Hospital, Salamanca, Spain
,
H Cortes-Pérez
19   Gastroenterology, Endoscopy Unit, 'San Juan de Dios' Medical Center, Santurce, Spain
,
R Durán-Bermejo
20   Gastroenterology, Endoscopy Unit, 'ServiDigest' Clinic, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 
 

    Aims:

    To assess the ability of SMSA to predict clinical outcomes of CR-ESD: length of the procedure and percentages of piecemeal resections, aborted procedures and complications.

    Methods:

    Consecutive patients were enrolled in a prospective multicenter Spanish CR-ESD registry since January 2016 to October 2018. We analyzed 585 cases in 19 hospitals.

    Results:

    The duration of the procedure was > 240 min in 36 ESDs (6.2%). There were 13 aborted procedures (2.2%), 92 piecemeal resections (16.1%), 86 intraprocedural perforations (14.7%), 19 delayed perforations (3.4%) and 37 delayed bleedings (6.6%). There were 40 SMSA2 (6.8%), 189 SMSA3 (32.3%) and 356 SMSA4 (60.8%) lesions. The median procedure duration was 74.5 min for SMSA2, 80 min for SMSA3 and 120 min for SMSA4. A statistically significant association was observed for SMSA4 and duration of the procedure > 240 min (8.4% vs. 2.6%; OR = 3.4; CI95%: 1.4 – 8.3; p = 0.004). The percentage of piecemeal resections was as follows SMSA2: 27.5% vs. SMSA3: 11.4% vs. SMSA4: 17.2%; p = 0.03. SMSA2 lesions were significantly associated with piecemeal resections (SMSA2 vs. SMSA3/4: 27.5% vs. 14.8%; OR = 2.1; CI95%: 1.01 – 4.4; p = 0.04). No significant differences were noted for aborted ESDs: SMSA2: 0% vs. SMSA3: 2.6% vs. SMSA4: 2.2%; p = 0.59. Statistically significant differences were observed between intraprocedural perforations and SMSA3/4 lesions (SMSA2 vs. SMSA3/4: 2.5% vs. 15.6%; OR = 7.2; IC95%: 1.01 – 53.1; p = 0.02). The delayed perforation rate was: 0%/2.7%/4.2%; p = 0.3 and the delayed bleeding rate: 8.1%/5.9%/6.8%; p = 0.8, respectively.

    Conclusions:

    The SMSA score may be useful for planning endoscopy lists since it significantly correlates with the length of the procedure. Higher scores were also associated with intraprocedural perforations. However, we did not find a direct proportional link when considering other procedural outcomes (piecemeal resections, aborted procedures and delayed perforation or bleeding).


    #