Colorectal endoscopic submucosal dissection and acute kidney injury: a rare but clinically relevant adverse event, a cohort study of 1,537 patients

Background and aims: Colorectal endoscopic submucosal dissection is established for large superficial neoplasia, but systemic adverse events remain underexplored. We aimed to assess the frequency, predictors, and outcomes of clinically evident acute kidney injury after colorectal endoscopic submucosal dissection. Methods: All consecutive colorectal endoscopic submucosal dissections performed at Limoges University Hospital (2017–2024) within the prospective French ESD Colorectal Cohort were retrospectively analysed to identify acute kidney injury events and related factors. Results: Among 1537 patients, the frequency of clinically evident acute kidney injury was 1.3% (n=20). Compared with those without acute kidney injury, patients who developed acute kidney injury were older (74 vs. 70 years, p=0.029) and more often receiving angiotensin-converting enzyme-inhibitors (40% vs. 13.6%, p=0.003). Patients who developed acute kidney injury had larger lesions (100 vs. 55 mm, p<0.001), longer procedures (181 vs. 55 min, p<0.001), and higher rates of perforation (35% vs. 10.4%, p=0.003) and delayed bleeding (36% vs. 5.4%, p=0.003). Angiotensin-converting enzyme-inhibitors (OR 3.96, 95% CI 1.40–9.36) and lesion diameter (OR 1.03, 95% CI 1.02–1.04) were independent predictors of acute kidney injury. By the end of follow-up, all patients recovered their baseline renal function. Conclusions: Acute kidney injury after colorectal endoscopic submucosal dissection is rare but clinically relevant. Patients receiving angiotensin-converting enzyme-inhibitors and with larger lesions are at higher risk. Careful peri-procedural management, including adequate hydration, close monitoring during prolonged or complex procedures, and consideration of angiotensin-converting enzyme inhibitor therapy, may be relevant in this setting.