Mo1770 INCREASED INCIDENCE OF ELECTROCOAGULATION SYNDROME AFTER COROLECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION IN ELDERLY PATIENTS: A RETROSPECTIVE STUDY

Abstract

Colorectal endoscopic submucosal dissection (ESD) is accepted as a minimally invasive treatment. Most studies have reported the safety of colorectal ESD for elderly patients. Post-ESD electrocoagulation syndrome (PECS) is a common adverse event caused by transmural injury due to electric current and must be distinguished from perforation, which results in a prolonged hospital stay. Till date, little is known about PECS in the elderly. This study aimed to evaluate the incidence of PECS after colorectal ESD in elderly patients. This retrospective study was conducted in a single tertiary referral hospital. Colorectal ESD was performed for 782 colorectal tumors in 703 consecutive patients between April 2005 and March 2019. We excluded a patient with inflammatory bowel disease and 2 with non-epithelial tumors. The patients were divided into the elderly group (aged ≥75 years) and younger group (aged <75 years). PECS was diagnosed based on localized abdominal tenderness and fever (≥37.6 °C) or inflammatory response (leukocytosis ≥10,000 cells/μL or raised CRP ≥0.5) without perforation, which occurred ≥6 h after ESD. The primary outcome was the incidence of PECS. The risk factors of PECS were analyzed. Of 700 patients included, 250 constituted the elderly group and 450 constituted the younger group. No significant differences in gender, diabetes mellitus, hemodialysis, and tumor location, size, and morphology were observed between the two groups. The frequency of ASA-PS 3, hypertension, and antithrombotic treatment was significantly higher in the elderly group than in the younger group (p<0.001, =0.003, <0.001, respectively). There was no significant difference in the rates of completion and en bloc resection between the two groups (97.6% and 98.7%, p=0.364; 96.0% and 97.1%, p=0.175). No significant differences were observed in the rates of delayed bleeding, acute perforation, and delayed perforation (5.2% and 3.3%, p=0.233; 4.8% and 6.2%, p=0.449; 0.8% and 0.7%, p=1.000, respectively). However, PECS incidence was significantly higher in the elderly group than in the younger group (9.2% and 4.4%, p=0.014). Multivariate analysis revealed that age (≥75 years) was an independent risk factor associated with PECS (odds ratio, 2.14; 95% confidence interval, 1.13–4.06; p=0.019), in addition to female sex and location in the right colon. Moreover, the length of hospital stay after ESD was longer in the elderly group than in the younger group (6.8±3.9 and 6.2±2.7, p<0.042). Among patients with PECS, post-operative hospitalization was significantly prolonged in the elderly group than in the younger group (10.0±4.9 and 6.4±3.6, p<0.001). PECS developed more often in the elderly patients than in the younger patients following colorectal ESD; this also implied longer hospital stay for the elderly group.