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Su1654 Fatty Tissue in the Submucosal Layer: Effect on Endoscopic Submucosal Dissection for Laterally Spreading Tumors (LST) in the Proximal Colon in Western Center
Abstracts
Factors
En bloc resection rate (n[59)
P-value <0.001
Confidence of en bloc Yes No
87.1% (54/62) 31.3% (5/16)
PATIENTS Sex: Male / Female n (%)
Mutivariate analysis of factors associated with en bloc resection Factors Dissection of submucosal layer ( 50%) Visualization during snaring ( 50%) Fibrosis Planned hybrid ESD
Table 1
Odds Ratio
P-value
95% Confidential Interval
2.181
0.291
0.091 – 6.149
7.811
0.008
1.722 – 35.426
0.258 3.896
0.049 0.114
0.068 – 0.993 0.722 – 21.002
Su1654 Fatty Tissue in the Submucosal Layer: Effect on Endoscopic Submucosal Dissection for Laterally Spreading Tumors (LST) in the Proximal Colon in Western Center Felipe Ramos Zabala1,2, Alejandra P. Alzina*1,2, Jorge Vásquez Guerrero3,2, José Miguel Cárdenas Rebollo2, Ana Domínguez Pino1, Marian Garcia3, Jesus Rodriguez Pascual1,2, Luis Moreno Almazán1 1 Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain; 2Facultad de Medicina. Universidad CEU San Pablo, Madrid, Spain; 3Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain Background/Aims:Endoscopic submucosal dissection (ESD) is a complex technique with a high risk profile of complications. Several factors, such as size, fibrosis presence or lession morphology, have been studied and related to a higher risk of complication. Except the fibrosis, none other submucosal findings have been studied. Fatty tissue in the submucosa layer (FTSL) of the proximal colon is a common finding. The aim of the study is to analyze the effect of fatty tissue in the results of ESD of LST located at the proximal colon. Patients and Methods:A retrospective analysis was carried out in a western medical institution in which ESD technique is being implemented. Between July 2013 and Octobre 2016, 108 patients with a total of 126 colorectal lesions were studied. Distal colonic and rectal lesions, those without a laterally spreading morphology, lesions with a deep submucosal invasion and those patients in which ESD had to be discontinued were excluded from this analysis. Patients features, lesions characteristics, submucosal morphology and technique procedure were analyzed into two different groups regarding the presence or absence of fatty tissue in the submucosa. Complicated ESD was defined as any procedure which presented any kind of complication or those in which en bloc resection was not achieved. Finally, the statistical analysis to define possible prognostic variables related to complicated ESD was carried out. Results:67 patients with a total of 76 lesions located in the proximal colon were studied. Table 1 summarizes lesion description and technique outcomes in both groups. The comparison of both groups showed statistically significant differences regarding body mass index, size of the lesions, en bloc resection rate and duration of the procedure and risk of perforation (see table 2). At least 16 of the ESD procedures (21%) were compatible with our definition of complicated ESD. Univariate analysis showed that variables such as size over 35 mm [62.5% vs. 33.9%; OR 3.254 (IC95%: 1.04-10.18); pZ 0.037], presence of serious fibrosis in the submucosa (F2) [62.5% vs. 6.5%; OR 24.167 (IC95%: 5.77-101.20); p< 0.001] and presence of fatty tissue in the submucosa [87.5% vs. 32.2%; OR 14.700 (IC95%: 3.04-70.96); p< 0.001] were related with a complicated ESD. Finally, in the multivariate analysis, presence of serious fibrosis in the submucosa (F2) [62.5% vs. 6.5%; OR 47.35 (IC95%: 5.2-430.4); pZ 0.001] and presence of fatty tissue in the submucosa [87.5% vs. 32.2%; OR 28.8 (IC95%: 2.9-286.6); pZ 0.004] were likely related to complicated. ESD. Conclusions: Severe fibrosis and size has already been described as prognostic factor of complicated ESD, in our analysis we also found that the presence of fatty tissue in the submucosa may also be related with a complicated procedure. These findings should be confirmed in a bigger and prospective population.
Age, y (Mean SD) BMI (Mean SD) LESIONS Size (Mean SD) LST-G n (%) LST-NG n (%) LOCATION Cecum /ICV Ascending colon Transvers colon FIBROSIS SM n (%) No F1 F2 TECHNIQUE En bloc n (%) Fragmented n (%) Incomplet n (%) Procedure time, min (Mean SD) Hospitalization time, days (Mean SD) Complications n (%) Bleeding n (%) Perforation n (%)
Group 1 FTSL (n[34)
Group 2 No FTSL (n[44)
20 (58.8) / 14 (42.2) 66.9 10.5 28.7 6.1
26 (59.1) / 18 (40.9) 63.7 9.8 24.8 3.5
NS 0,001
37.1 13.6 16 (47.1) 18 (52.9)
31.2 10.4 19 (43.2) 25 (56.8)
0.038 NS NS
16 (47.1) 15 (44.1) 3 (8.8)
14 (31.8) 21 (47.7) 9 (20.5)
NS NS NS
11 (32.3) 14 (41.2) 9 (26.5)
24 (54.5) 15 (34.1) 5 (11.4)
NS NS NS
22 (64.7) 11 (32.4) 1 (2.9) 176.7 36.5 1.76 2.0
42 (95.5) 2 (4.5) 0 (0) 117.3 47.2 1.13 0.5
<0.001 0.002 NS <0.001 NS
5 (14.7) 1 (2.9) 4 (11.7)
0 (0) 0 (0) 0 (0)
0.013 NS 0.033
p NS
NS, not significant; BMI, body mass index; LST-G, granular type laterally spreading tumor; LST-NG, non-granular type laterally spreading tumor; ICV, ileocecal valve
Complicated (n[16)
Non complicated (n [62)
AGE (years) < 70 70
9 (56.2%) 7 (43.7%)
40 (64.5%) 22 (35.5%)
0.542
1.414 (0.4634.318)
SEX Male Female
11 (68.7%) 5 (31.2%)
35 (56.5%) 27 (43.5%)
0.373
1.697 (0.5275.470)
BMI (Overweight) < 25 25
5 (31.2%) 11 (68.7%)
26 (41.9%) 36 (58.1%)
0.436
0.589 (0.4925.126)
BMI (Obese) < 30 30
11 (68.7%) 5 (31.2%)
54 (87%) 8 (13%)
0.126
3.068 (0.84311.167)
SIZE (mm) < 35 35
6 (37.5%) 10 (62.5%)
41 (66.1%) 21 (33.9%)
0.037
3.254 (1.04010.181)
MORPHOLOGY LST-G LST-NG
8 (50%) 8 (50%)
27 (43.5%) 35 (56.5%)
0.644
1.296 (0.4313.899)
LOCATION Cecum-ICV
5 (31.2%)
25 (40.3%)
1
Ascendent
7 (43.7%)
29 (46.8%)
0.771
0.829 (0.2342.939) 0.400 (0.0861.860)
P Univariate
Odds ratio Univariate
P Multivariate
Odds ratio Multivariate
Transvers SERIOUS FIBROSIS Yes No
4 (25%)
8 (12.9%)
0.406
10 (62.5%) 6 (37.5%)
4 (6.5%) 58 (93.5%)
<0.001
24.167 (5.771101.200)
0.001
47.35 (5.2-430.4)
FATTY TISSUE Yes No
14 (87.5%) 2 (12.5%)
20 (32.2%) 42 (67.8%)
<0.001
14.700 (3.04570.968)
0.004
28.8 (2.9-286.6)
BMI, body mass index; LST-G, granular type laterally spreading tumor; LST-NG, non-granular type laterally spreading tumor; ICV, ileocecal valve
AB382 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
www.giejournal.org
Factors
En bloc resection rate (n[59)
P-value <0.001
Confidence of en bloc Yes No
87.1% (54/62) 31.3% (5/16)
PATIENTS Sex: Male / Female n (%)
Mutivariate analysis of factors associated with en bloc resection Factors Dissection of submucosal layer ( 50%) Visualization during snaring ( 50%) Fibrosis Planned hybrid ESD
Table 1
Odds Ratio
P-value
95% Confidential Interval
2.181
0.291
0.091 – 6.149
7.811
0.008
1.722 – 35.426
0.258 3.896
0.049 0.114
0.068 – 0.993 0.722 – 21.002
Su1654 Fatty Tissue in the Submucosal Layer: Effect on Endoscopic Submucosal Dissection for Laterally Spreading Tumors (LST) in the Proximal Colon in Western Center Felipe Ramos Zabala1,2, Alejandra P. Alzina*1,2, Jorge Vásquez Guerrero3,2, José Miguel Cárdenas Rebollo2, Ana Domínguez Pino1, Marian Garcia3, Jesus Rodriguez Pascual1,2, Luis Moreno Almazán1 1 Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain; 2Facultad de Medicina. Universidad CEU San Pablo, Madrid, Spain; 3Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, Spain Background/Aims:Endoscopic submucosal dissection (ESD) is a complex technique with a high risk profile of complications. Several factors, such as size, fibrosis presence or lession morphology, have been studied and related to a higher risk of complication. Except the fibrosis, none other submucosal findings have been studied. Fatty tissue in the submucosa layer (FTSL) of the proximal colon is a common finding. The aim of the study is to analyze the effect of fatty tissue in the results of ESD of LST located at the proximal colon. Patients and Methods:A retrospective analysis was carried out in a western medical institution in which ESD technique is being implemented. Between July 2013 and Octobre 2016, 108 patients with a total of 126 colorectal lesions were studied. Distal colonic and rectal lesions, those without a laterally spreading morphology, lesions with a deep submucosal invasion and those patients in which ESD had to be discontinued were excluded from this analysis. Patients features, lesions characteristics, submucosal morphology and technique procedure were analyzed into two different groups regarding the presence or absence of fatty tissue in the submucosa. Complicated ESD was defined as any procedure which presented any kind of complication or those in which en bloc resection was not achieved. Finally, the statistical analysis to define possible prognostic variables related to complicated ESD was carried out. Results:67 patients with a total of 76 lesions located in the proximal colon were studied. Table 1 summarizes lesion description and technique outcomes in both groups. The comparison of both groups showed statistically significant differences regarding body mass index, size of the lesions, en bloc resection rate and duration of the procedure and risk of perforation (see table 2). At least 16 of the ESD procedures (21%) were compatible with our definition of complicated ESD. Univariate analysis showed that variables such as size over 35 mm [62.5% vs. 33.9%; OR 3.254 (IC95%: 1.04-10.18); pZ 0.037], presence of serious fibrosis in the submucosa (F2) [62.5% vs. 6.5%; OR 24.167 (IC95%: 5.77-101.20); p< 0.001] and presence of fatty tissue in the submucosa [87.5% vs. 32.2%; OR 14.700 (IC95%: 3.04-70.96); p< 0.001] were related with a complicated ESD. Finally, in the multivariate analysis, presence of serious fibrosis in the submucosa (F2) [62.5% vs. 6.5%; OR 47.35 (IC95%: 5.2-430.4); pZ 0.001] and presence of fatty tissue in the submucosa [87.5% vs. 32.2%; OR 28.8 (IC95%: 2.9-286.6); pZ 0.004] were likely related to complicated. ESD. Conclusions: Severe fibrosis and size has already been described as prognostic factor of complicated ESD, in our analysis we also found that the presence of fatty tissue in the submucosa may also be related with a complicated procedure. These findings should be confirmed in a bigger and prospective population.
Age, y (Mean SD) BMI (Mean SD) LESIONS Size (Mean SD) LST-G n (%) LST-NG n (%) LOCATION Cecum /ICV Ascending colon Transvers colon FIBROSIS SM n (%) No F1 F2 TECHNIQUE En bloc n (%) Fragmented n (%) Incomplet n (%) Procedure time, min (Mean SD) Hospitalization time, days (Mean SD) Complications n (%) Bleeding n (%) Perforation n (%)
Group 1 FTSL (n[34)
Group 2 No FTSL (n[44)
20 (58.8) / 14 (42.2) 66.9 10.5 28.7 6.1
26 (59.1) / 18 (40.9) 63.7 9.8 24.8 3.5
NS 0,001
37.1 13.6 16 (47.1) 18 (52.9)
31.2 10.4 19 (43.2) 25 (56.8)
0.038 NS NS
16 (47.1) 15 (44.1) 3 (8.8)
14 (31.8) 21 (47.7) 9 (20.5)
NS NS NS
11 (32.3) 14 (41.2) 9 (26.5)
24 (54.5) 15 (34.1) 5 (11.4)
NS NS NS
22 (64.7) 11 (32.4) 1 (2.9) 176.7 36.5 1.76 2.0
42 (95.5) 2 (4.5) 0 (0) 117.3 47.2 1.13 0.5
<0.001 0.002 NS <0.001 NS
5 (14.7) 1 (2.9) 4 (11.7)
0 (0) 0 (0) 0 (0)
0.013 NS 0.033
p NS
NS, not significant; BMI, body mass index; LST-G, granular type laterally spreading tumor; LST-NG, non-granular type laterally spreading tumor; ICV, ileocecal valve
Complicated (n[16)
Non complicated (n [62)
AGE (years) < 70 70
9 (56.2%) 7 (43.7%)
40 (64.5%) 22 (35.5%)
0.542
1.414 (0.4634.318)
SEX Male Female
11 (68.7%) 5 (31.2%)
35 (56.5%) 27 (43.5%)
0.373
1.697 (0.5275.470)
BMI (Overweight) < 25 25
5 (31.2%) 11 (68.7%)
26 (41.9%) 36 (58.1%)
0.436
0.589 (0.4925.126)
BMI (Obese) < 30 30
11 (68.7%) 5 (31.2%)
54 (87%) 8 (13%)
0.126
3.068 (0.84311.167)
SIZE (mm) < 35 35
6 (37.5%) 10 (62.5%)
41 (66.1%) 21 (33.9%)
0.037
3.254 (1.04010.181)
MORPHOLOGY LST-G LST-NG
8 (50%) 8 (50%)
27 (43.5%) 35 (56.5%)
0.644
1.296 (0.4313.899)
LOCATION Cecum-ICV
5 (31.2%)
25 (40.3%)
1
Ascendent
7 (43.7%)
29 (46.8%)
0.771
0.829 (0.2342.939) 0.400 (0.0861.860)
P Univariate
Odds ratio Univariate
P Multivariate
Odds ratio Multivariate
Transvers SERIOUS FIBROSIS Yes No
4 (25%)
8 (12.9%)
0.406
10 (62.5%) 6 (37.5%)
4 (6.5%) 58 (93.5%)
<0.001
24.167 (5.771101.200)
0.001
47.35 (5.2-430.4)
FATTY TISSUE Yes No
14 (87.5%) 2 (12.5%)
20 (32.2%) 42 (67.8%)
<0.001
14.700 (3.04570.968)
0.004
28.8 (2.9-286.6)
BMI, body mass index; LST-G, granular type laterally spreading tumor; LST-NG, non-granular type laterally spreading tumor; ICV, ileocecal valve
AB382 GASTROINTESTINAL ENDOSCOPY Volume 85, No. 5S : 2017
www.giejournal.org