title: Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors.
abstract: OBJECTIVE
  Colorectal endoscopic submucosal dissection (ESD) is technically challenging. Our aim was to identify predictors of incomplete resection and perforation in colorectal ESD.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Academic Japanese endoscopy unit.
  
  
  METHODS
  A total of 267 consecutive cases of colorectal tumors treated by ESD from May 2010 to February 2013 were analyzed. Predictors of incomplete resection and perforation, including lesion size, growth type, pathological diagnosis, use of hemostatic forceps, degree of fibrosis, history of biopsy, history of local endoscopic treatment, and endoscopic operability.
  
  
  RESULTS
  The incomplete resection rate was 4.1%. The perforation rate was 5.6%. Univariate analysis identified severe fibrosis (P = .032), submucosal (SM) deep (>1000 μm) invasion (P = .033) and poor endoscopic operability (P = .030) as predictors of incomplete resection, and severe fibrosis (P = .038), postendoscopic treatment (P = .016), and poor endoscopic operability (P = .012) as predictors of perforation. Multivariate analysis identified poor endoscopic operability and SM deep invasion as independent predictors of incomplete resection, and poor endoscopic operability and severe fibrosis as independent predictors of perforation. There was no adjustment of P values for multiple testing.
  
  
  CONCLUSIONS
  A single-center study by a single colonoscopist. All statistical results should be taken as descriptive only.
  
  
  CONCLUSIONS
  Poor endoscopic operability and SM deep invasion were significant independent predictors of incomplete resections. Poor endoscopic operability and severe fibrosis were significant independent predictors of perforation. These features may provide helpful information when planning colorectal ESD.
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Nana
authors.initials: N
authors.lastname: Hayashi
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Soki
authors.initials: S
authors.lastname: Nishiyama
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Motomi
authors.initials: M
authors.lastname: Terasaki
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Nakadoi
authors.affiliation: Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.affiliation: Health Service Center, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshihara
authors.affiliation: Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018365:Neoplasm, Residual; D012189:Retrospective Studies; D055815:Young Adult