Departamento de Gastroenterología, Hospital Universitario HM Montepríncipe, HM Hospitales, Boadilla del Monte.
Departamento de Ciencias Médicas Clínicas, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, España.
Eur J Gastroenterol Hepatol. 2021 Aug 1;33(8):1063-1070. doi: 10.1097/MEG.0000000000002146.
Obesity is associated with submucosal fatty tissue. The main aim of this study was to assess the impact of submucosal fatty tissue on the success of colonic endoscopic submucosal dissection (C-ESD) in a western population.
This was a retrospective analysis of 125 consecutive C-ESDs performed between October 2015 and July 2017. Fatty tissue sign was defined as positive when the submucosal layer was covered with fatty tissue. The complexity of performing an ESD was assessed by the performing endoscopist, defined by the occurrence of intraprocedural perforation, inability to complete an en-bloc resection or a procedure time exceeding 180 min.
Fatty tissue sign positive was present in 44.8% of the procedures. There were 28 (22.4%) c-ESD defined as complex. Factors associated with complex ESD included; fatty tissue sign [odds ratio (OR) 12.5; 95% confidence interval (CI), 1.9-81.9; P = 0.008], severe fibrosis (OR 148.6; 95% CI, 6.6-3358.0; P = 0.002), poor maneuverability (OR 267.4; 95% CI, 11.5-6212.5; P < 0.001) and polyp size ≥35 mm (OR 17.2; 95% CI, 2.6-113.8; P = 0.003). In patients demonstrating the fatty tissue sign, BMI and waist-to-height ratio (WHtR) were higher (27.8 vs. 24.7; P < 0.001 and 0.56 vs. 0.49; P < 0.001, respectively) and en-bloc resection was achieved less frequently (76.8 vs. 97.1%, P = 0.001). Multivariate analysis revealed higher risk of fatty tissue sign positive associated with WHtR ≥0.52 (OR 26.10, 95% CI, 7.63-89.35, P < 0.001).
This study demonstrates that the fatty tissue sign contributes to procedural complexity during C-ESD. Central obesity correlates with the likelihood of submucosal fatty tissue and as such should be taken into account when planning procedures.
肥胖与黏膜下脂肪组织有关。本研究的主要目的是评估西方人群中黏膜下脂肪组织对结肠内镜黏膜下剥离术（C-ESD）成功率的影响。
这是一项回顾性分析，纳入了 2015 年 10 月至 2017 年 7 月期间连续进行的 125 例 C-ESD。当黏膜下层被脂肪组织覆盖时，定义脂肪组织征阳性。由操作内镜医生评估 ESD 的复杂性，定义为术中穿孔、无法整块切除或手术时间超过 180 分钟。
44.8%的操作中存在脂肪组织征阳性。28 例（22.4%）c-ESD 被定义为复杂。与复杂 ESD 相关的因素包括：脂肪组织征（比值比 [OR] 12.5；95%置信区间 [CI]，1.9-81.9；P=0.008）、严重纤维化（OR 148.6；95%CI，6.6-3358.0；P=0.002）、操作困难（OR 267.4；95%CI，11.5-6212.5；P<0.001）和息肉大小≥35mm（OR 17.2；95%CI，2.6-113.8；P=0.003）。在表现出脂肪组织征的患者中，BMI 和腰围身高比（WHtR）更高（27.8 与 24.7；P<0.001 和 0.56 与 0.49；P<0.001），整块切除的频率更低（76.8 与 97.1%；P=0.001）。多变量分析显示，WHtR≥0.52 与脂肪组织征阳性的风险更高相关（OR 26.10，95%CI，7.63-89.35，P<0.001）。
本研究表明，脂肪组织征在 C-ESD 过程中导致了操作的复杂性。中心性肥胖与黏膜下脂肪组织的发生相关，因此在计划手术时应考虑到这一点。
