Su1717 IDENDIFICATION OF RISK FACTORS OF COAGULATION SYNDROME AFTER COLORECTAL ENDOSCOPIC SUBMUCOSAL DISSECTION AND DEVELOPMENT OF A PREDICTION MODEL

Abstract

In contrast to perforation and bleeding, which have been well studied, few studies have examined coagulation syndrome after endoscopic submucosal dissection (ESD) in the colon and rectum. The aims of this study were to evaluate the incidence of ESD, determine the risk factors for ESD, and establish a risk prediction model for post-ESD coagulation syndrome (PECS). We performed a cross-sectional analysis of 986 patients who underwent colorectal ESD at Samsung Medical Center in Seoul, Korea. Risk factors of PECS were identified using multivariate logistic regression. Model performance was internally validated using bootstrapping methods. ESD-induced perforation occurred in 201 patients (21.4%, 95% confidence interval [CI]=18.9%–24.1%). Multivariate logistic regression identified tumor size (+ 1 cm: odds ratio [OR]=1.29, 95% CI=1.16–7.09), tumor location (cecum: OR=1.96, 95% CI=1.09-1.53), simplified ESD technique (OR=0.64, 95% CI=0.43–0.95), and total procedure time (+ 30 minutes: OR=1.19, 95% CI=1.02-1.39) as risk factors for PECS. Using a simplified weighted scoring system based on adjusted odds ratio increments of 1, the risk of PECS ranged from 12.3% (95% CI, 0.3%-16.0%) for the low-risk group (score ≤ 4) to 36.0% (95% CI=29.4%–43.2%) for the high-risk group (score ≥ 8). The model had moderate to good overall discrimination (C-statistic=0.629; 95% CI=0.585–0.672) and calibration (p=0.993). This study reports the incidence and risk factors of PECS and describes the development of an internally validated prediction model to estimate the risk of PECS. Accurate risk prediction of PECS can guide effective management and prevention strategies.