Published online Mar 14, 2018. doi: 10.3748/wjg.v24.i10.1144
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.
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.