{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:20:38Z","timestamp":1787761238866,"version":"build-2784847793"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      Colorectal endoscopic submucosal dissection (CR-ESD) has become a promising treatment for laterally spreading tumors (LSTs), but is accompanied by great challenges\n                      <jats:bold>.<\/jats:bold>\n                      This study aimed to evaluate the efficacy and safety of CR-ESD with a hybrid knife, versus the conventional technique for LSTs \u226530 mm in diameter, and analyze the risk factors for piecemeal resection and perforation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patients eligible for CR-ESD were divided into two groups according to the use of the hybrid knife (HK group) or the use of the conventional technique, with an interchange of injection and hook knife (C-group). We performed propensity score matching (PSM) to compare the HK group and the C-group. Risk predictors for perforation and piecemeal resection were identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      PSM identified 61 (132 patients) and 61 (129 patients) patients in the C-group and the HK group, respectively. Resection speed was significantly faster in the HK group than in the C-group (18.86 vs. 13.33 mm\n                      <jats:sup>2<\/jats:sup>\n                      \/min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). The rate of knife exchange was significantly lower in the HK group than in the C-group (1.6% vs. 49.2%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Multivariate analysis revealed that unfavorable locations, including the splenic flexure, hepatic flexure, or cecum, were predictive of piecemeal resection. The presence of severe fibrosis and a semilunar fold were independent risk factors for perforation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The use of a hybrid knife appears to increase CR-ESD resection speed. The indicators for piecemeal resection or perforation in CR-ESD identified herein might help to assess the technical difficulties of CR-ESD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/sjg.sjg_373_22","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T07:06:18Z","timestamp":1672124778000},"page":"111-118","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":7,"title":["Conventional versus hybrid knife endoscopic submucosal dissection in large colorectal laterally spreading tumors: A propensity score analysis"],"prefix":"10.4103","volume":"29","author":[{"given":"Bin","family":"Yang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhong","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuxue","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Xuhui Center Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huazhong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinxiang","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Shanghai Xuhui Center Hospital, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,12,27]]},"reference":[{"key":"R1-20240829","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel","year":"2022","journal-title":"CA Cancer J Clin"},{"key":"R2-20240829","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.gie.2008.07.052","article-title":"Nonpolypoid neoplastic lesions of the colorectal mucosa","volume":"68","author":"ei Kudo","year":"2008","journal-title":"Gastrointest Endosc"},{"key":"R3-20240829","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1055\/s-0043-121144","article-title":"Endoscopic subtypes of colorectal laterally spreading tumors (LSTs) and the risk of submucosal invasion: A meta-analysis","volume":"50","author":"Bogie","year":"2018","journal-title":"Endoscopy"},{"key":"R4-20240829","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10147-019-01485-z","article-title":"Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer","volume":"25","author":"Hashiguchi","year":"2020","journal-title":"Int J Clin Oncol"},{"key":"R5-20240829","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1055\/s-0034-1377205","article-title":"Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum","volume":"46","author":"Hori","year":"2014","journal-title":"Endoscopy"},{"key":"R6-20240829","first-page":"2631774520957220","article-title":"Endoscopic submucosal dissection: An update on tools and accessories","volume":"13","author":"Harlow","year":"2020","journal-title":"Ther Adv Gastrointest Endosc"},{"key":"R7-20240829","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.gie.2012.08.036","article-title":"High efficacy of endoscopic submucosal dissection for rectal laterally spreading tumors larger than 3 cm","volume":"77","author":"Repici","year":"2013","journal-title":"Gastrointest Endosc"},{"key":"R8-20240829","doi-asserted-by":"crossref","first-page":"98","DOI":"10.4321\/S1130-01082014000200005","article-title":"Experimental study of hybrid-knife endoscopic submucosal dissection (ESD) versus standard ESD in a Western country","volume":"106","author":"De-la-Pena","year":"2014","journal-title":"Rev Esp Enferm Dig"},{"key":"R9-20240829","doi-asserted-by":"crossref","first-page":"874","DOI":"10.6004\/jnccn.2018.0061","article-title":"Rectal cancer, Version 2.2018, NCCN clinical practice guidelines in oncology","volume":"16","author":"Benson","year":"2018","journal-title":"J Natl Compr Canc Netw"},{"key":"R10-20240829","doi-asserted-by":"crossref","first-page":"359","DOI":"10.6004\/jnccn.2018.0021","article-title":"NCCN guidelines insights: Colon cancer, Version 2.2018","volume":"16","author":"Benson","year":"2018","journal-title":"J Natl Compr Canc Netw"},{"key":"R11-20240829","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1055\/s-0042-124366","article-title":"Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms in 423 cases: A retrospective study","volume":"49","author":"Yamada","year":"2017","journal-title":"Endoscopy"},{"key":"R12-20240829","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1055\/s-0034-1377531","article-title":"Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement","volume":"46","author":"Paspatis","year":"2014","journal-title":"Endoscopy"},{"key":"R13-20240829","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.3109\/00365521.2010.495416","article-title":"Outcome of endoscopic submucosal dissection for colorectal tumors accompanied by fibrosis","volume":"45","author":"Matsumoto","year":"2010","journal-title":"Scand J Gastroenterol"},{"key":"R14-20240829","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.gie.2018.11.029","article-title":"A risk-scoring model for the prediction of delayed bleeding after colorectal endoscopic submucosal dissection","volume":"89","author":"Seo","year":"2019","journal-title":"Gastrointest Endosc"},{"key":"R15-20240829","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1016\/j.gie.2017.05.051","article-title":"Clinical outcomes of endoscopic submucosal dissection for colorectal tumors: A large multicenter retrospective study from the Hiroshima GI Endoscopy Research Group","volume":"87","author":"Boda","year":"2018","journal-title":"Gastrointest Endosc"},{"key":"R16-20240829","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s00428-002-0680-3","article-title":"The new Vienna classification of epithelial neoplasia of the gastrointestinal tract: Advantages and disadvantages","volume":"442","author":"Stolte","year":"2003","journal-title":"Virchows Archiv"},{"key":"R17-20240829","doi-asserted-by":"crossref","first-page":"2167","DOI":"10.1007\/s00464-014-3449-2","article-title":"Should laterally spreading tumors granular type be resected en bloc in endoscopic resections?","volume":"28","author":"Imai","year":"2014","journal-title":"Surg Endosc"},{"key":"R18-20240829","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/den.14223","article-title":"Outcomes of endoscopic submucosal dissection for colorectal neoplasms: Prospective, multicenter, cohort trial","volume":"34","author":"Kobayashi","year":"2022","journal-title":"Dig Endosc"},{"key":"R19-20240829","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1055\/s-0030-1255654","article-title":"Retrospective study of technical aspects and complications of endoscopic submucosal dissection for laterally spreading tumors of the colorectum","volume":"42","author":"Toyonaga","year":"2010","journal-title":"Endoscopy"},{"key":"R20-20240829","doi-asserted-by":"crossref","first-page":"E421","DOI":"10.1055\/a-0848-8225","article-title":"Preoperative endoscopic predictors of severe submucosal fibrosis in colorectal tumors undergoing endoscopic submucosal dissection","volume":"7","author":"Kaosombatwattana","year":"2019","journal-title":"Endosc Int Open"},{"key":"R21-20240829","doi-asserted-by":"crossref","first-page":"E839","DOI":"10.1055\/s-0043-113566","article-title":"Colorectal endoscopic submucosal dissection: Predictors and neoplasm-related gradients of difficulty","volume":"5","author":"Iacopini","year":"2017","journal-title":"Endosc Int Open"},{"key":"R22-20240829","doi-asserted-by":"crossref","first-page":"3766","DOI":"10.1007\/s00464-020-07599-0","article-title":"Review on colorectal endoscopic submucosal dissection focusing on the technical aspect","volume":"34","author":"Fung","year":"2020","journal-title":"Surg Endosc"},{"key":"R23-20240829","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1177\/2050640618797854","article-title":"Colorectal polyps located across a fold are difficult to resect completely using endoscopic mucosal resection: A propensity score analysis","volume":"6","author":"Minamino","year":"2018","journal-title":"United European Gastroenterol J"},{"key":"R24-20240829","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1016\/j.dld.2021.03.005","article-title":"Superficial neoplasia involving the Ileocecal valve: Clinical outcomes of endoscopic submucosal dissection","volume":"53","author":"Andrisani","year":"2021","journal-title":"Dig Liver Dis"},{"key":"R25-20240829","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1055\/s-0042-110396","article-title":"Endoscopic submucosal dissection of cecal lesions in proximity to the appendiceal orifice","volume":"48","author":"Jacob","year":"2016","journal-title":"Endoscopy"},{"key":"R26-20240829","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1038\/ajg.2015.96","article-title":"Local recurrence after endoscopic resection for large colorectal neoplasia: A multicenter prospective study in Japan","volume":"110","author":"Oka","year":"2015","journal-title":"Am J Gastroenterol"},{"key":"R27-20240829","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1016\/j.gie.2015.08.024","article-title":"Preoperative indicators of failure of en bloc resection or perforation in colorectal endoscopic submucosal dissection: Implications for lesion stratification by technical difficulties during stepwise training","volume":"83","author":"Imai","year":"2016","journal-title":"Gastrointest Endosc"},{"key":"R28-20240829","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.gie.2015.12.011","article-title":"Prediction model and risk score for perforation in patients undergoing colorectal endoscopic submucosal dissection","volume":"84","author":"Hong","year":"2016","journal-title":"Gastrointest Endosc"},{"issue":"1S Suppl 1","key":"R29-20240829","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.1097\/MEG.0000000000001994","article-title":"Risk factors for adverse events of colorectal endoscopic submucosal dissection: A systematic review and meta-analysis","volume":"33","author":"Santos","year":"2021","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"R30-20240829","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1055\/s-0030-1256339","article-title":"Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors","volume":"43","author":"Kim","year":"2011","journal-title":"Endoscopy"},{"key":"R31-20240829","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.gie.2013.09.014","article-title":"Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors","volume":"79","author":"Hayashi","year":"2014","journal-title":"Gastrointest Endosc"},{"key":"R32-20240829","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s10620-019-05735-y","article-title":"Predictive factors of mild and severe fibrosis in colorectal endoscopic submucosal dissection","volume":"65","author":"Chiba","year":"2020","journal-title":"Dig Dis Sci"},{"key":"R33-20240829","doi-asserted-by":"crossref","first-page":"5698","DOI":"10.1007\/s00464-022-09250-6","article-title":"Factors for conversion risk of colorectal endoscopic submucosal dissection: A multicenter study","volume":"36","author":"Kamigaichi","year":"2022","journal-title":"Surg Endosc"}],"container-title":["Saudi Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sjg.sjg_373_22","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:27:40Z","timestamp":1787758060000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sjg.sjg_373_22"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,27]]},"references-count":33,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/sjg.sjg_373_22","relation":{},"ISSN":["1319-3767","1998-4049"],"issn-type":[{"value":"1319-3767","type":"print"},{"value":"1998-4049","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,27]]},"assertion":[{"value":"2022-08-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}