The Risk Factors Of Unsuccessful Endoscopic Submucosal Dissection

Background and objective:Endoscopic submucosal dissection (ESD) is an efficient method to treat gastrointestinal lesions.Our research aimed to study risk prediction factors by summarizing clinical and pathological characteristics of patients who underwent unsuccessful ESD procedure.Methods:Our research retrospect patients who underwent ESD procedure in The2nd Affiliated Hospital of Zhejiang University, school of medicine and Qujiang campus from March in2007to March in2012.Those patients all had gastrointestinal lesions which were not submucosal tumors diagnosed by pathology and were divided into two groups according to ESD procedure being successful or not. Factors including sex,age, lesion location, type, size, procedure duration, pathology, lifting sign and complications were analyzed.Results:The analysis showed that there were significant differences of factor of lifting sign(p<0.05),while not of factors such as sex, age, lesion location, type, size, procedure duration, pathology and complication between the two groups.The logistic regression analysis showed that only lifting sign was an independent risk factor of ESD procedure. In those11unsuccessful cases, two patients failed due to adhesion caused by tumor infiltration into submucosa with negative lifting sign; five patients failed due to fibrosis adhesion with negative lifting sign; one patients suffered obvious vagovagal reflex;another one patient was proved having vessel infiltrated in the post-ESD pathology; the other two patients had exceptional growed muscle bundle from muscular layer into mucosa layer crossing submucosa which lead to impossible dissection of the lesion.Conclusions:Negative lifting sign was the only independent risk factor which may serve as indicator of an unsuccessful ESD procedure. Not only adhesion from fibration and tumor infiltration but also exceptional growth of muscle bundle from muscular layer into submucosa could result in negative lifting sign.