Conservative management of delayed perforation after colorectal endoscopic submucosal dissection: a single-center...

Delayed perforation is a rare but serious complication of colorectal endoscopic submucosal dissection (ESD). This study aimed to evaluate the clinical characteristics and outcomes of patients undergoing conservative management for delayed perforation after colorectal ESD.

We retrospectively reviewed the medical records of 21 patients with delayed perforation after colorectal ESD treated between May 2011 and May 2025. Among them, 19 patients who received initial conservative management were included. These patients were divided into two groups: the Success Group (SG, n = 14), where conservative management succeeded, and the Failure Group (FG, n = 5), which required conversion to surgery. A comparative analysis of clinical, endoscopic, and laboratory findings between the two groups was performed.

Compared with the FG, the SG had lower baseline serum creatinine (median 67.0 vs. 90.0 µmol/L, P = 0.023), higher baseline albumin (mean 41.2 vs. 36.4 g/L, P = 0.042), and a significantly higher rate of complete endoscopic closure (P = 0.013) during the procedure. During conservative management, the SG exhibited a slower rise and a more rapid decline in serum procalcitonin (PCT) levels compared to the FG.

In this small single-center cohort, successful conservative management of delayed perforation after colorectal ESD appeared to be associated with adequate intraoperative defect closure and a relatively better baseline physiological profile, including lower preprocedural serum creatinine and higher preprocedural albumin levels. These findings should be interpreted as exploratory associations rather than definitive predictive indicators. Serial monitoring of serum PCT may provide additional information during conservative management, but treatment escalation should be determined through comprehensive clinical, laboratory, imaging, and multidisciplinary assessment.

Clinical trial number not applicable.