Outcomes of perforation after colorectal endoscopic submucosal dissection in a large prospective multicenter cohort - PubMed
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- #perforation outcomes
- #surgical management
- #colorectal ESD
- Perforation occurred in 8.9% of 3770 colorectal endoscopic submucosal dissections (ESDs), with 8.3% intraprocedural and 0.6% delayed.
- Conservative management was effective for 91.7% of perforations, especially intraprocedural ones (96.8%), but delayed perforations often required emergent surgery (81.8%).
- Risk factors for intraprocedural perforation included previous resection, lesion size ≥50 mm, poor maneuverability, and severe fibrosis; proximal location and severe fibrosis increased delayed perforation risk.
- A perforation ≥5 mm, fever, or abdominal pain were associated with surgery after intraprocedural perforation in univariable analysis.
- No deaths were directly linked to perforation, but one death occurred due to delayed bleeding; overall, ESD-related perforations are often manageable conservatively, though delayed cases remain challenging.