Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study

Abstract

Background and study aims Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS). Patients and methods This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure. Results PECS occurred in 15/106 (14.2 %), and 10 were women ( P = 0.01, OR: 7.74 [1.6 – 36.4]), 7 had lesions in the cecum ( P < 0.001, OR: 20.6 [3.7 – 115.2]), and 9 in whom ESD operation time was > 90 min ( P = 0.002, OR: 10.3 [2.4 – 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P < 0.001, OR: 38.9 [6.9 – 219.6]), and hospital stay was significantly longer in the PECS group. Conclusions Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS.

Effect of prophylactic closure on adverse events after colorectal endoscopic submucosal dissection: A meta‐analysis

“…Consequently, it is essential to know whether cases have risk factors for PECS when endoscopists perform colorectal ESD. Several studies have shown that female patients, tumor location, a long procedure time, submucosal fibrosis, and larger tumor size are risk factors for PECS 5,14,16,36,44 . Although other risk factors are still controversial, the lesion in the right side of the colon have been revealed as an important potential risk factor for PECS in many studies 15,34,46 .…”

“…Nevertheless, colorectal ESD is more difficult and time consuming to perform than EMR, and the correlative risks of perioperative adverse events (AEs) are also higher than those in EMR. The high frequency of AEs are intra‐ESD AEs, postoperative delayed perforation, postoperative delayed bleeding, and post‐ESD coagulation syndrome (PECS) 3–5 . Most perforation and bleeding during the ESD procedure can be successfully managed endoscopically.…”

Management of Complications of Colorectal Submucosal Dissection

“…Coagulation syndrome (CS) is transmural burn syndrome resulting from electrocoagulation injury in the bowel wall after endoscopic treatments including polypectomy, EMR and ESD [22,33,34]. CS is clinically diagnosed based on the presence of abdominal tenderness and/or rebound tenderness matched procedure site by transmural burn and localized peritonitis resulting to serosal inflammation, fever, leukocytosis, and elevated C-reactive protein levels without obvious perforation on abdominal radiography and/or CT scan after endoscopic treatment [22,33,34].…”

“…The incidence rate of post- ESD CS ranges from 4.8% to 14.2%, which is considerably higher than that of post-polypectomy CS [33-35].…”

“…The previously known risk factors of post-ESD CS are sex, tumor size, procedure time, tumor location and presence of submucosal fibrosis [22,33,34,36,37]. Right side colon is a known risk factor of post-ESD CS, and the cecum is a part that is a higher risk for adverse events related endoscopic procedures, including post-ESD CS than other parts of the colon [22,34,38].…”