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Background <p>Post-endoscopic submucosal dissection (ESD) electrocoagulation syndrome (PEECS) is a known complication in colorectal laterally spreading tumors (LSTs), but its risk factors in elderly patients remain unclear. This study aimed to develop and validate a risk-stratification scoring system for PEECS in elderly ESD patients.</p> Methods <p>A multicenter retrospective study (2020–2025) enrolled 506 elderly patients with colorectal LSTs undergoing ESD, randomly allocated to training (TC, n = 354) and validation (VC, n = 152) cohorts (7:3). Synthetic minority over-sampling technique (SMOTE) was used in the TC to identify risk factors and construct a predictive model,&#xa0;which was&#xa0;validated in the VC.</p> Results <p>The incidence of post-ESD PEECS was 8.1% (41 cases). After applying the SMOTE, multivariate analysis identified&#xa0;sex, lesion with fibrosis, and intraoperative bleeding&#xa0;as independent risk factors. The scoring system assigned:&#xa0;1 point for female sex, 3 points for lesion with fibrosis, and 2 points for intraoperative bleeding. In the VC, the model demonstrated an&#xa0;area under the curve (AUC) of 0.921, with a&#xa0;specificity of 0.949&#xa0;and an&#xa0;accuracy of 0.908. Following risk stratification, the low-risk group (0–4 points) showed a PEECS incidence of&#xa0;10.1% in the TC and 5.1% in the VC, while the high-risk group (5–6 points) exhibited&#xa0;94.5% in the TC and 53.3% in the VC.</p> Conclusion <p>In elderly patients with colorectal LSTs undergoing ESD, female sex, fibrotic lesions, and intraoperative bleeding were identified as independent predictors of PEECS. The proposed scoring system demonstrated good discriminatory ability in both cohorts and may be useful for risk stratification in this population.</p>

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Development and validation of a predictive scoring model for post-ESD coagulation syndrome in elderly with colorectal LSTs

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月2日

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  • Qian Zhang,
  • Fengcheng Zang,
  • Bin He,
  • Yunfu Feng,
  • Zhibing Wang,
  • Xiaodan Xu,
  • Jian Chen,
  • Luojie Liu,
  • Wenwen Diao

摘要

Background

Post-endoscopic submucosal dissection (ESD) electrocoagulation syndrome (PEECS) is a known complication in colorectal laterally spreading tumors (LSTs), but its risk factors in elderly patients remain unclear. This study aimed to develop and validate a risk-stratification scoring system for PEECS in elderly ESD patients.

Methods

A multicenter retrospective study (2020–2025) enrolled 506 elderly patients with colorectal LSTs undergoing ESD, randomly allocated to training (TC, n = 354) and validation (VC, n = 152) cohorts (7:3). Synthetic minority over-sampling technique (SMOTE) was used in the TC to identify risk factors and construct a predictive model, which was validated in the VC.

Results

The incidence of post-ESD PEECS was 8.1% (41 cases). After applying the SMOTE, multivariate analysis identified sex, lesion with fibrosis, and intraoperative bleeding as independent risk factors. The scoring system assigned: 1 point for female sex, 3 points for lesion with fibrosis, and 2 points for intraoperative bleeding. In the VC, the model demonstrated an area under the curve (AUC) of 0.921, with a specificity of 0.949 and an accuracy of 0.908. Following risk stratification, the low-risk group (0–4 points) showed a PEECS incidence of 10.1% in the TC and 5.1% in the VC, while the high-risk group (5–6 points) exhibited 94.5% in the TC and 53.3% in the VC.

Conclusion

In elderly patients with colorectal LSTs undergoing ESD, female sex, fibrotic lesions, and intraoperative bleeding were identified as independent predictors of PEECS. The proposed scoring system demonstrated good discriminatory ability in both cohorts and may be useful for risk stratification in this population.