Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2018; 24(10): 1144-1151
Published online Mar 14, 2018. doi: 10.3748/wjg.v24.i10.1144
Risk factors of electrocoagulation syndrome after esophageal endoscopic submucosal dissection
Dae Won Ma, Young Hoon Youn, Da Hyun Jung, Jae Jun Park, Jie-Hyun Kim, Hyojin Park
Dae Won Ma, Young Hoon Youn, Da Hyun Jung, Jae Jun Park, Jie-Hyun Kim, Hyojin Park, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, South Korea
Author contributions: All authors helped to perform their research; Ma DW substantial contributions to conception and design, or analysis and interpretation of data and drafting the article or revising it critically for important intellectual content; Youn YH substantial contributions to conception and design, final approval of the version to be published and agreement to be accountable for all aspects of the work; Jung DH, Park JJ, Kim JH and Park H revising the article critically for important intellectual content.
Supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT, No. NRF-2015R1C1A1A01054352.
Institutional review board statement: The Institutional Review Board of Gangnam Severance Hospital approved this study (3-2017-0163).
Informed consent statement: Patients were not required to give informed consent the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
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:
Correspondence to: Young Hoon Youn, MD, PhD, Professor, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonjuro, Gangnam-gu, Seoul 06273, South Korea.
Telephone: +82-2-20193453 Fax: +82-2-34633882
Received: January 15, 2018
Peer-review started: January 15, 2018
First decision: January 16, 2018
Revised: January 22, 2018
Accepted: January 29, 2018
Article in press: January 29, 2018
Published online: March 14, 2018

To investigate post endoscopic submucosal dissection electrocoagulation syndrome (PEECS) of the esophagus.


We analyzed 55 consecutive cases with esophageal endoscopic submucosal dissection for superficial esophageal squamous neoplasms at a tertiary referral hospital in South Korea. Esophageal PEECS was defined as “mild” meeting one of the following criteria without any obvious perforation: fever (≥ 37.8 °C), leukocytosis (> 10800 cells/μL), or regional chest pain more than 5/10 points as rated on a numeric pain intensity scale. The grade of PEECS was determined as “severe” when meet two or more of above criteria.


We included 51 cases without obvious complications in the analysis. The incidence of mild and severe esophageal PEECS was 47.1% and 17.6%, respectively. Risk factor analysis revealed that resected area, procedure time, and muscle layer exposure were significantly associated with PEECS. In multivariate analysis, a resected area larger than 6.0 cm2 (OR = 4.995, 95%CI: 1.110-22.489, P = 0.036) and muscle layer exposure (OR = 5.661, 95%CI: 1.422-22.534, P = 0.014) were independent predictors of esophageal PEECS. All patients with PEECS had favorable outcomes with conservative management approaches, such as intravenous hydration or antibiotics.


Clinicians should consider the possibility of esophageal PEECS when the resected area exceeds 6.0 cm2 or when the muscle layer exposure is noted.

Keywords: Electrocoagulation, Endoscopic submucosal dissection, Esophageal neoplasm, Syndrome

Core tip: A number of patients experience fever, chest pain, and/or a systemic inflammatory response after esophageal endoscopic submucosal dissection, even in the absence of obvious perforation. Post endoscopic submucosal dissection electrocoagulation syndrome which is characterized by fever, leukocytosis, and chest pain has been found to be a relatively common condition after esophageal endoscopic submucosal dissection. It more frequently occurs when the resection area is wide (OR = 4.995) or when there is muscle layer damage (OR = 5.661), but it is restored without significant sequelae by conservative treatment.