Safety of sedation-free endoscopic submucosal dissection of colon lesions: a single-center retrospective study

Abstract

Background: Endoscopic submucosal dissection (ESD) has emerged as an effective technique for the en bloc and curative removal of sizable colorectal tumors. Despite ESD’s advantages over traditional surgery, its primary associated complications of perforation and hemorrhage pose significant challenges. Sedation-free ESD allows for real-time reporting of symptoms by patients, improving the identification and management of complications. This study aimed to evaluate the safety of sedation-free ESD. Methods: A retrospective cohort study included patients undergoing sedation-free ESD for colorectal lesions at a tertiary center in Taiwan from 2018 to 2023. Patient demographics, lesion characteristics, procedure time, and clinical outcomes were collected. The primary outcome was safety as assessed via intraoperative complications (e.g., perforation or hemorrhage) and overall complication rates. Additional analyses included factors associated with perforation and management strategies (i.e., endoclips or surgical intervention) using univariate and multivariable logistic regression analyses. Results: A total of 134 patients were included in the study. The mean patient age was 65.3 years, with an average lesion size of 3.6 ± 1.5 cm. ESD-associated perforation or hemorrhage occurred in 6.7% and 10.4% of cases, respectively, most of which were successfully managed with endoclips. Patients with hemorrhage—compared with those without—had significantly larger lesions (median: 4.7 cm versus 3 cm, p = 0.004). Multivariable analysis revealed no statistically significant associations between lesion characteristics and perforation. No delayed perforations were reported. Conclusions: Sedation-free ESD is a safe alternative to traditional sedated ESD for colorectal lesions. Real-time symptom reporting by patients enhances management of complications. In addition, precision application of endoclips ensures optimal perforation and hemorrhage control, improving patient outcomes and safety.