Risk factors for post-colorectal endoscopic submucosal dissection (ESD) coagulation syndrome: a multicenter, prospective, observational study

Abstract

Background and study aims Colorectal cancer (CRC) is one of the most common neoplasms and endoscopic submucosal dissection (ESD) is an effective treatment for early-stage CRC. However, it has been observed that patients undergoing ESD often complain of pain, even if ESD has been successfully performed. Risk factors for such pain still remain unknown. The aim of this study was to explore the risk factors for post-colorectal ESD coagulation syndrome (PECS).

Patients and methods This was a prospective multicenter observational trial (UMIN000016781) conducted in 106 of 223 patients who underwent ESD between March 2015 and April 2016. We investigated age, sex, tumor location, ESD operation time, lesion size, duration of hospitalization, and frequency of PECS. We defined PECS as local abdominal pain (evaluated on a visual analogue scale) in the region corresponding to the site of the ESD that occurred within 4 days of the procedure.

Results PECS occurred in 15/106 (14.2 %), and 10 were women (P = 0.01, OR: 7.74 [1.6 – 36.4]), 7 had lesions in the cecum (P < 0.001, OR: 20.6 [3.7 – 115.2]), and 9 in whom ESD operation time was > 90 min (P = 0.002, OR: 10.3 [2.4 – 44.6]). Frequency of deviation from the prescribed clinical path was significantly higher (47 % [7/15] vs. 2 % [2/91], P < 0.001, OR: 38.9 [6.9 – 219.6]), and hospital stay was significantly longer in the PECS group. 

Conclusions Female gender, location of lesion in the cecum, and ESD operation time > 90 minutes were significant risk factors independent of PECS. These findings are important to management of PECS. 

• References

• 1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
• 2 Anderson WF, Umar A, Brawley OW. Colorectal carcinoma in black and white race. Cancer Metastasis Rev 2003; 22: 67-82
• 3 Waye JD. The postpolypectomy coagulation syndrome. Gastrointest Endosc 1981; 27: 184
• 4 Christie JP, Marrazzo J. “Mini-perforation” of the colon-not all postpolypectomy perforations require laparotomy. Dis. Colon Rectum 1991; 34: 132-135
• 5 Waye JD, Lewis BS, Yessayan S. Colonoscopy: a prospective report of complications. J Clin Gastroenterol 1992; 15: 347-351
• 6 Jung D, Youn YH, Jahng J. et al. Risk of electrocoagulation syndrome after endoscopic submucosal dissection in the colon and rectum. Endoscopy 2013; 45: 714-717
• 7 Hong JM, Kim HJ, Lee YS. et al. Prevalence and clinical features of coagulation syndrome after endoscopic submucosal dissection for colorectal neoplasms. Dig Dis Sci 2015; 60: 211-216
• 8 Yamashina T, Takeuchi Y, Uedo N. et al. Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm. J Gastroenterol Hepatol 2016; 31: 615-620
• 9 Keel KD. The pain chart. Lancet 1948; 2: 6-8
• 10 Huskisson EC. Measurement of pain. Lancet 1974; 2: 1127-1131
• 11 Huskisson EC. Visual analogue scales. In: Merzack R. ed. Pain measurement and assessment. New York: Raven Press; 1983: 33-37
• 12 Scott J, Huskisson EC. Graphic representation of pain. Pain 1976; 2: 175-184
• 13 Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimeters?. Pain 1997; 72: 95-97
• 14 Verbrugge LM. Gender and health: an update on hypotheses and evidence. J Health Soc Behav 1985; 26: 156-182
• 15 Ruau D, Liu LY, Clark JD. et al. Sex differences in reported pain across 11,000 patients captured in electronic medical records. J Pain 2012; 13: 228-234
• 16 Fillingim RB, King CD, Ribeiro-Dasilva MC. et al. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009; 10: 447-485
• 17 Unruh AM. Gender variations in clinical pain experience. Pain 1996; 65: 123-167
• 18 Picavet HS, Hazes JM. Prevalence of self reported musculoskeletal diseases is high. Ann Rheum Dis 2003; 62: 644-650
• 19 Gerdle B, Bjork J, Coster L. et al. Prevalence of widespread pain and associations with work status: A population study. BMC Musculoskel Disord 2008; 9: 102
• 20 Bassols A, Bosch F, Campillo M. et al. An epidemiological comparison of pain complaints in the general population of Catalonia. Pain 1999; 83: 9-16
• 21 Hardt J, Jacobsen C, Goldberg J. et al. Prevalence of chronic pain in a representative sample in the United States. Pain Med 2008; 9: 802-812
• 22 Greenspan JD, Craft RM, LeReesche L. et al. Studying sex and gender differences in pain and analgesia: a consensus report. Pain 2007; 132: S26-S45
• 23 Choo WK, Subhani J. Complication rates of colonic polypectomy in relation to polyp characteristics and techniques: a district hospital experience. J Interv Gastroenterol 2012; 2: 8-11
• 24 Wong SK, Ho YH, Leong AP. et al. Clinical behavior of complicated right-sided and left-sided diverticulosis. Dis. Colon Rectum 1997; 40: 344-348
• 25 Cha JM, Lim KS, Lee SH. et al. Clinical outcomes and risk factors of post-polypectomy coagulation syndrome: a multicenter, retrospective, case-control study. Endoscopy 2013; 45: 202-207
• 26 Lee H, Cheoi KS, Chung H. et al. Clinical features and predictive factors of coagulation syndrome after endoscopic submucosal dissection for early gastric neoplasm. Gastric Cancer 2012; 15: 83-90
• 27 Ohata K, Nonaka K, Misumi Y. et al. Usefulness of training using animal models for colorectal endoscopic submucosal dissection: is experience performing gastric ESD really needed?. Endosc Int Open 2016; 4: E333-E339