Novel intermittent electrocoagulation technique reduces post-endoscopic submucosal dissection electrocoagulation syndrome in colorectal neoplasms

doi:10.3748/wjg.123112

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Jan 14, 2027; 33(2): 123112
Published online Jan 14, 2027. doi: 10.3748/wjg.123112

Novel intermittent electrocoagulation technique reduces post-endoscopic submucosal dissection electrocoagulation syndrome in colorectal neoplasms

Jia-Wei Wang, Ke-Feng Hu, Zhen Xu, Yan-Ru Pan, Min Miao, Guo-Liang Ye, En-Pan Xu

Jia-Wei Wang, Ke-Feng Hu, Yan-Ru Pan, Min Miao, Guo-Liang Ye, En-Pan Xu, Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo 315020, Zhejiang Province, China

Zhen Xu, Department of Neurosurgery, People’s Hospital of Haishu District, Ningbo 315000, Zhejiang Province, China

Co-first authors: Jia-Wei Wang and Ke-Feng Hu.

Co-corresponding authors: Guo-Liang Ye and En-Pan Xu.

Author contributions: Wang JW and Hu KF contributed equally to this work as co-first authors; Wang JW made substantial contributions to data curation, methodology, drafting of the manuscript, and wrote the original draft; Hu KF made substantial contributions to manuscript review, critical revision, and intellectual content improvement; Xu EP and Ye GL contributed equally to this work as co-corresponding authors; Xu EP takes primary responsibility for communication with the journal during manuscript submission, peer review, and publication; Wang JW, Hu KF, Xu EP and Ye GL designed the research study; Wang JW, Xu Z, Pan YR and Miao M performed the research; Wang JW, Xu Z and Pan YR collected and curated the data; Wang JW and Xu Z analyzed the data; Hu KF, Ye GL and Xu EP reviewed and edited the manuscript; Ye GL and Xu EP acquired funding; Xu EP administered and supervised the project; all authors have read and approved the final manuscript.

AI contribution statement: Portions of this manuscript were polished using AI tools. The authors carefully reviewed and verified all AI-assisted content and take full responsibility for the scientific content of the manuscript.

Supported by National Natural Science Foundation of China, No. 82503120; and Ningbo Top Medical and Health Research Program, No. 2023020612.

Institutional review board statement: The study protocol received ethical approval from the Institutional Review Board of the First Affiliated Hospital of Ningbo University (No. 2025-127RS).

Informed consent statement: Written informed consent for colonoscopic endoscopic submucosal dissection and related procedures, including the subsequent use of relevant clinical data for research purposes, was obtained from all patients at the time of treatment. This retrospective study used clinical data previously collected during routine care, and did not include data from patients who had refused the use of their data for research. The requirement for additional informed consent for this retrospective analysis was waived by the institutional review board.

Conflict-of-interest statement: Jia-Wei Wang, Ke-Feng Hu, Zhen Xu, Yan-Ru Pan, Min Miao, Guo-Liang Ye, and En-Pan Xu have no conflicts of interest to disclose.

STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.

Data sharing statement: The anonymized dataset used and analyzed during the current study is available from the corresponding author upon reasonable request.

Corresponding author: En-Pan Xu, MD, Researcher, Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, No. 59 Liuting Street, Haishu District, Ningbo 315020, Zhejiang Province, China. xep19821832282@163.com

Received: May 9, 2026
Revised: June 17, 2026
Accepted: July 1, 2026
Published online: January 14, 2027
Processing time: 185 Days and 6.4 Hours

Abstract

BACKGROUND

As colorectal endoscopic submucosal dissection (ESD) is increasingly used, post-ESD electrocoagulation syndrome (PECS) has become an important adverse event.

AIM

To compare the incidence of PECS between intermittent electrocoagulation (I-ESD) technique and conventional continuous electrocoagulation (C-ESD) during colorectal ESD.

METHODS

This retrospective cohort study included patients who underwent colorectal ESD at the First Affiliated Hospital of Ningbo University between November 2023 and November 2024. Procedures were performed by experienced endoscopists, with one using I-ESD and the others using C-ESD. The primary outcome was the incidence of PECS. Secondary outcomes included procedural time, lesion size, resection quality, and adverse events.

RESULTS

The cohort included 199 patients, with technical success achieved in all cases. Baseline characteristics were comparable between groups (P > 0.05). The incidence of PECS was significantly lower in the I-ESD group than the C-ESD group (8.5% vs 19.0%; P = 0.033). The median procedural time [42.0, interquartile range (IQR): 30.0-60.0 minutes vs 49.0, IQR: 35.0-62.0 minutes; P = 0.057], mean lesion size (20.2 ± 9.4 mm vs 20.4 ± 7.4 mm; P = 0.176), and en bloc and R0 resection rates (P > 0.05) did not differ significantly between the groups. The overall adverse event rate was notably lower in the I-ESD group (P = 0.031).

CONCLUSION

As a potentially safer alternative to conventional continuous coagulation, the I-ESD technique significantly reduced the risk of PECS without compromising resection efficiency or safety.

Keywords: Post-endoscopic submucosal dissection electrocoagulation syndrome; Endoscopic submucosal dissection; Thermal injury; Intermittent electrocoagulation; Colorectal neoplasms

Core Tip: Post-endoscopic submucosal dissection electrocoagulation syndrome (PECS) is a notable adverse event after colorectal endoscopic submucosal dissection and is closely related to thermal injury. This study compared intermittent electrocoagulation with conventional continuous electrocoagulation in 199 patients undergoing colorectal endoscopic submucosal dissection. Intermittent electrocoagulation was associated with fewer cases of postoperative PECS and remained independently associated with lower PECS risk after adjustment. Resection efficiency, en bloc resection, and R0 resection were not compromised. These findings suggests that intermittent electrocoagulation is a simple, safe, and clinically practical strategy for PECS prevention.