Risk Factors and a Nomogram for Prediction of Post-endoscopic Submucosal Dissection Electrocoagulation Syndrome for Superficial Colorectal Lesions

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2024 May 23

PMID 38782827

Authors

Jiayu Qiu

Yanxia Zhang

Qingping Ouyang

Yanhong Xia

Liping Wang

Xu Shu

Youxiang Chen

Xiaolin Pan

Affiliations

Soon will be listed here.

Abstract

Background: Post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) is an uncommon complication after colorectal endoscopic submucosal dissection (ESD). This study aimed to explore the risk factors of PEECS for superficial colorectal lesions based on the latest and consistent diagnostic criteria and to establish a predictive nomogram model.

Methods: This retrospective analysis included patients with superficial colorectal lesions who underwent endoscopic submucosal dissection (ESD) between June 2008 and December 2021 in our center. The independent risk factors of PEECS for superficial colorectal lesions were identified using least absolute shrinkage and selection operator (LASSO) logistic regression analysis, as well as univariate analysis and multivariate logistic regression, and derived predictive nomogram model was constructed.

Results: Among the 555 patients with superficial colorectal lesions enrolled, PEECS occurred in 45 (8.1%) patients. Multivariate logistic regression revealed that female sex (OR 3.94, P < 0.001), age > 50 years (OR 4.28, P = 0.02), injury to muscle layer (OR 10.38, P < 0.001), non-lifting sign (OR 2.20, P = 0.04) and inadequate bowel preparation (OR 5.61, P < 0.001) were independent risk factors of PEECS for superficial colorectal lesions. A predictive nomogram model was constructed based on the above five predictors. For this model, the area under the receiver operating characteristic (ROC) curve was 0.855, the calibration curve exhibited good consistency between the prediction and the actual observation, and the C-index was confirmed as 0.843 by bootstrap method.

Conclusion: Female sex, age > 50 years, injury to muscle layer, non-lifting sign and inadequate bowel preparation were independent risk factors of PEECS for superficial colorectal lesions. The proposed nomogram could accurately predict the risk of PEECS for superficial colorectal lesions.

References

Shigita K, Oka S, Tanaka S, Sumimoto K, Hirano D, Tamaru Y . Long-term outcomes after endoscopic submucosal dissection for superficial colorectal tumors. Gastrointest Endosc. 2016; 85(3):546-553. DOI: 10.1016/j.gie.2016.07.044. View

Yamada M, Saito Y, Takamaru H, Sasaki H, Yokota T, Matsuyama Y . Long-term clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms in 423 cases: a retrospective study. Endoscopy. 2017; 49(3):233-242. DOI: 10.1055/s-0042-124366. View

Repici A, Hassan C, De Paula Pessoa D, Pagano N, Arezzo A, Zullo A . Efficacy and safety of endoscopic submucosal dissection for colorectal neoplasia: a systematic review. Endoscopy. 2012; 44(2):137-50. DOI: 10.1055/s-0031-1291448. View

Takeuchi Y, Iishi H, Tanaka S, Saito Y, Ikematsu H, Kudo S . Factors associated with technical difficulties and adverse events of colorectal endoscopic submucosal dissection: retrospective exploratory factor analysis of a multicenter prospective cohort. Int J Colorectal Dis. 2014; 29(10):1275-84. DOI: 10.1007/s00384-014-1947-2. View

Hori K, Uraoka T, Harada K, Higashi R, Kawahara Y, Okada H . Predictive factors for technically difficult endoscopic submucosal dissection in the colorectum. Endoscopy. 2014; 46(10):862-70. DOI: 10.1055/s-0034-1377205. View

Benson B, Myers J, Laczek J . Postpolypectomy electrocoagulation syndrome: a mimicker of colonic perforation. Case Rep Emerg Med. 2013; 2013:687931. PMC: 3728495. DOI: 10.1155/2013/687931. View

Chen S, Chang C, Chiang M, Tseng W . Postpolypectomy Electrocoagulation Syndrome: A Rare Complication of Colonoscopic Polypectomy Mimicking Colonic Perforation. J Emerg Med. 2021; 60(5):e127-e129. DOI: 10.1016/j.jemermed.2020.12.030. View

Jung D, Youn Y, Jahng J, Kim J, Park H . Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endoscopy. 2013; 45(9):714-7. DOI: 10.1055/s-0033-1344555. View

Yamashina T, Takeuchi Y, Uedo N, Hamada K, Aoi K, Yamasaki Y . Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm. J Gastroenterol Hepatol. 2015; 31(3):615-20. DOI: 10.1111/jgh.13052. View

10.

Ochi M, Kawagoe R, Kamoshida T, Hamano Y, Ohkawara H, Ohkawara A . High total Joule heat increases the risk of post-endoscopic submucosal dissection electrocoagulation syndrome after colorectal endoscopic submucosal dissection. World J Gastroenterol. 2021; 27(38):6442-6452. PMC: 8517781. DOI: 10.3748/wjg.v27.i38.6442. View

11.

Qiu J, Ouyang Q, Zhang Y, Xu J, Xie Y, Wei W . Post-endoscopic submucosal dissection electrocoagulation syndrome: a clinical overview. Expert Rev Gastroenterol Hepatol. 2022; 16(11-12):1079-1087. DOI: 10.1080/17474124.2022.2156858. View

12.

Kobayashi R, Hirasawa K, Sato C, Makazu M, Kaneko H, Ikeda R . Utility of multi-detector computed tomography scans after colorectal endoscopic submucosal dissection: a prospective study. Gastrointest Endosc. 2017; 87(3):818-826. DOI: 10.1016/j.gie.2017.10.038. View

13.

Ito S, Hotta K, Imai K, Yamaguchi Y, Kishida Y, Takizawa K . Risk factors of post-endoscopic submucosal dissection electrocoagulation syndrome for colorectal neoplasm. J Gastroenterol Hepatol. 2018; 33(12):2001-2006. DOI: 10.1111/jgh.14302. View

14.

Omori T, Funasaka K, Horiguchi N, Kamano T, Nagasaka M, Nakagawa Y . Injury to the muscle layer, increasing the risk of post-colorectal endoscopic submucosal dissection electrocoagulation syndrome. J Gastroenterol Hepatol. 2022; 38(1):87-93. DOI: 10.1111/jgh.16021. View

15.

Yamamoto S, Kinugasa H, Yamasaki Y, Hirai M, Ako S, Takei K . Fever and electrocoagulation syndrome after colorectal endoscopic submucosal dissection for patients with immunosuppressants and steroids. DEN Open. 2022; 2(1):e83. PMC: 8828197. DOI: 10.1002/deo2.83. View

16.

Kim S, Kim S, Lee J . Prognosis and risk factors of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Large cohort study. Surg Endosc. 2022; 36(8):6243-6249. DOI: 10.1007/s00464-022-09060-w. View

17.

Shichijo S, Takeuchi Y, Shimodate Y, Yamashina T, Yamasaki T, Hayashi T . Performance of perioperative antibiotics against post-endoscopic submucosal dissection coagulation syndrome: a multicenter randomized controlled trial. Gastrointest Endosc. 2021; 95(2):349-359. DOI: 10.1016/j.gie.2021.08.025. View

18.

Nomura S, Shimura T, Katano T, Iwai T, Mizuno Y, Yamada T . A multicenter, single-blind randomized controlled trial of endoscopic clipping closure for preventing coagulation syndrome after colorectal endoscopic submucosal dissection. Gastrointest Endosc. 2019; 91(4):859-867.e1. DOI: 10.1016/j.gie.2019.11.030. View

19.

Yamasaki Y, Takeuchi Y, Iwatsubo T, Kato M, Hamada K, Tonai Y . Line-assisted complete closure for a large mucosal defect after colorectal endoscopic submucosal dissection decreased post-electrocoagulation syndrome. Dig Endosc. 2018; 30(5):633-641. DOI: 10.1111/den.13052. View

20.

Kus J, Haque S, Kazan-Tannus J, Jawahar A . Postpolypectomy coagulation syndrome - an uncommon complication of colonoscopy. Clin Imaging. 2021; 79:133-135. DOI: 10.1016/j.clinimag.2021.04.037. View