Tu1060 COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION BY NON-EXPERTS AS A RISK FACTOR FOR THE ONSET OF POST-ESD ELECTROCOAGULATION SYNDROME

Colorectal endoscopic submucosal dissection (ESD) is technically more difficult than gastric or esophageal ESD from the viewpoint of anatomy, and post-ESD complications, such as postoperative hemorrhage and perforation, have been reported. In particular, a post-ESD complication, post-ESD electrocoagulation syndrome (PECS), may lead to delayed perforation. Previous studies reported that risk factors for PECS included female sex, a long operative time, sample diameter, tumor diameter, and fractional excision. However, considering these risk factors, most patients require strict postoperative management, and it has been necessary to establish simpler risk factors. Our aim was to clarify risk factors for PECS after colorectal ESD and establish satisfactory postoperative management. We conducted a retrospective cohort study involving 164 patients with colorectal tumors (170 lesions) who had undergone colorectal ESD at our hospital between May 2013 and September 2018. Physicians who had experienced ≥1,000 sessions of colonoscopy were assigned to the expert group, and those who had experienced <1,000 sessions of colonoscopy were assigned to the non-expert group. We analyzed 156 patients. There were 107 males (68.5%). The mean age was 67 years (39-92 years). The expert group consisted of 102 patients and the non-expert group consisted of 54 patients. Based on univariate analysis, the operative time (expert and non-expert groups: 60 vs. 161 minutes, respectively), incidence of PECS (3.9 vs. 24.0%, respectively), and C-reactive protein level (0.480 vs. 1.615 mg/dL, respectively) were significantly higher in the non-expert group (p<0.001). According to multivariate analysis, the operative time (odds ratio: 1.01, 95%CI: 1.00-1.01, p=0.013) and incidence of PECS (odds ratio: 4.00, 95%CI: 1.01-15.9, p=0.049) were significantly higher in the non-expert group. Colorectal ESD is technically difficult, requiring high-level skills. This study demonstrated that treatment by non-experts required a long operative time, increasing the incidence of PECS. At most medical institutions, the admission period for colorectal ESD is established in a protocol, and it is important to predict risk factors for PECS before ESD. The operative time, sample diameter, tumor diameter, and fractional excision become known after ESD, but ESD treatment by non-experts is an index that can be predicted. Therefore, for colorectal ESD by non-experts, postoperative management in consideration of the onset of PECS is necessary.