C-reactive protein and procalcitonin behavior post colorectal ESD: a single center prospective cohort study

Aims Serological inflammatory markers may increase after colorectal endoscopic submucosal dissection (ESD), even if there is no polypectomy syndrome. We aimed to find predictive factors for C-reactive protein (CRP) and procalcitonin elevation post colorectal ESD.

Methods We assessed the 2003 to 2024 results of a prospective singe center registry of ESD for colorectal laterally spreading tumors (LST). We evaluated the prospective factors for CRP elevation after colorectal ESD.

Results We have prospectively included 68 patients with 70 lesions. ESD was successful in 62 lesions (88.6%). Of the 60 lesions with histopathological diagnosis, 57 were en-bloc R0 resections (95%) and 55 were curative resections (91.6%). 11 LST were adenocarcinomas, of which 7 were superficial T1a carcinomas with curative resection (63.6%). There were 5 delayed bleedings (8.1%) and 2 perforations (3.2%). On day one post ESD, the mean CRP value was significantly higher for patients with perforation, 68.5 mg/l [42.2 – 94.8] vs. 17.6 mg/l [0.44 – 137], p=0.035. Also, patients who received antibiotics post ESD had significantly higher CRP values, 22.9 mg/l [1.1 – 137] vs. 11.2 mg/l [0.44 – 33.1], p=0.040. Day one CRP values correlated with lesion diameter (r=0.589, p<0.001) and ESD duration (r=0.426, p=0.001). Overall post ESD, the mean maximal elevation CRP value was comparable in patients with or without perforation, 94.9 mg/l [71.6 – 118.3] vs. 40.9 mg/l [1.4 – 352.7], p=0.077. Similarly, patients who received antibiotics post ESD had significantly higher maximal CRP values, 56.5 mg/l [5.3 – 352.7] vs. 16.1 [1.4 – 43.9], p=0.002. Maximal CRP elevation correlated with lesion diameter (r=0.614, p<0.001) and ESD duration (r=0.529, p<0.001). The mean maximal procalcitonin value was significantly higher for patients with perforation, 0.8 ng/ml [0.17 – 1.44] vs. 0.18 ng/ml [0.05 – 2.41], p=0.002. Patients who received antibiotics had comparable maximal procalcitonin values as patients without, 0.28 ng/ml [0.05 – 2.41] vs. 0.5 ng/ml [0.05 – 0.11], p=0.219. Maximal procalcitonin values did not correlate with lesion diameter (r=0.276, p=0.073), whilst it correlated with ESD duration (r=0.451, p=0.002).

Conclusions CRP and procalcitonin increased after colorectal ESD, significantly higher in patients with perforation. Post ESD antibiotics were prescribed more often in patients with higher CRP values. CRP elevations on day one and its peak value significantly correlated with lesion diameter and ESD duration, while maximal procalcitonin value only correlated with ESD duration.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025