Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study

Taro Iwatsubo, Yoji Takeuchi, Yasushi Yamasaki, Kentaro Nakagawa, Masamichi Arao, Masayasu Ohmori, Hiroyoshi Iwagami, Kenshi Matsuno, Shuntaro Inoue, Hiroko Nakahira, Noriko Matsuura, Satoki Shichijo, Akira Maekawa, Takashi Kanesaka, Sachiko Yamamoto, Koji Higashino, Noriya Uedo, Ryu Ishihara

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Although the use of endoscopic submucosal dissection (ESD) as a minimally invasive treatment for large superficial colorectal neoplasms is increasing, colorectal ESD remains technically challenging. As perforation in the colorectum is generally considered to be associated with a higher risk of complications, the aim of this study was to investigate the characteristics of perforation caused by colorectal ESD.

METHODS: This retrospective study included 635 lesions treated with colorectal ESD, between February 2011 and December 2015, in a tertiary cancer center. We evaluated and compared the clinical course and short-term outcomes of the intraprocedural perforation group with those of the delayed perforation and no perforation groups.

RESULTS: Perforation occurred in 45 (7.1%) of the 635 cases. Thirty-six cases were intraprocedural perforation (5.7%), all of which were successfully closed with endoclips during the procedure. Nine cases of delayed perforation occurred (1.4%). No emergency surgery was performed in the intraprocedural perforation group; however, 5 of 9 cases underwent emergency surgery in the delayed perforation group (56%, p < 0.0001). There were statistically significant differences between the intraprocedural and delayed perforation groups with regard to the hospitalization period, fasting period, abdominal pain scale, peak white blood cell (WBC) count, and peak C-reactive protein (CRP), and between the intraprocedural and no perforation groups with regard to the location of the lesion, hospitalization period, fasting period, abdominal pain scale, peak WBC, peak CRP, and en bloc resection rate.

CONCLUSIONS: While intraprocedural perforation due to colorectal ESD can be managed conservatively, delayed perforation can lead to serious adverse events.

Original languageEnglish
Pages (from-to)53-62
Number of pages10
JournalDigestive Diseases
Volume37
Issue number1
DOIs
Publication statusPublished - 2019
Externally publishedYes

Keywords

  • Abdominal Pain/etiology
  • Aged
  • Aged, 80 and over
  • C-Reactive Protein/metabolism
  • Colorectal Neoplasms/blood
  • Endoscopic Mucosal Resection/adverse effects
  • Female
  • Humans
  • Intestinal Mucosa/pathology
  • Intestinal Perforation/etiology
  • Leukocyte Count
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult

Fingerprint Dive into the research topics of 'Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study'. Together they form a unique fingerprint.

  • Cite this

    Iwatsubo, T., Takeuchi, Y., Yamasaki, Y., Nakagawa, K., Arao, M., Ohmori, M., Iwagami, H., Matsuno, K., Inoue, S., Nakahira, H., Matsuura, N., Shichijo, S., Maekawa, A., Kanesaka, T., Yamamoto, S., Higashino, K., Uedo, N., & Ishihara, R. (2019). Differences in Clinical Course of Intraprocedural and Delayed Perforation Caused by Endoscopic Submucosal Dissection for Colorectal Neoplasms: A Retrospective Study. Digestive Diseases, 37(1), 53-62. https://doi.org/10.1159/000492868