Gut Liver.  2016 May;10(3):420-428. 10.5009/gnl15252.

Endoscopic and Clinical Factors Affecting the Prognosis of Colorectal Endoscopic Submucosal Dissection-Related Perforation

• Kang DU
• Choi Y
• Lee HS
• Lee HJ
• Park SH
• Yang DH
• Yoon SM
• Kim KJ
• Ye BD
• Myung SJ
• Yang SK
• Kim JH
• Byeon JS

• KMID: 2411970
• DOI: http://doi.org/10.5009/gnl15252

Abstract

BACKGROUND/AIMS
Although colorectal endoscopic submucosal dissection (ESD)-related perforation is not uncommon, the factors affecting clinical outcomes after perforation have not been investigated. This study was designed to investigate the factors influencing the clinical course of ESD-related colon perforation.
METHODS
Forty-three patients with colorectal ESD-related perforation were evaluated. The perforations were classified as endoscopic or radiologic perforations. The patients' medical records and endoscopic pictures were analyzed.
RESULTS
The clinical outcomes were assessed by the duration of nil per os, intravenous antibiotics administration, and hospital stays, which were 2.7±1.5, 4.9±2.3, and 5.1±2.3 days, respectively. Multivariate analyses revealed that a larger tumor size, ESD failure, specific endoscopists, and abdominal pain were independently related to a poorer outcome. The time between perforation and clipping was 15.8±25.4 minutes in the endoscopic perforation group. The multivariate analysis of this group indicated that delayed clipping, specific endoscopists, and abdominal pain were independently associated with poorer outcomes.
CONCLUSIONS
Tumor size, ESD failure, abdominal pain, and the endoscopist were factors that affected the clinical outcomes of patients with colorectal ESD-related perforation. The time between the perforation and clipping was an additional factor influencing the clinical course of endoscopic perforation. Decreasing this time period may improve outcomes.

Keyword

Colon; Endoscopic submucosal dissection; Outcome; Perforation

MeSH Terms

C-Reactive Protein/metabolism
Colonic Diseases/*etiology
Colonoscopy
Colorectal Neoplasms/surgery
Endoscopic Mucosal Resection/*adverse effects
Female
Humans
Intestinal Mucosa/surgery
Intestinal Perforation/*etiology
Intraoperative Complications/etiology
Male
Middle Aged
Prognosis
Retrospective Studies
C-Reactive Protein