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
Research background

A number of patients experience fever, chest pain, and/or a systemic inflammatory response after esophageal endoscopic submucosal dissection (ESD), even in the absence of obvious perforation.

Research motivation

Post ESD electrocoagulation syndrome (PEECS) is known as a common complication after colon ESD. However, there were no studies of PEECS after esophageal ESD.

Research objectives

We aimed to investigate the incidence and risk factors of PEECS in the esophagus.

Research methods

We retrospectively analyzed electronic medical database of patients who underwent esophageal ESD for superficial esophageal squamous neoplasms between March 2009 and December 2016 at single center in South Korea. PEECS was defined as meeting one of following criteria: fever (≥ 37.8 °C), leukocytosis (> 10800 counts/μL), or regional chest pain greater than 5/10 points as assessed on a numeric pain rating scale within 24 h after ESD.

Research results

As a result, 24 patients (47.1%) developed mild PEECS and 9 patients (17.6%) developed severe PEECS during the post-ESD period. We identified that that a resection area larger than 6.0 cm2 (OR = 4.995, 95%CI: 1.110-22.489, P = 0.036) and a present of muscle layer exposure (OR 5.661, 95%CI: 1.422-22.534, P = 0.014) were independent risk factors for PEECS. All patients diagnosed with PEECS fully recovered with conservative management, such as intravenous hydration and antibiotics.

Research conclusions

PEECS is not a rare clinical after esophageal ESD. However, PEECS can be easily controlled by conservative management without surgical intervention when there is no obvious perforation. We conclude that the incidence of PEECS is expected to be high when the resected tumor area exceeds 6.0 cm2 or when the muscle layer exposure is present.

Research perspective

If these risk factors are accompanied, careful attention should be paid to the potential occurrence of PEECS after esophageal ESD. Further large-scale study is needed to validate our research.