Risk Factors of Post-ESD Electrocoagulation Syndrome for Colorectal Neoplasms: A Systematic Review and Comprehensive...

Endoscopic submucosal dissection (ESD) has gained increasing popularity in the management of complicated colorectal polyps. Post-ESD electrocoagulation syndrome (PECS) has been recognized as one of the significant complications. Several studies have evaluated different risk factors associated with post-endoscopic submucosal dissection electrocoagulation syndrome for colorectal neoplasms. In this meta-analysis, we aimed to identify the risk factors of PECS after colorectal ESD.

A comprehensive literature search of PubMed, Embase, Web of Science Core Collection, and the Cochrane Database for Systematic Reviews was conducted from inception to February 05, 2025. All studies that used a multivariate model to assess risk factors for post-ESD electrocoagulation syndrome were included. Pooled odds ratios (OR) with 95% confidence intervals (CI) for risk factors reported in ≥ 2 studies were obtained within a random-effects model.

Nineteen studies (3 prospective, 2 RCTs, 14 retrospective studies) with 8151 patients who underwent endoscopic submucosal dissection for colorectal lesions were included. Pooled Incidence of PECS was 8.9%. Ten different risk factors were analyzed. Meta-analysis demonstrated that female gender OR 3.03 (2.16, 4.24), tumor size ≥ 20 mm OR 2.57 (1.65, 3.99), procedure time ≥ 60 min OR 2.25 (1.33, 3.79), tumor location in right sided colon OR 3.33 (1.85, 5.99), submucosal fibrosis OR 3.34 (1.65, 6.75), injury to muscle layer high OR 5.43 (3.04, 9.67) and high joule heat accumulation OR 10.01 (2.83, 35.40) were significant predictors of Post-ESD electrocoagulation syndrome. Older age ≥ 60 years, lesions in the left-sided colon (rectosigmoid), traction-assisted ESD, Tumor morphology LST-G type, non-lifting, and deep submucosal invasions were not significant risk factors in post-ESD electrocoagulation syndrome.

This meta-analysis demonstrates that female sex, lesion size ≥ 20 mm, procedure time ≥ 60 min, right-sided location, submucosal fibrosis, muscle layer injury, and high Joule heat accumulation were associated with increased odds of PECS. Understanding these risk factors can help clinicians identify patients at higher risk of PECS and implement preventive measures to improve outcomes after colorectal ESD.