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
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.
Post ESD electrocoagulation syndrome (PEECS) is known as a common complication after colon ESD. However, there were no studies of PEECS after esophageal ESD.
We aimed to investigate the incidence and risk factors of PEECS in the esophagus.
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.
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.
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.
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.