Risk factors for perforation during colorectal endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) achieves higher en bloc resection rates than endoscopic mucosal resection in early colorectal neoplasms. However, perforation occurs more frequently during ESD. We aimed to identify the risk factors for perforation during colorectal ESD. A total of 161 patients treated with colorectal ESD at a tertiary center between January 2014 and December 2019 were enrolled in this retrospective study. Perforation was defined as a deep defect of the muscularis propria, with or without direct contact with connective tissue outside the colon. Clinical risk factors for perforation during ESD, including age, sex, tumor morphology, tumor size, tumor location, procedure time, en bloc resection rate, histology, and submucosal fibrosis, were analyzed. The mean size of the ESD specimens was 38.2 ± 24.6 mm. The overall en bloc resection rate was 98.1%. Perforations occurred during ESD in 31 out of 161 patients (19.3%). All perforations were successfully treated with endoscopic closure using the hemoclips and nonsurgical management. Emergency surgery was not required in our patients. On multivariate analysis, severe submucosal fibrosis (odds ratio [OR] 3.06; 95% confidence interval [CI] 1.23-7.59; P = .016) and location in the right colon (OR 4.54; 95% CI 1.31-15.79; P = .017) were independent risk factors. Perforation during colorectal ESD occurred in 31 patients (19.3%), but all patients had a good outcome without surgery. Submucosal fibrosis and its location are risk factors for perforation during ESD.