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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Sep 10, 2015; 7(12): 1055-1061
Published online Sep 10, 2015. doi: 10.4253/wjge.v7.i12.1055
Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments
Kingo Hirasawa, Chiko Sato, Makomo Makazu, Hiroaki Kaneko, Ryosuke Kobayashi, Atsushi Kokawa, Shin Maeda
Kingo Hirasawa, Chiko Sato, Makomo Makazu, Hiroaki Kaneko, Ryosuke Kobayashi, Atsushi Kokawa, Division of Endoscopy, Yokohama City University Medical Center, Yokohama 232-0024, Japan
Shin Maeda, Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
Author contributions: Hirasawa K designed and drafted of the article, and contributed to analysis and interpretation of data; Sato C, Makazu M, Kaneko H, Kobayashi R and Kokawa A contributed to acquisition of previous reports; Maeda S critically revised and finally approved of the article.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kingo Hirasawa, MD, Division of Endoscopy, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan. kingo-h@urahp.yokohama-cu.ac.jp
Telephone: +81-45-2615656 Fax: +81-45-2535382
Received: April 28, 2015
Peer-review started: May 1, 2015
First decision: June 1, 2015
Revised: June 18, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: September 10, 2015
Processing time: 136 Days and 17.2 Hours
Abstract

Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients.

Keywords: Endoscopy; Syndrome; Colorectal; Dissection; Coagulation

Core tip: Few studies have reported on coagulation syndrome (CS) and delayed perforation associated with CS. Thus, in this review, we focused on CS after colonoscopic treatments. CS is found in around 1% of cases after polypectomy and endoscopic mucosal resection and in 7%-8% of cases after endoscopic submucosal dissection. The prognosis for CS is excellent. However, clinicians should be mindful of delayed perforation in CS patients.