Intest Res.  2016 Oct;14(4):358-364. 10.5217/ir.2016.14.4.358.

The submucosal fibrosis: what does it mean for colorectal endoscopic submucosal dissection?

• Kim EK
• Han DS
• Ro Y
• Eun CS
• Yoo KS
• Oh YH

• KMID: 2354954
• DOI: http://doi.org/10.5217/ir.2016.14.4.358

Abstract

BACKGROUND/AIMS
Endoscopic submucosal dissection (ESD) allows removal of colorectal epithelial neoplasms en bloc regardless of size. Colorectal ESD is a difficult procedure because of technical difficulties and risks of complications. This study aimed to assess the relationship between ESD outcome and degree of submucosal fibrosis.
METHODS
Patients with colorectal tumors undergoing ESD and their medical records were reviewed retrospectively. The degree of submucosal fibrosis was classified into three types. The relationship between ESD outcome and degree of submucosal fibrosis was analyzed.
RESULTS
ESD was performed in 158 patients. Thirty-eight cases of F0 (no) fibrosis (24.1%) and 46 cases of F2 (severe) fibrosis (29.1%) were observed. Complete resection was achieved for 138 lesions (87.3%). Multivariate analysis demonstrated that submucosal invasion of tumor and histology of carcinoma were independent risk factors for F2 fibrosis. Severe fibrosis was an independent risk factor for incomplete resection.
CONCLUSIONS
Severe fibrosis is an important factor related to incomplete resection during colorectal ESD. In cases of severe fibrosis, the rate of complete resection was low even when ESD was performed by an experienced operator. Evaluation of submucosal fibrosis may be helpful to predict the submucosal invasion of tumors and technical difficulties in ESD.

Keyword

Colorectal neoplasms; Endoscopic submucosal dissection; Submucosal fibrosis; Risk factors

MeSH Terms

Colorectal Neoplasms
Fibrosis*
Humans
Medical Records
Multivariate Analysis
Neoplasms, Glandular and Epithelial
Retrospective Studies
Risk Factors

Figure

• 

  Fig. 1 Degrees of endoscopic submucosal fibrosis in early colorectal tumors. (A) F0, no fibrosis, which manifests as a transparent submucosal layer. (B) F1, mild fibrosis, which appears as a white web-like structure in the transparent submucosal layer. (C) F2, severe fibrosis, which appears as a white muscular-like structure without a transparent submucosal layer.

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