A Comprehensive Analysis of Prevalence, Risk Stratification, and Early Post-Procedure Predictive Scoring for Post-endoscopic Submucosal Dissection Coagulation Syndrome

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Abstract
Background and study aims: Post-endoscopic submucosal dissection (ESD) coagulation syndrome (PECS) is defined as abdominal pain with inflammatory responses, requiring careful differentiation from delayed perforation (DP). This study aimed to evaluate clinical and biochemical characteristics associated with PECS and DP following ESD, and to develop a scoring system for predicting PECS. Patients and methods: We retrospectively analyzed 318 consecutive patients who underwent colorectal ESD at our institution between January 2022 and June 2024. Patients were classified into three groups: PECS (n=32), DP (n=7), and no-PECS/no-DP (NPD) (n=279). Multivariate analysis was performed to identify predictors of PECS for clinical factors and values such as C-reactive protein (CRP), white blood cell (WBC) count, and body temperature. Based on significant predictors, we constructed a five-variable PECS-predictive scoring system (FPSS) for early post-procedure prediction of PECS. Results: Among 318 patients, the incidence of PECS and DP was 10.1% and 2.2%, respectively. DP cases demonstrated greater CRP elevation (p<0.001) and higher leukocytosis (p=0.011) compared with PECS, while PECS cases showed significantly higher WBC (p<0.001) and CRP (p<0.001) than the NPD group. Multivariate analysis identified five independent predictors of PECS: right colon (OR=3.54; p=0.004), female gender (OR=2.10; p=0.018), body temperature ≥37.6°C (OR=16.70; p8,000/µL on day 1 (OR=13.78; p24 mm (OR=3.03; p=0.003). The FPSS (range 0–9) achieved an AUC of 0.881, with high negative predictive value (97.4%). Conclusion: The characteristics of PECS were clarified in comparison with NPD and DP, and the newly developed FPSS demonstrated excellent diagnostic performance of PECS.

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