Factors influencing the prolonged duration of endoscopic submucosal dissection Response

We read with great interest the study by Hihara et al,1Hihara D. Takamaru H. Sekiguchi M. et al.Factors associated with increased duration of endoscopic submucosal dissection for rectal tumors: a 22-year retrospective analysis.Gastrointest Endosc. 2023; 98: 420-427.e1Google Scholar who published the findings of their investigation of the variables linked to prolonged duration of endoscopic submucosal dissection (ESD) for rectal tumors. We do, however, have a few questions regarding this study. First, it should be highlighted that the features of the lesions themselves, such as their location, size, scope, and depth, were the risk factors described in this study. It is crucial to remember that this study did not take operation-related factors into account. The duration of ESD may be affected by various resection devices, traction techniques, and even submucosal injection materials. We observe that these parameters showed multiple patterns in this study, which might have further influenced the outcomes. Additionally, some studies have suggested that lesion fibrosis may alter how long an ESD lasts2Miyaguchi K. Tashima T. Terada R. et al.A retrospective cohort study of factors influencing long procedure times in colorectal endoscopic submucosal dissection.Scand J Gastroenterol. 2021; 56: 1255-1263Google Scholar,3Hayashi N. Tanaka S. Nishiyama S. et al.Predictors of incomplete resection and perforation associated with endoscopic submucosal dissection for colorectal tumors.Gastrointest Endosc. 2014; 79: 427-435Google Scholar; hence, this investigation should take that into account. Second, this study discovered that endoscopists' level of experience had no bearing on how long ESD lasted. However, this might have been related to several factors. We noted that the expert subgroup had larger lesion sizes and faster procedure speeds but lower R0 resection rates and more adverse events. All of these factors imply that the lesions resected by endoscopists in the 2 subgroups of this study were done in a selected manner. Inaccurate results may also have emerged from this selection bias. All authors disclosed no financial relationships.