title: Factors predictive of perforation during endoscopic submucosal dissection for the treatment of colorectal tumors.
abstract: OBJECTIVE
  Although perforation of the colon is known as one of the main complications of endoscopic submucosal dissection (ESD) for colorectal tumor management, factors predictive of perforation have not been fully evaluated. This study aimed to determine the factors associated with perforation during colorectal ESD.
  
  
  METHODS
  Patients with colorectal tumors undergoing ESD were enrolled and their records were reviewed retrospectively. Age, sex, co-morbidity, medication history, procedure time, resection method, tumor size, location, gross morphology, the presence of fibrosis, and histologic findings were included as possible risk factors. In the cases where perforation had occurred, factors associated with the duration of hospitalization were analyzed.
  
  
  RESULTS
  One hundred eight lesions in 108 patients were eligible for inclusion in the study (68 patients were male; mean patient age was 63.01 ± 10.71 years). Mean tumor size was 27.59 ± 10.10 mm (range: 8 - 53 mm). Laterally spreading tumor was the most common type (75 %), followed by the protruding type (25 %). Procedure time was 61.95 ± 41.90 minutes (range: 5 - 198 minutes). Complete en bloc resection was achieved for 85 lesions (78.7 %). Perforation occurred in 22 patients (20.4 %). Multivariate analysis confirmed that tumor size [odds ratio (OR): 1.084; 95 % confidence interval (CI): 1.015 - 1.158; P = 0.017] and the presence of fibrosis (OR: 4.551; 95 %CI: 1.092 - 18.960; P = 0.037) were independent risk factors for perforation. All cases of perforation were managed with nonsurgical treatment. Younger age and abdominal pain appeared to be related to prolonged hospitalization.
  
  
  CONCLUSIONS
  Tumor size and fibrosis are important factors related to complications during colorectal ESD. Younger age and development of abdominal pain can predict the hospital course in patients with perforation after ESD.
authors: Department of Internal Medicine, Institute of Gastroenterology and Hepatology, Keimyung University School of Medicine, Daegu, South Korea.
authors: E S
authors: ES
authors: Kim
authors: K B
authors: KB
authors: Cho
authors: K S
authors: KS
authors: Park
authors: K I
authors: KI
authors: Lee
authors: B K
authors: BK
authors: Jang
authors: W J
authors: WJ
authors: Chung
authors: J S
authors: JS
authors: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D003106:Colon / Q000293:injuries; D003113:Colonoscopy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000601:surgery*; D004210:Dissection / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000293:injuries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors