A Comprehensive Analysis of Prevalence, Risk Stratification, and Early Post-Procedure Predictive Scoring for...

Area of Science:

• Gastroenterology
• Endoscopic Procedures
• Surgical Complications

Background:

• Post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) presents with abdominal pain and inflammation, mimicking delayed perforation (DP).
• Accurate differentiation between PECS and DP is crucial for appropriate patient management following ESD.

Purpose of the Study:

• To evaluate clinical and biochemical characteristics differentiating PECS from DP after colorectal ESD.
• To develop and validate a predictive scoring system for early identification of PECS.

Main Methods:

• Retrospective analysis of 318 patients undergoing colorectal ESD.
• Classification into PECS (n=32), DP (n=7), and no-PECS/no-DP (NPD) (n=279) groups.
• Multivariate analysis to identify PECS predictors, leading to the development of a five-variable PECS-predictive scoring system (FPSS).

Main Results:

• The incidence of PECS and DP was 10.1% and 2.2%, respectively.
• DP showed greater CRP elevation and leukocytosis than PECS.
• Key predictors for PECS included right colon location, female gender, elevated body temperature, higher day 1 WBC count, and larger lesion size.
• The FPSS demonstrated an AUC of 0.881 with a high negative predictive value (97.4%).

Conclusions:

• The study clarified the distinct characteristics of PECS compared to NPD and DP.
• The newly developed FPSS offers excellent diagnostic performance for predicting PECS after colorectal ESD.