Risk Factors for Post-Endoscopic Submucosal Dissection Electrocoagulation Syndrome in Patients with Colorectal Neoplasms: A Multicenter, Large-Scale, Retrospective Cohort Study by the Honam Association for the Study of Intestinal Disease (HASID)

Author:

Song Hyo-Yeop1,Kim Seong-Jung2ORCID,Lee Jun2,Jin Byung Chul3,Kim Dong Hyun4ORCID,Kim Hyun-Soo4,Oh Hyung-Hoon4,Joo Young-Eun4ORCID,Myung Dae-Seong4,Kim Sang-Wook3ORCID,Seo Geom-Seog1

Affiliation:

1. Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan 54538, Republic of Korea

2. Department of Internal Medicine, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea

3. Department of Internal Medicine, Research Institute of Clinical Medicine, Biomedical Research Institute, Jeonbuk National University, Jeonbuk National Medical School, Jeonju 54907, Republic of Korea

4. Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea

Abstract

Background and Objectives: Colorectal endoscopic submucosal dissection (ESD) is an effective technique for removing colorectal neoplasms with large or cancerous lesions. However, there are few studies on post-ESD electrocoagulation syndrome (PECS), a complication of colorectal ESD. Therefore, this study aimed to investigate the various risk factors for PECS after colorectal ESD. Materials and Methods: We retrospectively analyzed the medical records of 1413 lesions from 1408 patients who underwent colorectal ESD at five tertiary hospitals between January 2015 and December 2020. We investigated the incidence and risk factors associated with PECS. Based on the data, we developed a risk-scoring model to predict the risk of PECS after colorectal ESD. Results: The incidence rate of PECS was 2.6% (37 patients). In multivariate analysis, the use of anti-platelet agents (odds ratio (OR), 2.474; 95% confidence interval (CI), 1.088–5.626; p < 0.031), a lesion larger than 6 cm (OR 3.755; 95% CI, 1.237–11.395; p = 0.028), a deep submucosal invasion (OR 2.579; 95% CI, 1.022–6.507; p = 0.045), and an ESD procedure time ≥ 60 min (OR 2.691; 95% CI, 1.302–5.560; p = 0.008) were independent risk factors of PECS after colorectal ESD. We developed a scoring model for predicting PECS using these four factors. As the score increased, the incidence of PECS also increased, from 1.3% to 16.6%. PECS occurred more frequently in the high-risk group (≥2) (1.8% vs. 12.4%, p < 0.001). Conclusions: In this study, the risk factors for PECS after colorectal ESD were the use of anti-platelet agents, a lesion larger than 6 cm, a deep submucosal invasion, and an ESD procedure time ≥ 60 min. The risk-scoring model developed in this study using these factors could be effective in predicting and preventing PECS.

Publisher

MDPI AG

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