Colorectal Endoscopic Submucosal Dissection and Acute Kidney Injury: A Rare but Clinically Relevant Adverse Event, a Cohort Study of 1537 Patients.

Background and Aims Colorectal endoscopic submucosal dissection (ESD) 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 (AKI) after colorectal ESD. Methods All consecutive colorectal ESDs performed at Limoges University Hospital (2017-2024) within the prospective French ESD Colorectal Cohort (FECCO) were retrospectively analyzed to identify AKI events and related factors. Results Among 1537 patients, the frequency of clinically evident AKI was 1.3% ( n = 20). Compared with non-AKI patients, AKI-patients were older (74 vs. 70 years, p = 0.029) and more often receiving angiotensin-converting enzyme (ACE) inhibitors (40% vs. 13.6%, p = 0.003). AKI-patients 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). ACE-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 AKI. By the end of follow-up, all patients recovered their baseline renal function. Conclusions AKI after colorectal ESD is rare but clinically relevant. Patients receiving ACE inhibitors and with larger lesions are at higher risk. Careful periprocedural management, including adequate hydration, close monitoring during prolonged or complex procedures, and consideration of ACE inhibitor therapy, may be relevant in this setting.