Feasibility and learning curve of unsupervised colorectal endoscopic submucosal hydrodissection at a Western Center.

Autor:	Ramos-Zabala F; Department of Gastroenterology, HM Montepríncipe University Hospital, HM Hospitales Group, CEU San Pablo University, Boadilla del Monte, Madrid, Spain., Parra-Blanco A; Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK., Beg S; Department of Gastroenterology, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK., García-Mayor M; Department of Gastroenterology, HM Montepríncipe University Hospital, HM Hospitales Group, CEU San Pablo University, Boadilla del Monte, Madrid, Spain., Domínguez-Pino A; Department of Anesthesiology and Resuscitation, HM Montepríncipe University Hospital., Cárdenas-Rebollo JM; Department of Basic Medical Sciences, CEU San Pablo University., Rodríguez-Pascual J; Department of Clinical Oncology, HM Monteprincipe University Hospital, HM Hospitales Group, Boadilla del Monte, Madrid, Spain., Moreno-Almazán L; Department of Gastroenterology, HM Montepríncipe University Hospital, HM Hospitales Group, CEU San Pablo University, Boadilla del Monte, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	European journal of gastroenterology & hepatology [Eur J Gastroenterol Hepatol] 2020 Jul; Vol. 32 (7), pp. 804-812.
DOI:	10.1097/MEG.0000000000001703
Abstrakt:	Objectives: Colorectal endoscopic submucosal dissection (CR-ESD) is an evolving technique in Western countries. We aimed to determine the results of the untutored implementation of endoscopic submucosal hydrodissection for the treatment of complex colorectal polyps and establish the learning curve for this technique. Methods: This study included data from 80 consecutive CR-ESDs performed by a single unsupervised western therapeutic endoscopist. To assess the learning curve, procedures were divided into four groups of 20 each. Results: En bloc resection was achieved in 55, 75, 75 and 95% cases in the consecutive time periods (period 1 vs. 4, P = 0.003). Curative resection was achieved in 55, 75, 70 and 95%, respectively (P = 0.037). Overall, series results demonstrated R0 resection in 75% of cases, with 23.7% requiring conversion to endoscopic piecemeal mucosal resection, and 1.25% incomplete resections. Complications included perforations (7.5%) and bleeding (3.7%). Multivariate analysis revealed factors more likely to result in association with non en bloc vs. En bloc resection, where polyp size ≥35 mm [70 vs. 23.4%; odds ratio (OR) 13.2 (1.7-100.9); P = 0. 013], severe fibrosis [40 vs. 11.7%; OR 10.2 (1.2-86.3); P = 0.033] and where carbon dioxide for insufflation was not used [65 vs. 30%; OR 0.09 (0.01-0.53); P = 0.008]. Conclusion: CR-ESD by hydrodissection has good safety and efficacy profile and offers well tolerated and effective treatment for complex polyps. As such, this technique may be useful in the West, in centers, where previous gastric ESD is not frequent or Japanese mentoring is not possible.
Databáze:	MEDLINE
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