PREDICTIVE FACTORS OF COMPLICATIONS IN COLORECTAL SUBMUCOSAL DISSECTION, A FRENCH TERTIARY CENTER EXPERIENCE

Aims Colorectal endoscopic submucosal dissection (ESD) is an innovative technique from Japan to resect superficial tumors without any size limit and avoid a complete monobloc resection. Colorectal ESD main complications are perforation, delayed bleeding and post electrocoagulation syndrome (PECS), appearing approximately in 10% of cases. This study aim was to define the incidence of colorectal ESD related complications and identify predictive factors of complications in a French tertiary center.

Methods All the colorectal ESD procedures performed in Nancy’s university hospital were retrospectively identified. Endoscopic, clinical and biological datas were collected and analyzed.

Results 180 ESD were performed between June 2016 and November 2020. The characteristics of the patients, the lesions and the histological outcomes are shown in [Table 1]. Perforation rate was 6,6%, delayed bleeding rate was 5% and post-ESD electrocoagulation syndrome rate was 10%. No death occurred. Univariate analysis identified female gender (p=0,026) and median procedure time (p=0,016) as predictive factors for perforation. Arterial hypertension (p=0,037), rectal location (p=0,02), use of anticoagulant agents (p=0,045), median procedure time (p=0,005), and tumor size (p=0,035) were predictive factors for delayed bleeding. Median procedure time (p=0,003), tumor size (p=0,004) and temperature measured the afternoon after ESD (p=0,0001), were identified as predictive factors for post-ESD electrocoagulation syndrome. In our study, multivariate analysis did not identify any significative predictive factors.

Table 1

Patients, tumor and procedure characteristics (n=180)	n (%)
Median age (IQR)	68 (61-75,75)
Use of Anticoagulant agents	27 (15)
Maximal diameter mm (IQR)	50 (35-66,75)
R0 endoscopic resection	165 (91,7)

Conclusions In this tertiary university care center study, ESD appears to be a safe and effective procedure. Few risk factors for complications were identified in univariate analysis but none in multivariate analysis

Publication History

Article published online:
14 April 2022