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DOI: 10.1055/s-0030-1256339
© Georg Thieme Verlag KG Stuttgart · New York
Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors
Publikationsverlauf
submitted 1 May 2010
accepted after revision 10 December 2010
Publikationsdatum:
29. März 2011 (online)
![](https://www.thieme-connect.de/media/endoscopy/201107/lookinside/thumbnails/10.1055-s-0030-1256339-1.jpg)
Background and aim: Although perforation of the colon is known as one of the main complications of endoscopic submucosal dissection (ESD) for colorectal tumor management, factors predictive of perforation have not been fully evaluated. This study aimed to determine the factors associated with perforation during colorectal ESD.
Methods: Patients with colorectal tumors undergoing ESD were enrolled and their records were reviewed retrospectively. Age, sex, co-morbidity, medication history, procedure time, resection method, tumor size, location, gross morphology, the presence of fibrosis, and histologic findings were included as possible risk factors. In the cases where perforation had occurred, factors associated with the duration of hospitalization were analyzed.
Results: One hundred eight lesions in 108 patients were eligible for inclusion in the study (68 patients were male; mean patient age was 63.01 ± 10.71 years). Mean tumor size was 27.59 ± 10.10 mm (range: 8 – 53 mm). Laterally spreading tumor was the most common type (75 %), followed by the protruding type (25 %). Procedure time was 61.95 ± 41.90 minutes (range: 5 – 198 minutes). Complete en bloc resection was achieved for 85 lesions (78.7 %). Perforation occurred in 22 patients (20.4 %). Multivariate analysis confirmed that tumor size [odds ratio (OR): 1.084; 95 % confidence interval (CI): 1.015 – 1.158; P = 0.017] and the presence of fibrosis (OR: 4.551; 95 %CI: 1.092 – 18.960; P = 0.037) were independent risk factors for perforation. All cases of perforation were managed with nonsurgical treatment. Younger age and abdominal pain appeared to be related to prolonged hospitalization.
Conclusion: Tumor size and fibrosis are important factors related to complications during colorectal ESD. Younger age and development of abdominal pain can predict the hospital course in patients with perforation after ESD.
References
- 1 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009; 58 331-336
- 2 Chung I K, Lee J H, Lee S H et al. Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study. Gastrointest Endosc. 2009; 69 1228-1235
- 3 Nakamoto S, Sakai Y, Kasanuki J et al. Indications for the use of endoscopic mucosal resection for early gastric cancer in Japan: a comparative study with endoscopic submucosal dissection. Endoscopy. 2009; 41 746-750
- 4 Oka S, Tanaka S, Kaneko I et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc. 2006; 64 877-883
- 5 Tanaka S, Oka S, Chayama K. Colorectal endoscopic submucosal dissection: present status and future perspective, including its differentiation from endoscopic mucosal resection. J Gastroenterol. 2008; 43 641-651
- 6 Japanese Research Society for Cancer of the Colon and Rectum . General rules for clinical and pathological studies on cancer of the colon, rectum and anus. Part I. Clinical classification. Jpn J Surg. 1983; 13 557-573
- 7 Uraoka T, Saito Y, Matsuda T et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumours in the colorectum. Gut. 2006; 55 1592-1597
- 8 Isomoto H, Nishiyama H, Yamaguchi N et al. Clinicopathological factors associated with clinical outcomes of endoscopic submucosal dissection for colorectal epithelial neoplasms. Endoscopy. 2009; 41 679-683
- 9 Tanaka S, Oka S, Kaneko I et al. Endoscopic submucosal dissection for colorectal neoplasia: possibility of standardization. Gastrointest Endosc. 2007; 66 100-107
- 10 Saito Y, Uraoka T, Matsuda T et al. Endoscopic treatment of large superficial colorectal tumors: a case series of 200 endoscopic submucosal dissections (with video). Gastrointest Endosc. 2007; 66 966-973
- 11 Tamegai Y, Saito Y, Masaki N et al. Endoscopic submucosal dissection: a safe technique for colorectal tumors. Endoscopy. 2007; 39 418-422
- 12 Repici A. Endoscopic submucosal dissection: established, or still needs improving?. Gastrointest Endosc. 2009; 69 16-18
- 13 Taku K, Sano Y, Fu K I et al. Iatrogenic perforation associated with therapeutic colonoscopy: a multicenter study in Japan. J Gastroenterol Hepatol. 2007; 22 1409-1414
- 14 Piessevaux H, Dewit O, Azzouzi K. Endoscopic submucosal dissection for en bloc resection of large colorectal adenomas: experience in a Western population. Gastrointest Endosc. 2008; 67 AB149
- 15 Sanaka M R, Deepinder F, Thota P N et al. Adenomas are detected more often in morning than in afternoon colonoscopy. Am J Gastroenterol. 2009; 104 1659-1664; quiz 1665
- 16 Yoshida N, Wakabayashi N, Kanemasa K et al. Endoscopic submucosal dissection for colorectal tumors: technical difficulties and rate of perforation. Endoscopy. 2009; 41 758-761
- 17 Pautrat K, Bretagnol F, Huten N, de Calan L. Acute diverticulitis in very young patients: a frequent surgical management. Dis Colon Rectum. 2007; 50 472-477
- 18 Simonowitz D, Paloyan D. Diverticular disease of the colon in patients under 40 years of age. Am J Gastroenterol. 1977; 67 69-72
K. B. ChoMD
Department of Internal Medicine and Institute of Gastroenterology and Hepatology
Keimyung University School of Medicine
194 Dong San-dong, Jung-gu
Daegu 700–712
South Korea
Fax: +82-53-2507088
eMail: chokb@dsmc.or.kr