de Sire, Roberto (2025) UNDERWATER VERSUS CONVENTIONAL COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION A PROPENSITY SCORE MATCHED ANALYSIS. [Tesi di dottorato]
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| Tipologia del documento: | Tesi di dottorato |
|---|---|
| Lingua: | English |
| Titolo: | UNDERWATER VERSUS CONVENTIONAL COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION A PROPENSITY SCORE MATCHED ANALYSIS |
| Autori: | Autore Email de Sire, Roberto roberto.desire@libero.it |
| Data: | 19 Dicembre 2025 |
| Numero di pagine: | 45 |
| Istituzione: | Università degli Studi di Napoli Federico II |
| Dipartimento: | Medicina Clinica e Chirurgia |
| Dottorato: | Terapie avanzate biomediche e chirurgiche |
| Ciclo di dottorato: | 38 |
| Coordinatore del Corso di dottorato: | nome email Settembre, Carmine [non definito] |
| Tutor: | nome email Castiglione, Fabiana [non definito] |
| Data: | 19 Dicembre 2025 |
| Numero di pagine: | 45 |
| Parole chiave: | ESD; underwater; saline; CO2; coagulation; sealing; hemostasis; vessels; propensity score matching. |
| Settori scientifico-disciplinari del MIUR: | Area 06 - Scienze mediche > MED/12 - Gastroenterologia |
| Depositato il: | 21 Gen 2026 21:53 |
| Ultima modifica: | 12 Ago 2026 05:37 |
| URI: | https://www.fedoa.unina.it/id/eprint/16141 |
Abstract
Background and Aims: Underwater endoscopic submucosal dissection (U-ESD) has emerged as one of the preferred techniques for the resection of colorectal lesions. Aim of the study is to evaluate the efficacy and safety of U-ESD compared to conventional ESD (C-ESD) for the treatment of large nonpedunculated colorectal polyps (LNPCPs). Methods: All consecutive LNPCPs treated by U-ESD and C-ESD from January 2021 to December 2023 were included. Resections were performed by six operators at a high- volume therapeutic endoscopy center. Procedural outcomes were R0 resection, intraprocedural perforations, intraprocedural bleeding (IPB) requiring the use of hemostatic forceps, delayed adverse events (AEs), and dissection speed. A propensity score 1:1 matching (PSM) analysis without replacement for baseline lesion characteristics was performed to minimize selection bias. Results: 82 lesions with 1:1 matching were included in the final analysis. U-ESD demonstrated a significantly higher rate of R0 resection (97.6% vs 82.9%; 95%CI 0.975: 0.871-0.999 vs 95%CI 0.829: 0.679-0.928; p=0.02) and a significantly lower rate of IPB requiring hemostatic forceps (0% vs 14.6%; 95%CI 0.000: 0.000-0.000 vs. 95%CI 0.1463: 0.038-0.254; p=0.002) compared to C-ESD. Dissection speed was significantly increased in the U-ESD group (31.8 mm2/min vs 22.9 mm2/min; 95%CI 28.170-35.430 vs 95%CI 19.560-26.240; p=0.004), while intraprocedural perforations (4.9% vs 12.2%; 95%CI 0.048: 0.006-0.165 vs 95%CI 0.122: 0.021-0.222; p=0.1), and delayed AEs (4.9% vs 4.9%; 95%CI 0.048: 0.006-0.165 vs 95%CI 0.048: 0.006-0.165; p=1.0) were similar with no statistically significant differences. Conclusions: U-ESD significantly improves R0 resection rates, reduces IPB requiring hemostatic forceps, and enhances dissection speed compared to C-ESD.
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