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Publications

Journal Article Ahead of print

PubMed: 41713521 DOI: 10.1016/j.gie.2026.02.011

Lyon ESD Dissection score: A pre-procedure prediction model for operating time in colorectal endoscopic submucosal dissection.

Gastrointest Endosc

Authors: Elena De Cristofaro, Jean Grimaldi, Diana Giannarelli, Roupen Djinbachian, Jérémie Jacques, Timothée Wallenhorst, Clara Yzet, Louis-Jean Masgnaux, Florian Rostain, Alexandru Lupu, Jérôme Rivory, Mathieu Pioche

Affiliations

  • Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
  • Department of Gastroenterology and Endoscopy, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
  • Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Montreal University Hospital Research Center, Montreal, Quebec, Canada; Division of Gastroenterology, Montreal University Hospital Center, Montreal, Quebec, Canada.
  • Department of Gastroenterology and Endoscopy, Dupuytren University Hospital, Limoges, France.
  • Hépato-Gastro-Entérologie, CHU de Rennes, Rennes, France.
  • Amiens University Hospital, Department of Gastroenterology, Amiens, France.
  • Department of Gastroenterology and Endoscopy, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.

Abstract

BACKGROUND AND AIMS

Colorectal endoscopic submucosal dissection (ESD) is an effective curative technique for superficial colorectal lesions but remains technically demanding, with variable procedure times. This study aimed to develop and validate a pre-procedure predictive model for colorectal ESD duration in the era of traction-assisted strategies.

METHODS

We retrospectively analyzed prospectively collected data from patients who underwent colorectal ESD at Edouard Herriot Hospital (Lyon, France). The derivation cohort included 423 cases (January-December 2024) and an independent temporal validation cohort 148 cases (January-May 2025). A generalized linear model with a gamma distribution and log-link function identified independent pre-procedural predictors of ESD duration. Variables were selected based on univariate significance and the Akaike Information Criterion. Model calibration and discrimination were assessed using R 2, mean absolute error, and classification accuracy at predefined thresholds (60, 90, 120 minutes). A point-based score (Lyon ESD Dissection Score, LEDs) and nomogram were derived from model coefficients.

RESULTS

Median procedure time in the derivation cohort was 50 minutes (IQR 30-90). Independent predictors of ESD duration included dissection speed of endoscopists, lesion location (flexures, appendix, cecum, ileocecal valve), predicted lesion size, and suspected fibrosis (all p < 0.05). The LEDs provides a direct estimation of the expected procedure time in minutes based on these variables, showing a strong correlation between predicted and observed durations (R 2 = 0.52). Classification accuracy was 76.1%, 82.2%, and 88.1% for thresholds of 60, 90, and 120 minutes, respectively. Validation confirmed good performance (R 2 = 0.48) with 91.8% accuracy for procedures ≥120 minutes.

CONCLUSION

This validated pre-procedure scoring system accurately predicts colorectal ESD duration, especially for longer procedures. It may facilitate scheduling, optimize resource use, and improve workflow in endoscopy units.

MeSH

Gastroenterology, Endoscopy, Dissection, Endoscopic Mucosal Resection