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UNDERWATER TECHNIQUE AND NEOPLASM SIZE ARE ASSOCIATED TO LESS DISCOMFORT DURING COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Paolo Cecinato 1, Martina Costetti 1, Matteo Lucarini 1, Giorgio Iori 1, Anna Sabina D'Incà 1, Yasmin Abdel Hadi 1, Chiara Sicuro 1, Fabio Bassi 1, Romano Sassatelli 1

Affiliations

1 AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

Summary

AI Generated

A retrospective analysis of 136 colorectal endoscopic submucosal dissection procedures identified underwater technique and lesion size under 40 mm as factors independently associated with reduced intra-procedural patient discomfort.

In multivariate analysis, underwater-ESD technique was significantly associated with lower intra-procedural discomfort (OR 2.76, 95% CI 1.21–6.28, p=0.0154) compared to conventional technique.
Lesion size less than 40 mm was independently associated with reduced discomfort during the procedure (OR 2.78, 95% CI 1.29–5.99, p=0.0092).
Among 136 procedures performed under sedation without anaesthesiologist assistance, 67% of patients experienced no or mild discomfort (Gloucester 1-2) while 33% had moderate to severe discomfort (Gloucester 3-4).
Lesion morphology (granular, non-granular, or sessile) and anatomical location (right colon, left colon, or rectum) were not associated with intra-procedural discomfort levels.
This study may inform procedural planning for colorectal ESD, particularly regarding sedation requirements and technique selection.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Colorectal endoscopic submucosal dissection (ESD) allows high rate of en bloc resection of colorectal neoplasm. It is still not widely used; however, the factors that limit its diffusion are its technical difficulty, its duration and the risk of complications. Due to the long duration and the high risk of intra-procedural discomfort, colorectal ESD is usually performed under deep sedation or in narcosis. The aim of the study is to determine the factors associated with intra-procedural discomfort.

Aims & Methods

We retrospectively analyzed colorectal ESD performed in our centre between November 2018 March 2023. Procedures performed in narcosis with anaesthesiologist assistance were excluded. We collected data of sedation, in particularly the presence of pain during the procedure was measured with the Gloucester scale from nursing records. The patients were divided into two groups: the first with no/mild discomfort (Gloucester 1-2), the second group with moderate/severe discomfort (Gloucester 3-4). Univariate and multivariate analyses were performed to examine factors that may have influenced intra-procedural discomfort.

Results

		UNIVARIATE ANALYSIS			MULTIVARIATE ANALYSIS
VARIABLE	OR	95% CI	p	OR	CI	p
Size lesion < 40 mm	2.30	1.11 - 4.77	0.0237	2.78	1.29 - 5.99	0.0092
Underwater-ESD	2.26	1.03 - 4.92	0.0357	2.76	1.21 - 6.28	0.0154
Rectum	1.81	0.79 - 4.13	0.1501
Right colon	0.72	0.35 - 1.47	0.3632
Left colon	0.82	0.35 - 1.90	0.6391
Non granular	0.74	0.35 - 1.55	0.4214
Granular	0.93	0.46 - 1.91	0.8531
Sessile	2.55	0.69 - 9.36	0.1293

A total of 154 colorectal ESD for superficial neoplasms were considered. 18 colorectal ESD were excluded because performed in narcosis. The remaining 136 colorectal ESD (male 59,6% with a median age of 68.4 ± 10.1) achived en bloc resection and complete resection in 124 (91 %) and 121 (89 %) cases respectively; mean major diameter’s neoplasms was 3.8 cm (±1.81cm), in 79 cases the size was < 40 mm (42%). 65 neoplasms were located in the right colon (48%), 30 in the left colon (22%) and 41 in the rectum (30%). 53 colorectal ESD (39%) were performed using underwater technique. 92 patients (67 %) were included in the first group (Goucester 1-2), the other 45 patients (33 %) in the second group (Goucester 3-4). On univariate analysis, underwater-ESD (OR 2.2; 95% CI 1.03 – 4.92) and small size of the neoplasms (< 4 cm) (OR2.3; 95% CI 1.11 – 4.78) were significantly associated with lower intra-procedural discomfort during the procedure. The morphology (non granular, granular or sessile) and the localization were not associated with intra-procedural discomfort. The multivariate analysis confirmed the significantly correlation of underwater-ESD and small neoplasms size with lower discomfort during procedures.

Conclusion

Underwater-ESD and lesion size < 40 mm are associated to less discomfort during colorectal ESD. These findings should be taken into consideration approaching colorectal ESD.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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UNDERWATER ENDOSCOPIC SUBMUCOSAL DISSECTION (U-ESD) VERSUS GAS ENDOSCOPIC SUBMUCOSAL DISSECTION (G-ESD) FOR NON-PEDUNCULATED COLORECTAL LESIONS: PRELIMINARY RESULTS

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