<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452023000300048</article-id>
<article-id pub-id-type="doi">10.1159/000522579</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Outcomes and Learning Curve in Endoscopic Submucosal Dissection of Rectal Neoplasms with Severe Fibrosis: Experience of a Western Center]]></article-title>
<article-title xml:lang="pt"><![CDATA[Resultados e curva de aprendizagem da disseção endoscópica da submucosa de lesões retais com fibrose severa: experiência de um centro ocidental]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Félix]]></surname>
<given-names><![CDATA[Catarina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Barreiro]]></surname>
<given-names><![CDATA[Pedro]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mendo]]></surname>
<given-names><![CDATA[Rui]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mascarenhas]]></surname>
<given-names><![CDATA[André]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chagas]]></surname>
<given-names><![CDATA[Cristina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Centro Hospitalar de Lisboa Ocidental EPE Gastroenterology Department ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Lusíadas Lisbon Advanced Endoscopic Center ]]></institution>
<addr-line><![CDATA[Lisbon ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2023</year>
</pub-date>
<volume>30</volume>
<numero>3</numero>
<fpage>48</fpage>
<lpage>56</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452023000300048&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452023000300048&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452023000300048&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Endoscopic submucosal dissection (ESD) of lesions with severe submucosal fibrosis has been associated with worse outcomes, such as lower curative resection rate and higher incidence of adverse events. This study aims to investigate its true impact on rectal ESD performed in the West and to assess predictive factors of severe fibrosis.  Methods:  We conducted a retrospective study including all rectal ESDs performed at our tertiary center from January 2013 to January 2021. Lesions were grouped as nonsevere fibrosis or severe fibrosis. ESD outcomes, predictors of severe fibrosis, and the learning curve were evaluated.  Results:  ESD was performed in 195 lesions, 45 with severe fibrosis. Three resections were interrupted (one due to severe fibrosis). The presence of severe fibrosis was related to a significantly lower resection speed (16.93 mm2/min vs. 24.66 mm2/min, p = 0.007), en bloc (86.4% vs. 96.6%, p = 0.019), R0 (61.4% vs. 79.7%, p = 0.013), and curative (54.5% vs. 78.4%, p = 0.003) resection rates and a higher rate of hybrid ESD required to complete resection (13.6% vs. 2.0%, p = 0.005). No significant difference was noted regarding adverse events rate (18.2% vs. 8.1%, p = 0.09). Male sex, ulcerative colitis, pelvic radiotherapy, a lesion on the anastomotic site, previous manipulation, and deep submucosal invasion were independent predictors for severe fibrosis. En bloc resection rate improved during time (60.0% vs. 94.1%, p = 0.018).  Conclusions:  Severe submucosal fibrosis is an important factor related to noncurative resections and challenging rectal ESD. Factors predicting its severity are extremely important and could allow more experienced endoscopists to be assigned to more difficult cases, allowing safer procedures.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A disseção endoscópica da submucosa (DES) de lesões com fibrose severa tem sido associada a piores resultados, nomeadamente uma menor taxa de ressecção curativa e maior taxa de complicações. Este estudo tem como objetivo investigar o impacto da fibrose severa na DES de lesões do reto realizada no ocidente e avaliar fatores preditivos de fibrose severa.  Métodos:  Foi realizado um estudo retrospetivo incluindo todas as DES de lesões do reto realizadas no nosso centro entre janeiro de 2013 e janeiro de 2021. As lesões foram agrupadas em lesões sem fibrose severa ou com fibrose severa. Foram analisa-dos os resultados da DES, preditores de fibrose severa e a curva de aprendizagem.  Resultados:  Foi realizada DES em 195 lesões: 45 com fibrose severa. Três resseções foram interrompidas (uma devido a fibrose severa). A presença de fibrose severa associou-se a uma significativa menor velocidade de resseção (16.93 mm2/min vs. 24.66 mm2/min, p = 0.007) e significativas menores taxas de excisão em bloco (86.4% vs. 96.6%, p = 0.019), R0 (61.4% vs. 79.7%, p = 0.013) e curativa (54.5% vs. 78.4%, p = 0.003), bem como uma maior taxa de resseção híbrida necessária para completar a excisão (13.6% vs. 2.0%, p = 0.005). Não se verificou uma diferença estatisticamente significativa em relação aos efeitos adversos nos dois grupos (18.2% vs. 8.1%, p = 0.09). O sexo masculino, a presença de colite ulcerosa, radioterapia pélvica prévia, localização em anastomose, manipulação prévia ou invasão profunda da sub-mucosa foram identificados como fatores preditores de fibrose severa. A taxa de excisão em bloco aumentou ao longo do tempo (60.0% vs. 94.1%, p = 0.018).  Conclusão:  A fibrose severa é um importante fator relacionado com excisões não curativas e mais complexas. A identificação de fatores proditores da sua gravidade é de extrema importância e pode permitir a alocação de endoscopistas mais experientes para casos mais difíceis, permitindo procedimentos mais seguros.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Gastrointestinal endoscopy]]></kwd>
<kwd lng="en"><![CDATA[Endoscopic mucosal resection]]></kwd>
<kwd lng="en"><![CDATA[Rectal neoplasms]]></kwd>
<kwd lng="pt"><![CDATA[Endoscopia gastrointestinal]]></kwd>
<kwd lng="pt"><![CDATA[Mucosectomia endoscópica]]></kwd>
<kwd lng="pt"><![CDATA[Neoplasia do reto]]></kwd>
</kwd-group>
</article-meta>
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<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Mendo]]></surname>
<given-names><![CDATA[R]]></given-names>
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<name>
<surname><![CDATA[Félix]]></surname>
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<name>
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<given-names><![CDATA[I]]></given-names>
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<article-title xml:lang=""><![CDATA[Endoscopic submucosal dissection for polyps in the anal transitional zone after ileoanal anastomosis in a patient with familial adenomatous polyposis.]]></article-title>
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<year>2022</year>
<volume>54</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>E11-2</page-range></nlm-citation>
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