Risk Factors And A Nomogram For Prediction Of Post-Endoscopic Submucosal Dissection Electrocoagulation Syndrome For Superficial Colorectal Lesions

Background and objective:Post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)is an uncommon complication after colorectal endoscopic submucosal dissection(ESD).Currently,many aspects of colorectal PEECS remain controversial and the diagnostic criteria have tended to be consistent in the last two years.This study aimed to explore the risk factors of PEECS for superficial colorectal lesions based on the latest and consistent diagnostic criteria and establish a predictive nomogram model,which helps clinicians predict and prevent PEECS for superficial colorectal lesions as early as possible.Methods:This retrospective analysis included 555 patients with superficial colorectal lesions who underwent ESD between June 2008 and December 2021 in the endoscopic center of the First Affiliated Hospital of Nanchang University.These patients were divided into “PEECS” group and “non-PEECS” group according to whether PEECS occurred after colorectal ESD.After collecting the relevant clinical information of the patients,we analyzed the incidence of colorectal PEECS and its clinical characteristics.Multivariate logistic regression analyses were performed to identify the independent risk factors of PEECS for superficial colorectal lesions based on the potential risk factors screened by univariate analysis,and derived predictive nomogram model was constructed.The receiver operating characteristic(ROC)curve and calibration curve were used to evaluate the differentiation and calibration of the model,and the model was internally validated by bootstrap method.Results:1.Among the 555 patients with superficial colorectal lesions underwent ESD enrolled,PEECS occurred in 45(8.1%)patients.2.Univariate analysis showed statistically significant differences between PEECS group and non-PEECS group in female sex,age>50 years,use of antithrombotic,tumor≥25mm,injury to muscle layer,non-lifting sign,inadequate bowel preparation and ESD procedure time≥60min.3.Multivariate logistic regression revealed that female sex(OR: 3.94;95%CI:1.94-8.46;P<0.001),age>50 years(OR: 4.28;95%CI: 1.44-18.41;P=0.02),injury to muscle layer(OR: 10.38;95%CI: 3.83-33.80;P<0.001),non-lifting sign(OR: 2.20;95%CI: 1.05-4.68;P=0.04)and inadequate bowel preparation(OR: 5.61;95%CI:2.17-14.47;P<0.001)were independent risk factors of PEECS for superficial colorectal lesions.4.A predictive nomogram model was constructed based on the above five predictors.For this model,the area under the ROC curve(AUC)was 0.855(95%CI:0.80-0.91),the calibration curve exhibited good consistency between the prediction and the actual observation,and the C-index was confirmed as 0.843 by bootstrap method,which suggested this predictive model had a good discrimination and calibration.Conclusion:Female sex,age>50 years,injury to muscle layer,non-lifting sign and inadequate bowel preparation were independent risk factors of PEECS for superficial colorectal lesions.The proposed nomogram based on the above independent risk factors exhibited satisfactory performance and could accurately predict the risk of PEECS for superficial colorectal lesions.