{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T15:42:47Z","timestamp":1770910967960,"version":"3.50.1"},"reference-count":30,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T00:00:00Z","timestamp":1722556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Endoscopic submucosal dissection (ESD) is an advanced technique that can become more challenging in the presence of submucosal fibrosis. Predicting the grade of fibrosis is important in order to identify technically difficult ESD. Aims and Methods: Our study aimed to derive and validate a prediction model to determine the preoperative degree of submucosal fibrosis in colorectal tumours undergoing ESD. A predictive model was developed to derive the probability of an increasing submucosal fibrosis in the derivation cohort and then externally validated. Results: 309 patients (age: 68 \u00b1 10.9 years) underwent colorectal ESD between January 2016 and June 2020. F0, F1, and F2 fibroses were reported in 196 (63.4%), 70 (22.6%), and 43 (13.9%) cases, respectively. R0 resection was found in 266 (87%) lesions. At multivariable analysis in the derivation cohort, lesion morphology (OR = 0.37 and CI = 0.14\u20130.97 for LST-NG vs. 0-Is; OR = 0.29 and CI = 0.1\u20130.87 for the LST mixed type vs. 0-Is; and OR = 0.32 and CI = 0.1\u20131.03 for LST-G vs. 0-Is) and increasing size (OR = 1.02 and CI = 1.01\u20131.04 for a 1 mm increase) were significantly associated with an increasing degree of fibrosis. The model had fair discriminating ability in the derivation group (AUROC = 0.61 and CI = 0.52\u20130.69 for F1\u2013F2 vs. F0 fibroses; AUROC = 0.61 and CI = 0.45\u20130.77 for F2 vs. F0\u2013F1 fibroses) and in the validation group (AUROC = 0.71 and CI = 0.59\u20130.83 for F1\u2013F2 vs. F0 fibroses; AUROC = 0.65 and CI = 0.52\u20130.77 for F2 vs. F0\u2013F1 fibroses). Conclusions: Our findings introduce a new tool for the stratification of ESD technical difficulty based on lesion size and morphological characteristics which could become crucial during the procedure\u2019s planning process.<\/jats:p>","DOI":"10.3390\/jcm13154517","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T09:34:17Z","timestamp":1722591257000},"page":"4517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Derivation and External Validation of a Fibrosis Risk Model for Colorectal Tumours Undergoing Endoscopic Submucosal Dissection"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7595-0129","authenticated-orcid":false,"given":"Sandro","family":"Sferrazza","sequence":"first","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, \u201cARNAS Civico-Di Cristina-Benfratelli\u201d Hospital, 90127 Palermo, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4992-9289","authenticated-orcid":false,"given":"Marcello","family":"Maida","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Enna \u2018Kore\u2019, 94100 Enna, Italy"},{"name":"Gastroenterology Unit, Ospedale Umberto I, 94100 Enna, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0802-3173","authenticated-orcid":false,"given":"Giulio","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, \u201cARNAS Civico-Di Cristina-Benfratelli\u201d Hospital, 90127 Palermo, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2107-2156","authenticated-orcid":false,"given":"Antonio","family":"Facciorusso","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 71122 Foggia, Italy"}]},{"given":"Lorenzo","family":"Fuccio","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40123 Bologna, Italy"},{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7084-6157","authenticated-orcid":false,"given":"Leonardo","family":"Frazzoni","sequence":"additional","affiliation":[{"name":"IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"},{"name":"Morgagni-Pierantoni Hospital, 47121 Forli, Italy"}]},{"given":"Roberta","family":"Maselli","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20089 Pieve Emanuele, Italy"}]},{"given":"Alessandro","family":"Repici","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Humanitas Clinical and Research Hospital, IRCCS, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20089 Pieve Emanuele, Italy"}]},{"given":"Roberto","family":"Di Mitri","sequence":"additional","affiliation":[{"name":"Gastroenterology and Endoscopy Unit, \u201cARNAS Civico-Di Cristina-Benfratelli\u201d Hospital, 90127 Palermo, Italy"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-0576","authenticated-orcid":false,"given":"Jo\u00e3o","family":"Santos-Antunes","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, 4200-319 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1055\/a-1811-7025","article-title":"Endoscopic Submucosal Dissection for Superficial Gastrointestinal Lesions: European Society of Gastrointestinal Endoscopy (ESGE) Guideline\u2014Update 2022","volume":"54","author":"Bastiaansen","year":"2022","journal-title":"Endoscopy"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.gie.2017.02.024","article-title":"Clinical Outcomes after Endoscopic Submucosal Dissection for Colorectal Neoplasia: A Systematic Review and Meta-Analysis","volume":"86","author":"Fuccio","year":"2017","journal-title":"Gastrointest. 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