Optimal definition of coagulation syndrome after colorectal endoscopic submucosal dissection: a post hoc analysis of randomized controlled trial

Katano, Takahito; Shimura, Takaya; Nomura, Satoshi; Iwai, Tomohiro; Mizuno, Yusuke; Yamada, Terumasa; Ebi, Masahide; Hirata, Yoshikazu; Nishie, Hirotada; Mizushima, Takashi; Nojiri, Yu; Togawa, Shozo; Koguchi, Hiroki; Shibata, Shunsuke; Hayashi, Noriyuki; Itoh, K.; Kataoka, Hiromi

doi:10.1007/s00384-021-03921-x

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…Some studies defined PECS according to the presence of both abdominal pain and an inflammatory response, 2,4,6,11,14–17 whereas others defined PECS as the presence of either abdominal pain or an inflammatory response 3,7,18 . However, the results of our previous study indicating that the later criteria comprising the presence of either localized abdominal pain or an inflammatory response is the optimal diagnostic criteria for PECS as some patients with obvious abdominal pain or severe inflammation did not meet the former criteria for PECS 13 . We therefore defined PECS as either localized abdominal pain or an inflammatory response (fever or leukocytosis) in the present study accordingly to our previously proposed definition of PECS 13 …”

Section: Discussionmentioning

confidence: 71%

“…3,7,18 However, the results of our previous study indicating that the later criteria comprising the presence of either localized abdominal pain or an inflammatory response is the optimal diagnostic criteria for PECS as some patients with obvious abdominal pain or severe inflammation did not meet the former criteria for PECS. 13 We therefore defined PECS as either localized abdominal pain or an inflammatory response (fever or leukocytosis) in the present study accordingly to our previously proposed definition of PECS. 13 In conclusion, the maXium unit, which is a novel electrosurgical unit, did not reduce the incidence of PECS following colorectal ESD.…”

Section: Discussionmentioning

confidence: 99%

“…13 We therefore defined PECS as either localized abdominal pain or an inflammatory response (fever or leukocytosis) in the present study accordingly to our previously proposed definition of PECS. 13 In conclusion, the maXium unit, which is a novel electrosurgical unit, did not reduce the incidence of PECS following colorectal ESD. However, the maXium unit had equivalent performance to a conventional electrosurgical unit during colorectal ESD.…”

Section: Discussionmentioning

confidence: 99%

“…PECS was defined as either of the following findings on days 1–7 post‐ESD: VAS score ≥ 30 mm or increase in VAS score of ≥ 20 mm from baseline, body temperature ≥ 37.5°C, or WBC ≥ 10 000/μL. Based on the results of previous studies, 3,13 PECS was classified into “type I, conventional PECS without extra‐luminal air” and “type II, PECS with peri‐luminal air.” Delayed perforation was defined as PECS accompanied by intra‐abdominal free air. Extra‐luminal air in the absence of PECS was defined as simple extra‐luminal air.…”

Section: Methodsmentioning

confidence: 99%

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A prospective cohort study of a new electrosurgical unit for preventing colorectal post‐endoscopic submucosal dissection coagulation syndrome

Shimura,

Iwasaki,

Ozeki

et al. 2023

J of Gastro and Hepatol

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Background and AimPost‐endoscopic submucosal dissection coagulation syndrome (PECS) is a recognized complication of colorectal endoscopic submucosal dissection (ESD); however, there is a lack of interventions for preventing PECS. We therefore conducted a prospective study to evaluate the utility of maXium, a novel electrosurgical unit, for preventing PECS.MethodsThis single‐center, prospective cohort study prospectively enrolled patients undergoing colorectal ESD. The voltage and power of the electrosurgical units were measured. PECS was defined as a visual analog scale (VAS) ≥ 30 mm, an increase of VAS ≥ 20 mm from baseline, body temperature ≥ 37.5°C, or white blood cell count ≥ 10 000/μL after ESD. PECS was classified into type I (without extra‐luminal air) and type II (with peri‐luminal air). The primary endpoint was the incidence of PECS. A sample size of 92 patients was required to ensure the upper limit of the 90% CI for the incidence of PECS was less than 15%.ResultsAt resistances greater than 400 Ω, the maXium unit allowed submucosal dissection with lower power than with the VIO300D unit. Ninety‐one patients meeting the inclusion criteria were included in the final study analysis. The incidence of PECS was 16% (90% CI, 10–23%), comprising type I (11%) and type II (5%) PECS. Simple extra‐luminal air without PECS was observed in 7% of patients.ConclusionUse of the maXium electrosurgical unit did not reduce the incidence of PECS after colorectal ESD; however, the maXium unit had equivalent performance to a conventional electrosurgical unit used for colorectal ESD.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A prospective cohort study of a new electrosurgical unit for preventing colorectal post‐endoscopic submucosal dissection coagulation syndrome

Shimura,

Iwasaki,

Ozeki

et al. 2023

J of Gastro and Hepatol

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“…Although post-ESD coagulation syndrome (PECS) is not well defined, clinical diagnosis is based on the presence of localized abdominal tenderness near the ESD site, fever, or laboratory evidence of an inflammatory response, such as elevated C-reactive protein levels and leukocytosis. 36 , 37 The pathogenesis of PECS is similar to that of postpolypectomy coagulation syndrome. 38 , 39 The mechanism of PECS involves transmural bowel injury complicated by electrocautery ( Fig.…”

Section: Postprocedural Complicationsmentioning

confidence: 99%

Management of complications related to colorectal endoscopic submucosal dissection

Gweon

Yang

2023

Clin Endosc

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Compared to endoscopic mucosal resection (EMR), colonoscopic endoscopic submucosal dissection (C-ESD) has the advantages of higher en bloc resection rates and lower recurrence rates of colorectal neoplasms. Therefore, C-ESD is considered an effective treatment method for laterally spread tumors and early colorectal cancer. However, C-ESD is technically more difficult and requires a longer procedure time than EMR. In addition to therapeutic efficacy and procedural difficulty, safety concerns should always be considered when performing C-ESD in clinical practice. Bleeding and perforation are the main adverse events associated with C-ESD and can occur during C-ESD or after the completion of the procedure. Most bleeding associated with C-ESD can be managed endoscopically, even if it occurs during or after the procedure. More recently, most perforations identified during C-ESD can also be managed endoscopically, unless the mural defect is too large to be sutured with endoscopic devices or the patient is hemodynamically unstable. Delayed perforations are quite rare, but they require surgical treatment more frequently than endoscopically identified intraprocedural perforations or radiologically identified immediate postprocedural perforations. Post-ESD coagulation syndrome is a relatively underestimated adverse event, which can mimic localized peritonitis from perforation. Here, we classify and characterize the complications associated with C-ESD and recommend management options for them.

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Is there a best choice of equipment for colorectal endoscopic submucosal dissection?

Cocomazzi,

Carparelli,

Labarile

et al. 2024

Expert Review of Medical Devices

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Optimal definition of coagulation syndrome after colorectal endoscopic submucosal dissection: a post hoc analysis of randomized controlled trial

Cited by 4 publications

References 18 publications

A prospective cohort study of a new electrosurgical unit for preventing colorectal post‐endoscopic submucosal dissection coagulation syndrome

A prospective cohort study of a new electrosurgical unit for preventing colorectal post‐endoscopic submucosal dissection coagulation syndrome

Management of complications related to colorectal endoscopic submucosal dissection

Is there a best choice of equipment for colorectal endoscopic submucosal dissection?

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