Risk factors of post‐endoscopic submucosal dissection electrocoagulation syndrome for colorectal neoplasm

Ito, Sayo; Imai, Kenichiro; Yamaguchi, Yoshihiro; Kishida, Yoshihiro; Takizawa, Kohei; Kakushima, Naomi; Tanaka, Masaki; Kawata, Noboru; Yoshida, Masao; Ishiwatari, Hirotoshi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

doi:10.1111/jgh.14302

Cited by 46 publications

(56 citation statements)

References 26 publications

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Zhang

Wang

et al. 2020

J of Gastro and Hepatol

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Background and Aim Endoscopic submucosal dissection (ESD) has a high en bloc resection rate and is widely performed for large colorectal lesions. However, colorectal ESD is associated with a high frequency of adverse events (AEs), and the efficacy of prophylactic endoscopic closure after ESD for preventing AEs is still controversial. This meta‐analysis was conducted to assess the efficacy of closure on AEs following colorectal ESD. Methods We searched PubMed, Embase, and the Cochrane Library for eligible studies. The chi‐square‐based Q statistics and the I2 test were used to test for heterogeneity. Pooling was conducted using a fixed or random effects model. Results We identified eight eligible studies that compared the effects of closure vs non‐closure with respect to delayed bleeding, delayed perforation, and post‐ESD coagulation syndrome. Compared with non‐closure (5.2%), closure was associated with a lower incidence (0.9%) of delayed bleeding (pooled odd ratios [ORs]:0.19, 95% CI: 0.08–0.49) following ESD. The pooled ORs showed no significant differences in incidence of delayed perforation (pooled OR: 0.22; 95% CI: 0.05–1.03) or post‐ESD coagulation syndrome (pooled OR:0.75; 95% CI: 0.26–2.18) between the closure and non‐closure groups. Conclusion Prophylactic endoscopic closure may reduce the incidence of delayed bleeding following ESD of colorectal lesions. Future studies are needed to further illuminate risk factors and stratify high risk subjects for a cost‐effective preventive strategy.

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Section: Discussionmentioning

confidence: 99%

“…The rates of delayed bleeding, delayed perforation, and PECS after colorectal ESD are reported to be 1.5–11.9%, 0.3–0.7%, and 4.8–40.8%, respectively, in previous studies 6–16 . To reduce the risk of AEs, several studies have suggested prophylactic endoscopic closure of the mucosal defect after colorectal ESD 17–20 .…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Zhang

Wang

et al. 2020

J of Gastro and Hepatol

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“…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].…”

Section: Post-esd Coagulation Syndromementioning

confidence: 99%

“…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]. It is supposed that the cecal wall is thinner than the other parts of colon and air insufflation during the procedure generates a higher pressure in the cecum than in other parts of the colon, thereby increasing vulnerability to injury [22,38].…”

Section: Post-esd Coagulation Syndromementioning

confidence: 99%

“…Anti-biotics were administered 1 h before ESD and then additionally injected every 8 h twice more, and the prophylactic use of anti-biotics was then associated with decreased C-reactive protein level and abdominal pain. However, because post-ESD CS occurs only in a few patients, the prophylactic use of anti-biotics in high-risk patients compared with all patients may be effective [34].…”

Section: Post-esd Coagulation Syndromementioning

confidence: 99%

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Management of Complications of Colorectal Submucosal Dissection

Kim

Chang

2019

Clin Endosc

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Endoscopic submucosal dissection (ESD) is a useful procedure for the treatment of superficial gastrointestinal neoplasm. Compared with endoscopic mucosal resection (EMR), ESD has several benefits, which include resectability of various difficult lesion, accurate histologic assessment of specimen, and lower recurrence rate. However, the risk of procedure-related complications is higher with ESD than with EMR. Moreover, because the colon has a thin wall and limited endoscopic maneuverability, ESD is considered a more challenging and risky procedure when performed in the colon than in the stomach. ESD-related complications are more likely to occur. The significant complications associated with ESD are bleeding, perforation, coagulation syndrome and stenosis, most of which can be treated and prevented by endoscopic intervention and preparation. Therefore, it is important to know how to occur and manage the ESD related complication. clin endosc 2019;52:114-119

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Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer

Seki¹,

Sakamoto

Makiguchi³

et al. 2022

DEN Open

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Various complications of colorectal endoscopic submucosal dissection (ESD) have been reported, including bleeding, penetration, perforation, and coagulation syndrome. However, the occurrence of bowel obstruction after ESD is rare. We report a case of adhesive bowel obstruction after ESD for a laterally spreading tumor in the sigmoid colon. The 35‐mm tumor was successfully removed by ESD without intraoperative complications. The patient had a fever, lower abdominal pain, and a small amount of bloody stool the day after ESD. Endoscopy revealed minor bleeding from the ESD scar, which was treated by hemostatic clips. Pathological analysis showed adenocarcinoma was exposed to the vertical margin; therefore, the resection was non‐curative. At 39 days after ESD and 36 days after discharge, the patient had abdominal pain and nausea. She was readmitted with a diagnosis of adhesive bowel obstruction. Conservative treatment was ineffective; therefore, she underwent sigmoidectomy combined with partial resection of the small intestine because of small intestinal stenosis caused by inflammation. The pathological examination showed localized peritonitis around the sigmoid colon where ESD was performed. There was more fibrosis along the serous surface of the small intestine than on the sigmoid colon. We concluded that there was a micro‐perforation that could not be detected by endoscopy or physical examination. This case indicates that adhesive bowel obstruction may occur as a complication of ESD.

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Risk factors of post‐endoscopic submucosal dissection electrocoagulation syndrome for colorectal neoplasm

Abstract: This study identified the risk factors for PECS. Patients with high-risk factors of PECS require careful management after colorectal ESD.

Cited by 46 publications

References 26 publications

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

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

Management of Complications of Colorectal Submucosal Dissection

Unexpected adhesive bowel obstruction after endoscopic submucosal dissection of early sigmoid colon cancer

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