Related Experiment Video
Updated: May 23, 2025
The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage
Published on: November 4, 2010
Risk Factors, Clinical Course, and Management of Delayed Perforation After Colorectal Endoscopic Submucosal
Naohisa Yoshida1, Ryohei Hirose2, Ken Inoue3
1Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan. naohisa@koto.kpu-m.ac.jp.
Introduction:
Delayed perforation (DP) remains a significant complication of colorectal endoscopic submucosal dissection (ESD). This study analyzed the risk factors, clinical course, and management for DP following colorectal ESD.
Methods:
We retrospectively reviewed 4,632 consecutive colorectal ESD cases from 13 institutions between January 2006 and May 2024. DP cases were identified, and the incidence rate, along with patient/lesion characteristics (as tumor size, location, and severe fibrosis) were assessed. The clinical course, including onset timing, initial treatments, need for surgery, and risk factors were examined.
Results:
DP occurred in 18 cases, with an incidence rate of 0.39% [95% confidence interval (CI): 0.24-0.62]. The mean tumor size was 49.7 ± 35.7 mm. The rates of right-sided colon lesions and severe fibrosis were observed in 77.8 and 61.2%, respectively. DP occurred on post-procedure day 1 in 55.8% of cases, day 2 in 22.2%, and on day 3 or later in 22.2%. Initial DP management included conservative treatment in five cases (27.8%), endoscopic closure in six (33.3%), and surgery in seven cases (38.9%). Among the six cases managed endoscopically, five (83.3%) were successfully managed without surgery. Finally, surgery was required in 11 cases (61.1%). Multivariate analysis (odds ratio [95%CI]) identified severe fibrosis (4.61 [1.50-14.20], p = 0.007), and long procedure time (1.01 [1.00-1.02], p = 0.042), as significant risk factors for DP, while complete closure was inversely correlated with DP risk (0.12 [0.01-0.96], p = 0.046).
Conclusions:
This study identified DP incidence and risk factors after colorectal ESD, with some cases requiring surgery. Endoscopic treatment may prevent surgery.
Related Concept Videos
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:22Esophageal Perforation-I: Introduction
The location of esophageal perforation can vary, occurring anywhere along the esophagus....
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:29Endoscopic Procedures I: Esophagogastroduodenoscopy
During an EGD, the endoscope can be used to:
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...