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Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography.

Makino T, Kanmura S, Sasaki F, Nasu Y, Funakawa K, Tanaka A, Arima S, Nakazawa J, Taguchi H, Hashimoto S, Numata M, Uto H, Tsubouchi H, Ido A - Endosc Int Open (2015)

Bottom Line: However, there was a high accuracy (97.2 %, 35/36) for only the 36 LSTs with clear and visible images.In one case, EUS diagnosed no fibrosis but significant fibrosis was found during ESD, the result of colon cancer invasion into the submucosa.Preoperative EUS before colorectal ESD successfully predicted the degree of fibrosis in a number of cases.

View Article: PubMed Central - PubMed

Affiliation: Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

ABSTRACT

Background and study aims: Although endoscopic submucosal dissection (ESD) is an established therapy for colon neoplasms including laterally spreading tumors (LSTs), its application to advanced fibrotic lesions is very difficult owing to the thin walls of the large intestine. We examined the ability of preoperative endoscopic ultrasonography (EUS) to predict lesion fibrosis in patients undergoing colorectal ESD.

Patients and methods: From 2009 to 2013, 58 LSTs were evaluated retrospectively with EUS and treated using colorectal ESD. The degree of submucosal fibrosis was determined during ESD and classified as F0 (no fibrosis), F1 (mild fibrosis), or F2 (severe fibrosis).

Results: The sensitivity and specificity of fibrosis prediction by preoperative EUS of all cases were 77.8 % and 57.1 %, respectively. However, there was a high accuracy (97.2 %, 35/36) for only the 36 LSTs with clear and visible images. In one case, EUS diagnosed no fibrosis but significant fibrosis was found during ESD, the result of colon cancer invasion into the submucosa.

Conclusions: Preoperative EUS before colorectal ESD successfully predicted the degree of fibrosis in a number of cases.

No MeSH data available.


Related in: MedlinePlus

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Mentions: We demonstrated the utility of EUS for predicting submucosal fibrosis of CRC lesions before ESD for colorectal LST. It is important to correctly determine these parameters before ESD because they influence the surgical treatment performed. The sensitivity and specificity for fibrosis severity prediction were 77.8 % and 57.1 %, respectively, which were reasonable. However, in the 36 cases in which we could obtain clear scanned images, the sensitivity, specificity, and accuracy for prediction of fibrosis severity were excellent. One case was predicted by EUS to have no fibrosis (EUS-F0), but was eventually diagnosed with severe fibrosis (ESD-F2) based on ESD findings. This case had tumor invasion into the submucosa. We misjudged the degree of submucosal fibrosis, because the fibrosis area in the submucosa might be narrow (Fig 3).


Preoperative classification of submucosal fibrosis in colorectal laterally spreading tumors by endoscopic ultrasonography.

Makino T, Kanmura S, Sasaki F, Nasu Y, Funakawa K, Tanaka A, Arima S, Nakazawa J, Taguchi H, Hashimoto S, Numata M, Uto H, Tsubouchi H, Ido A - Endosc Int Open (2015)

© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554499&req=5

Mentions: We demonstrated the utility of EUS for predicting submucosal fibrosis of CRC lesions before ESD for colorectal LST. It is important to correctly determine these parameters before ESD because they influence the surgical treatment performed. The sensitivity and specificity for fibrosis severity prediction were 77.8 % and 57.1 %, respectively, which were reasonable. However, in the 36 cases in which we could obtain clear scanned images, the sensitivity, specificity, and accuracy for prediction of fibrosis severity were excellent. One case was predicted by EUS to have no fibrosis (EUS-F0), but was eventually diagnosed with severe fibrosis (ESD-F2) based on ESD findings. This case had tumor invasion into the submucosa. We misjudged the degree of submucosal fibrosis, because the fibrosis area in the submucosa might be narrow (Fig 3).

Bottom Line: However, there was a high accuracy (97.2 %, 35/36) for only the 36 LSTs with clear and visible images.In one case, EUS diagnosed no fibrosis but significant fibrosis was found during ESD, the result of colon cancer invasion into the submucosa.Preoperative EUS before colorectal ESD successfully predicted the degree of fibrosis in a number of cases.

View Article: PubMed Central - PubMed

Affiliation: Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

ABSTRACT

Background and study aims: Although endoscopic submucosal dissection (ESD) is an established therapy for colon neoplasms including laterally spreading tumors (LSTs), its application to advanced fibrotic lesions is very difficult owing to the thin walls of the large intestine. We examined the ability of preoperative endoscopic ultrasonography (EUS) to predict lesion fibrosis in patients undergoing colorectal ESD.

Patients and methods: From 2009 to 2013, 58 LSTs were evaluated retrospectively with EUS and treated using colorectal ESD. The degree of submucosal fibrosis was determined during ESD and classified as F0 (no fibrosis), F1 (mild fibrosis), or F2 (severe fibrosis).

Results: The sensitivity and specificity of fibrosis prediction by preoperative EUS of all cases were 77.8 % and 57.1 %, respectively. However, there was a high accuracy (97.2 %, 35/36) for only the 36 LSTs with clear and visible images. In one case, EUS diagnosed no fibrosis but significant fibrosis was found during ESD, the result of colon cancer invasion into the submucosa.

Conclusions: Preoperative EUS before colorectal ESD successfully predicted the degree of fibrosis in a number of cases.

No MeSH data available.


Related in: MedlinePlus