Impact of prior abdominal surgery on post-polypectomy complications following endoscopic mucosal resection and endoscopic submucosal dissection

Abstract

BACKGROUND

Endoscopic resection, encompassing both endoscopic mucosal resection and endoscopic submucosal dissection (ESD), is the mainstay intervention for colorectal polyps; however, post-procedural complications persist. Although patient and polyp factors are known modulators, the effect of prior abdominal surgery (PAS), which potentially leads to adhesions and an elevated risk, is poorly defined. However, a key unanswered question is whether PAS is an independent risk factor. Resolving this issue is essential for optimizing pre-operative risk assessment and personalized patient management.

AIM

To evaluate the association between PAS and complication risk after endoscopic resection procedures to inform clinical decision-making.

METHODS

This single-center retrospective cohort study included 80 patients who underwent endoscopic resection for colorectal polyps, stratified into PAS (n = 31) and non-PAS (n = 49) groups. Demographics, polyp characteristics, procedural variables, and post-procedural recovery indices were extracted. The primary endpoint was 30-day clinically significant complications (post-polypectomy bleeding, perforation, infection, fever ≥ 38 °C, or moderate-to-severe abdominal pain). Independent predictors were identified using multivariate logistic regression and discriminative performance was quantified using receiver operating characteristic curve analysis.

RESULTS

The overall complication rate was higher in the PAS group than in the non-PAS group (P < 0.05). Patients with PAS exhibited larger polyps, higher polyp multiplicity, a greater proportion of ESD, longer procedure times, more frequent hemoclip use, prolonged hospital stay, delayed resumption of oral intake and ambulation, and elevated post-procedural pain scores (P < 0.05). Multivariate analysis identified PAS, arterial hypertension, hyperlipidemia, anticoagulant/antiplatelet therapy, polyp diameter, polyp multiplicity, ESD as the resection modality, prolonged procedure time, and hemoclip deployment as independent risk factors for complications. Receiver operating characteristic - derived area under the curve values for these variables ranged from 0.71 to 0.84, indicating moderate-to-good predictive accuracy.

CONCLUSION

PAS independently predicts endoscopic resection complications, increasing technical difficulty, procedural time, and the risk of adverse events. Identifying pre-procedure PAS status should inform risk stratification and peri-operative management.

Keywords: Endoscopic polypectomy; Endoscopic mucosal resection; Endoscopic submucosal dissection; Post-operative complications; Prior abdominal surgery

Core Tip: Prior abdominal surgery (PAS) is an independent risk factor for polypectomy complications after endoscopic mucosal resection and endoscopic submucosal dissection. This retrospective cohort study of 80 patients demonstrated that PAS increased technical difficulty, prolonged procedure time, and elevates rates of bleeding, perforation, infection, and post-procedural pain. Larger and multiple polyps, the endoscopic submucosal dissection modality, and hemoclip use further contribute to the risk of complications. Preoperative recognition of PAS status can guide individualized risk stratification, optimize procedural planning, and inform perioperative management strategies, ultimately improving patient safety and clinical outcomes in colorectal polypectomies.